Presented by Illinois DocAssist Consultant Dr. Elizabeth Charney, MD.
This is dr. elizabeth charney consultant at the illinois diocese program talking you today about adhd management during coded nineteen illinois talk assist presenters have no relevant conflict of interest the goals and objective of this talk are to learn how to adjust current adhd medications to optimize response during home confinement to assess for emergence
Of anxiety depression ptsd substances during the current pandemic to understand how to help adult caretakers create a structured home environment with use of behavioral interventions an overview of psychopharmacology is as follows first line agents for adhd includes methylphenidate and amphetamine products these inhibit uptake of norepinephrine and dopamine and
Increase the release of these neurotransmitters in the prefrontal cortex and basal ganglia second line agents are non stimulants such as strattera they target the same neurotransmitters norepinephrine in the prefrontal cortex and our fda approved as a tamoxifen generic and strattera third line our alpha agonist which targets similar dis neurotransmitters these
Are clonidine and its own acting form cafe and guanfacine you know long-acting form intuniv an overview can be seen over in this table stimulants can be divided in terms of immediate release lasting three to five hours extended release lasting seven to nine hours or long acting lasting eight to twelve hours or longer immediate release products are adderall and
Generic mixed amphetamine salts as well as dexedrine focalin and it’s generic root illan and it’s jr. and non stimulants carnitine and guanfacine extended-release agents or adderall extended-release xr dexedrine spaetzle coquelin extended-release medidate cd controlled delivery ritalin la long-acting long-acting stimulants include five aunts and my dais there
Is none in the dextroamphetamine based and for methylphenidate products there’s concerta and join a non stimulant long-acting products includes strattera cafe and intuniv durrington it there may be other considerations that can impact case management let’s look at an example a nine-year-old girl did well on conservative thirty six milligrams prior to quarantine
Her sleep has phase shifted as she stays up late using social media and playing electronic games of her older siblings she wakes up five minutes prior to her virtual summer camp programming mother reports she has increased irritability and on the weekends she sleeps late and does not take her medications until noon mother reports working from home during social
Isolation and does not mind that the nine-year-old is sleeping late this allows her to care for the four-year-old sibling and get work test owns completed in the morning she’s concerned about her daughter taking the stimulants away in the day and the impact it might have on sleep any thoughts about management assess the big picture the impact of social and physical
Distancing the lack of structure and activities possible caregiver stress and the functioning of the child you can sculpt the dose consider suspending a concerta and using immediate releases needed for example you can use ritalin methylphenidate 10 milligrams immediate release at noon in at 4 p.m. you might want to use a media release meditate you might want to
Use real win long-acting twenty milligrams or focal and extended release ten milligrams at noon another case might highlight some other management considerations during this time a sixteen year old sophomore will begin online summer school historically he did not tolerate any stimulant medication and stop medication one year ago he reported stimulants made him
Feel like a zombie and experience mild appetite suppression he’s an athlete who runs in lifts weights but appetite suppression interfered with his ability to gain muscle physical activity had helped with regulations this male the red book makes wriggler exercise difficult and his grades suffered given his inability to remain organized and attentive with remote
Learning he reports feeling depressed and anxious as he must bring up his grades hoping to get recruited for college sports and he thought one might want to consider a trial than on stimulants such as strattera one might want to provide provide resources for this youth tools for structure exercise improvement of his executive functioning annualization of cbt
Skills considerations during the pandemic will include the onset of possible comorbidities social stressors and worries can lead to anxiety loss of social supports relationships milestones and deaths in the family or in friends can result in depression youth especially adolescents may engage in substance use to regulate their emotions isolation and family stress
Place children at increased risk for abuse and exposure to mystic violence call the illinois talk is’s for consultation visit our website for screening tools treatment of adhd is multimodal family dynamics need to be understood and supported avoid increasing stimulants for quick fixes use caution and stopping medications encourage parents to set expectations and
Routines assess and understand parents functioning acknowledged stress and express compassion support and tips for parents to structure the home use of rewards and sticker charts create home routines and consistency chunk time and vary tasks checklists and schedules with breaks use eye contact and clear expectations simple behavioral techniques include positive
Reinforcement which means to reward a child for good behavior for example if you finish your homework properly and on time you can play a video game use of a token economy combining the idea of reward and consequence teachers often use this method by giving out things like star stickers the same principle can be used at home response cost unwanted behaviors lead
To a loss of privilege or reward you don’t do your homework you lose your computer time timeout a common consequence often use when the child uses bad behavior if you hit your sister you must sit quietly alone for a few minutes which can support the resilience of the youth and the family by addressing core needs make sure your youth and family are exercising daily
Consider online exercise platforms go outside biking walking calisthenics reinforce wearing a mask and keeping social distance practice good sleep hygiene consistent routine and bedtime encourages better sleep keep televisions out of the bedroom limit screen time and caffeine prior to bedtime eat as healthy as possible avoid using food as a reward cooking is a
Great activity and can keep the adhd child busy active and engaged teach real life skills through meal planning and preparation continue to have connections with families and friends this is key use technology to help the youth maintain healthy peer connections have extended family members socialize and interact remotely utilize many skills to relax such as deep
Breathing yoga mindfulness stream experiences explore museums zoos gardens and aquariums virtually set an amount of time and remain consistent about the use of screen time consider time frames for screen use as such as not going before bed use time on screen wisely and concisely implement a family media the doc assess program has many resources on our site you
Will find screening tools treatment options pharmacologic guidelines and many family supports and resources contact us for any consultation at the number below visit our website for screening tools the resources and any webinars thank you
Transcribed from video
ADHD Management During COVID-19 By Illinois DocAssist