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ADHD MOOD DISORDERS

Date: 07/25/23

Attention deficit hyperactive disorder (ADHD) is a common children’s mental disorder often lasting through adulthood. Symptoms of ADHD include hyperactivity, lack of ability to pay attention to detail and control impulsivity at a greater amount than expected for a certain age or developmental age¹. This can cause difficulty at school, home, and with friends.  

ADHD Criteria

People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development:

  1. Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for people aged 17 and older; symptoms of inattention have been present for at least six months, and they are inappropriate for developmental level:
    • Often fails to pay close attention to details or makes careless mistakes in schoolwork, at work, or with other activities
    • Often has trouble holding attention on tasks or play activities
    • Often does not seem to listen when spoken to directly
    • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked)
    • Often has trouble organizing tasks and activities
    • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework)
    • Often loses things necessary for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)
    • Is often easily distracted
    • Is often forgetful in daily activities
  2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for people aged 17 and older; symptoms of hyperactivity-impulsivity have been present for at least six months to an extent that is disruptive and inappropriate for the person’s developmental level:
    • Often fidgets with or taping hands or feet, or squirming in seat
    • Often leaves seat in situations when remaining seated is expected
    • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless)
    • Often unable to play or take part in leisure activities quietly
    • Often acts “on the go” acting as if “driven by a motor”
    • Often talks excessively
    • Often blurts out an answer before a question has been completed
    • Often has trouble waiting their turn
    • Often interrupts or intrudes on others (e.g., butts into conversations or games)

Additionally, the following conditions must be met:

  • Several inattentive or hyperactive-impulsive symptoms were present before age 12
  • Several symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities)
  • There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning
  • The symptoms are not better explained by another mental disorder (e.g., a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder); The symptoms do not happen only during schizophrenia or another psychotic disorder

Diagnosis

Listed below are the Diagnostic and Statistical Manual of Mental Disorders-V criteria for diagnosis. Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

  • Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
  • Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
  • Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity, but not inattention, were present for the past six months.

Because symptoms can change over time, the presentation may change over time as well.

Treatment

Treatment usually consists of a combination of therapy and medication. Psychostimulant medications are the recommended first line pharmacotherapy. The medications listed below are on Meridian’s preferred drug list (PDL). If there is a documented national shortage of a medication, Meridian can place an override on a case-by-case basis. To access the PDL, visit ILmeridian.com/providers/pharmacy.html.

Medication name

Status

Amphetamine/dextroamphetamine

Preferred

Clonidine/Clonidine ER

Concerta®

Dexmethylphenidate tablets

Focalin® XR

Guanfacine

Methylphendiate tablets

Methylphenidate ER 10mg and 20mg tablets

Strattera

Vyvanse®

 

Medication name

Status

Daytrana®

Preferred with Prior Authorization

Dyanavel® XR (Suspension)

Jornay PM®

 

References:

1.       Symptoms and diagnosis of ADHD. cdc.gov/ncbddd/adhd/diagnosis.html. Accessed June 13, 2023

2.       What is ADHD? psychiatry.org/patients-families/adhd/what-is-adhd#section_5. Accessed June 13, 2023.

3.       American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., Text Revision, American Psychiatric Publishing, 2022, doi.org/10.1176/appi.books.L.