Attention deficit hyperactivity disorder (ADHD) is seen in 4-8% of children, which means that at least one or two children with ADHD can be seen in a class of 25-30 people. is coming. Although it is a condition that is just beginning to be recognized by the society, it has actually been known for a long time and hundreds of new studies are published every year about the disease and its treatment.
Brain-based disease, which is thought to be mostly genetic, is related to the brain regulating and managing certain functions. It is a syndrome. These parts of the brain are regions that generally contain very important functions such as attention, concentration, memory, motivation, impulsivity, hyperactivity, organization and social skills.
DSM-V (Diagnostic and Statistical Manual of Mental Disorders). According to the Statistical Manual), the presence of at least 6 symptoms in those under 17 years of age and at least 5 symptoms in those over 17 years of age is required for diagnosis. In children, these symptoms must be present for 6 months or longer and must be evident from their peers. There are two types of clinics; 1.Attention deficit dominant type 2.Hyperactive/impulsivity dominant type.
Children with ADHD should be consulted by a child psychiatrist, pedagogue, child development specialist, clinical psychologist, school counselor, mother and father, pediatrician, if necessary. It should be evaluated in a multidisciplinary manner together with the pediatric neurologist. After the necessary examinations are completed, it may be necessary to use some medications that can be prescribed specifically for ADHD by the child psychiatrist, if clinically necessary.
Drugs used in the treatment of ADHD. What are the side effects?
Drugs used in the treatment of attention deficit hyperactivity disorder are effective for the treatment of attention deficit but may also have side effects. The use of attention deficit or hyperactivity medications is not recommended unless necessary. Well-known side effects of these drugs are: sleep problems, decreased appetite, weight loss, increased blood pressure and heart rate, dizziness, headache, abdominal pain, rebound effect, irritability, irritability.
Before starting ADHD treatment What should be done about the heart?
Medicine for a child diagnosed with ADHD If heart treatment is planned to be started, the history of individuals in the family with heart disease (such as sudden death) should be taken, a detailed physical examination should be performed, the child should be asked about chest pain, fainting, palpitations, dizziness and the history of congenital heart disease should be questioned. After the heart rate and blood pressure are checked by the pediatrician and the physical examination is completed (presence of arrhythmia or murmur by listening), the patient's electrocardiography (ECG) should be taken and the pediatric cardiologist should be consulted before starting the medication.
What are the possible cardiac side effects that may occur when using ADHD medications?
FDA (Food and Drug Administration) Cardiovascular side effects such as stroke, stroke, heart attack and sudden cardiac death are associated with the use of ADHD medications. Although a clear relationship between the effects has not been demonstrated, it is recommended that patients who will use these drugs and are currently using them should be closely monitored in terms of heart rate, blood pressure and heart rhythm. There are clinical studies reporting the association of Adderall, used at ages three and above, with sudden cardiac death, especially in those under 21 years of age.
This group of stimulant drugs can increase blood pressure and heart rate. In the system where drug side effects of patients using ADHD medications are recorded, sudden deaths were reported in 300 people, and 25 of them were stated to be drug-related. Structural heart disease was also detected in the autopsy of some of these 25 cases. Drug-related chest pain, heart attack, stroke or paralysis, and cardiac arrhythmia were reported in 26 cases. In other words, close monitoring by a pediatric cardiologist is recommended before and during the use of this group of drugs.
According to the AHA (American Heart Association, 2008) and American Academy of Pediatrics (APA) guidelines, which are valid all over the world, ECG screening (Class IIA recommendation, level of evidence C) is recommended in children, and a careful physical examination for structural heart diseases and a pediatric cardiologist should be consulted if there is a heart murmur, a family history of heart disease, hypertension, palpitations, arrhythmia, fainting or signs of Marfan syndrome. evaluation v It is recommended to perform echocardiography.
Which children who are using ADHD medications should be referred to a pediatric cardiologist and when? Children who have heart rate, who are thought to have an arrhythmia, who have complaints of palpitations, fainting, chest pain, or dizziness, who have a family history of heart disease, or who have a rhythm problem in their family, especially in their first-degree relatives, should be evaluated by a pediatric cardiologist before and after the start of treatment. In fact, looking at the clinical studies and records of drug side effects, all children with ADHD should have a heart check-up and close cardiac monitoring. In fact, these follow-ups should be performed by experienced specialist physicians who have at least 3 years of pediatric cardiology experience and who follow this patient group of children. After evaluating the patient, the physician should inform the family in detail and explain to the family in detail what to do during the child's treatment. The child psychiatrist who evaluates the child patient who is planned to start medication for ADHD should monitor the case by staying in close cooperation and communication with the pediatric cardiologist, and the family should be informed at each visit.
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