ADHD

• 5-10 % of school age children
• Males>1Female
• 3 components: Inattention, Hyperactivity, Impulsivity
• Diagnosis based on DSM criteria in 3 areas:
  • Inattention
  • Hyperactivity
  • Impulsivity
• Symptoms present for >6 months
• Symptoms present before age 7
• Symptoms present in 2 or more settings
• Clinically significant impairment in social, academic or occupational functioning
• Response to stimulant medications is NOT a diagnostic criteria
• Good behavior in an office visit does NOT rule out ADHD

Treatment

• Recognition as a chronic condition
• Establish target outcomes INDIVIDUAL to child
• Medications
  • Stimulants (Ritalin/methylphenidate, Dexedrine/d-amphetamine) 80% effective
    • Side effects –decreased appetite, abdpain, sleep problems, new or exacerbation of tics, Schedule II meds
  • NonStimulants (Strattera –atomoxetine)
    • Less appetite/GI side effects
    • qd dosing, not schedule II –recent reports of cardiac dysrhythmias
• Behavioral therapy involving family/teachers
• If not meeting target outcomes, re-evaluate
• Follow-up frequently

CHLA Board review 2005

Iron Deficiency in Children With Attention-Deficit/Hyperactivity Disorder
Eric Konofal, MD, PhD; Michel Lecendreux, MD; Isabelle Arnulf, MD, PhD; Marie-Christine Mouren, MD

Background
Iron deficiency causes abnormal dopaminergic neurotransmission and may contribute to the physiopathology of attention-deficit/hyperactivity disorder (ADHD).

Objective
To evaluate iron deficiency in children with ADHD vs iron deficiency in an age- and sex-matched control group. Design Controlled group comparison study. Setting Child and Adolescent Psychopathology Department in European Pediatric Hospital, Paris, France.

Patients
Fifty-three children with ADHD aged 4 to 14 years (mean ± SD, 9.2 ± 2.2 years) and 27 controls (mean ± SD, 9.5 ± 2.8 years).

Main Outcome Measures
Serum ferritin levels evaluating iron stores and Conners’ Parent Rating Scale scores measuring severity of ADHD symptoms have been obtained.

Results
The mean serum ferritin levels were lower in the children with ADHD (mean ± SD, 23 ± 13 ng/mL) than in the controls (mean ± SD, 44 ± 22 ng/mL; P < .001). Serum ferritin levels were abnormal (<30 ng/mL) in 84% of children with ADHD and 18% of controls (P < .001). In addition, low serum ferritin levels were correlated with more severe general ADHD symptoms measured with Conners’ Parent Rating Scale (Pearson correlation coefficient, r = –0.34; P < .02) and greater cognitive deficits (r = –0.38; P < .01).

Conclusions
These results suggest that low iron stores contribute to ADHD and that ADHD children may benefit from iron supplementation.

Arch Pediatr Adolesc Med. 2004;158:1113-1115.