ADHD and Tic disorder Essay

ADHD and Tic disorder Essay

Attention deficit hyperactivity disorder (ADHD) is a disorder primarily characterized by inattention, hyperactivity, and impulsivity that causes functional impairment (Higgins & George, 2018). It is a disorder that starts in childhood and insufficient treatment can lead to several adverse outcomes. The disorder may persist into adulthood. The main aim of treating ADHD is to reduce the core symptoms of inattention, hyperactivity, and impulsivity. Inattention is characterized by difficulty paying and sustaining attention, lack of interest in activities that require mental effort, being easily distracted, and losing things. Hyperactive behavior is characterized by being restless, fidgety, and being unable to focus on quiet activities. Impulsive symptoms include engaging in risky behaviors without considering the consequences. These symptoms can affect academic and social functioning in children and adolescents. In adults, it can affect occupational functioning. When choosing which symptoms to treat first, the symptoms that cause the most distress should be considered first. The disorder may present predominantly with either inattentiveness, hyperactive-impulsive, or a combination of all features (Higgins & George, 2018).

Treatment guidelines recommend the use of psychoeducation, pharmacological and non-pharmacological interventions. Available pharmacological treatment options are stimulants and non-stimulants (Rosenthal & Burchum, 2017). Stimulants are the first-line treatment of choice for patients with ADHD. Stimulants include drugs such as amphetamine and methylphenidate. The mechanism of action of amphetamine includes the inhibition of norepinephrine and dopamine transporter. It also inhibits monoamine oxidase activity and vesicular monoamine transporter 2. The mechanism of action of methylphenidate is inhibition of norepinephrine and dopamine transporter. It also acts as an agonist at the serotonin type 1A receptor. Stimulants enhance the impact of dopamine and norepinephrine. The net effect of this is that it increases activity at the prefrontal cortex and also maximizes attention in patients with ADHD (Rosenthal & Burchum, 2017).

Stimulants are prepared in different formulations. They are either short-acting, intermediate-acting, or long-acting. Long-acting drugs have different control release formulations. Extended-release formulations are preferred as the first option when choosing the drug to use. This is because they are associated with better drug compliance and adherence. The extended-release formulation of methylphenidates is the preferred stimulant to be used as first-line treatment. The drug is started at a lower dose which is then titrated upwards until the optimal result is achieved. Another stimulant drug can be used if the selected stimulant does not yield the desired results. Switching to non-stimulants is recommended if both stimulants don’t yield any success in treatment (Brown et al., 2018).

Tic disorders are common comorbidities in children with ADHD. Some evidence suggests that treatment of ADHD with stimulants may precipitate or exacerbate tic disorders (Osland et al., 2018). Management of tics depends on the severity of symptoms. comorbid ADHD and tics should be treated based on the condition that causes most difficulties for the child and the one that causes most impairment treated first.  Mild to moderate symptoms of tics are managed using psychoeducation. Moderate to severe symptoms are managed using pharmacotherapy. The first-line drugs of choice for the treatment of tics include alpha-adrenergic agonists such as clonidine and guanfacine. Both stimulants and non-stimulants have been shown to be effective in reducing the symptoms of ADHD in children with tics (Ogundele & Ayyash, 2018). Stimulants are the drugs of choice for the treatment of children with symptoms of moderate to severe ADHD in tic disorders. Mild symptoms of both ADHD and tics can be treated using a non-stimulant such as clonidine or guanfacine. This is because these drugs are effective in the treatment of both ADHD and tics and reduce the symptoms of both disorders.

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References

Brown, K. A., Samuel, S., & Patel, D. R. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: a review for practitioners. Translational Pediatrics, 7(1), 36–47. https://doi.org/10.21037/tp.2017.08.02

Higgins, E.S. & George, M.S. (2018). The neuroscience of clinical psychiatry (3rd ed.). Baltimore, MD: Wolters Kluwer/Lippincott Williams & Wilkins Co. ISBN 978149637200 [H & G] (Chapter 20)12)

Ogundele, M. O., & Ayyash, H. F. (2018). Review of the evidence for the management of co-morbid Tic disorders in children and adolescents with attention deficit hyperactivity disorder. World journal of clinical pediatrics, 7(1), 36–42. https://doi.org/10.5409/wjcp.v7.i1.36

Osland, S. T., Steeves, T. D., & Pringsheim, T. (2018). Pharmacological treatment for attention deficit hyperactivity disorder (ADHD) in children with comorbid tic disorders. The Cochrane database of systematic reviews, 6(6), CD007990. https://doi.org/10.1002/14651858.CD007990.pub3

Rosenthal, L., & Burchum, J. (2017). Lehne’s pharmacotherapeutics for advanced practice providers. Atlanta, GA: Elsevier. ISBN 9780323447836 [R & B] (Chapters 8, 29)

 

Module 7 – Neurodevelopmental and Neurocognitive Disorders

We will be focusing on the treatment of Intellectual Disability (ID), Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), and Tic Disorders. While reading this section keep in mind that children and adolescents tend to be more sensitive to the effects of medication and they may have more difficulty vocalizing any problems, especially those diagnosed with ID or ASD. A thorough evaluation should be completed prior to starting medication and doses should be kept at the lowest effective doses. Although pharmacotherapy is a mainstay in the treatment of these disorders it should be used as an adjunct to psychosocial and behavioral interventions.

Psychiatric disorders are three to four times more likely to be diagnosed in people with an ID diagnosis than in the general population. (Gabbard, pg 6) Targeting pharmacotherapy at these comorbid disorders can have a positive impact on functional outcomes. In certain circumstances pharmacotherapy will be targeted at behavioral problems associated with ID, as is the case with ASD. Pharmacotherapy for behavioral problems of ID and ASD should only be considered after nonpharmacological interventions have failed.

Pharmacological treatment is very effective at reducing symptoms of ADHD and tic disorders and is even considered a first line treatment for ADHD. When well controlled, patients with these disorders are able to perform better at school and work and can maintain more positive personal and social relationships. Nonpharmacological treatments are also effective and should be used when possible. These disorders do not persist into adulthood for many patients so frequent evaluation of symptoms and trials off medication to assess continued need should be employed.

 

                                                                  ASSIGNMENT

Discuss first line treatment options for ADHD. What symptoms do you treat first? Also discuss pharmacological considerations for individuals with co-morbid ADHD and tic disorder.