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  • Image not available. Inattention and impulsivity caused by attention deficit/hyperactivity disorder (ADHD) begins before age 7 years and can continue into adolescence and adulthood, often requiring ongoing drug treatment.
  • Image not available. Stimulants are first-line treatment for ADHD because they are the most effective medications and have overall good tolerability. Atomoxetine, guanfacine extended release (XR), and bupropion are second-line alternatives for those unresponsive to or unable to tolerate stimulants. Clonidine and guanfacine can also be considered as adjuncts to stimulants to optimize treatment of oppositional symptoms or persistent insomnia.
  • Image not available. Coexisting disorders or symptoms such as anxiety, mood, and behavior dysregulation have an impact on drug selection for ADHD and can necessitate the use of additional agents.
  • Image not available. Tourette's disorder presents with both motor and vocal tics, which are present during childhood, plateau during adolescence, and can continue during adulthood with a fluctuating course.
  • Image not available. The decision to medicate patients with Tourette's disorder is based on the degree of concern perceived by the patient, symptom severity, and comorbid disorders.
  • Image not available. Individuals with Tourette's disorder are particularly sensitive to medication side effects, so medication dosing must be individualized carefully, and close monitoring is essential.
  • Image not available. Nondrug approaches to enuresis management, such as behavioral interventions and the use of bed-wetting alarms, are preferred because of lasting cure rates and avoidance of drug side effects.
  • Image not available.Desmopressin tablets are preferred over tricyclic antidepressants (TCAs) because of better safety and tolerability. Both desmopressin and TCAs have a rapid onset of effect (1–2 weeks); however, the relapse rate on drug discontinuation is high.

Upon completion of the chapter, the reader will be able to:

  • 1. Recognize and describe the clinical signs and symptoms of attention deficit/hyperactivity disorder (ADHD), Tourette’s disorder, and enuresis.
  • 2. Discuss the neurotransmitter dysregulation and proposed mechanism of action of medications approved to treat ADHD.
  • 3. Identify common comorbid conditions in a patient with ADHD, and use the ADHD treatment algorithm to select drug therapy based on an individual child’s comorbid conditions.
  • 4. Differentiate brain maturation patterns, and discuss structural and receptor density differences in patients with ADHD compared with those without ADHD.
  • 5. Describe the clinical course of ADHD, Tourette’s disorder, and enuresis. For example, what is the typical age of onset, and how do symptoms change as a child grows into adolescence and adulthood?
  • 6. Discuss the target symptoms and behaviors of ADHD and Tourette’s disorder that are responsive to pharmacologic intervention.
  • 7. Compare the advantages and disadvantages of once-daily stimulant preparations (e.g., Concerta and Adderall XR) with immediate-release stimulants (e.g., methylphenidate and mixed amphetamine salts).
  • 8. Identify an appropriate starting dose, and list therapeutic dosing ranges for medications used to treat ADHD, Tourette’s disorder, and enuresis.
  • 9. Compare and contrast the efficacy and adverse effect profiles of the stimulants, bupropion, atomoxetine, tricyclic antidepressants (TCAs), and α2-agonists in the treatment of ADHD.
  • 10. Recommend appropriate monitoring parameters for stimulants, bupropion, atomoxetine, TCAs, and α2-agonists in the treatment of ADHD.
  • 11. Compare the therapeutic efficacy and adverse effect potential of haloperidol, pimozide, risperidone, and ...

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