Advances in the Management of Complex ADHD in Pediatric Patients - Episode 2
Theresa Cerulli, MD: What are some of the signs and symptoms for you that prompt an ADHD [attention-deficit/hyperactivity disorder] evaluation?
Frank Lopez, MD: Well, as you know, the core symptoms are inattention, hyperactivity, and poor impulse control. If you look at all of that, and based on what we know, it’s does this child have difficulty sustaining their attention? Can they follow through on a task? Can they finish it? Are they rushing through their work, making careless mistakes? It’s a compound picture. It is not just 1 item. You see these children avoiding tasks that require a lot of sustained mental effort. If it’s something they like, they’ll stick with it. If it’s something they don’t like, they get frustrated, they give up, they close the book, they close the laptop, and walk away.
Now on the other side of this, the other domain is a hyperactive domain. They’re fidgety, they’re restless, they’re moving around, they’re sitting down but they’re drumming, they’re playing with their pencil. I’ve seen them spin their pencils, actually getting out of control and flying across the room in the examination room. Very interesting, I’ve dodged a few of those.
Theresa Cerulli, MD: Frank, I had 1 of my little ones take apart, while I was sitting in 1 chair, the other office chair in my room, the little guy turned it upside down, took it apart, and disassembled the chair while I was speaking with the parents.
Frank Lopez, MD: That doesn’t surprise me. My exam table, it’s about 4 feet or so, 4-1/2 feet, from where my scale and my stadiometer are. And I have had children actually tell me, “Watch, I can jump from the exam table all the way over here.” Not too long ago I had a mom with her child there, and the child decided he was going to play like a football. I became a tight end; I caught the child in midair before he hit the ground. It was just remarkable.
I’ve been doing this for 29 years, and every day I find a new experience. I find something that I hadn’t seen before in terms of how they present in the office. But going on a little bit further, one of the other pieces that is quite interesting is how intrusive they can be. That intrusion into other people’s conversations or activities leads to disruption. But more importantly, if you look at what that is based on is that they can’t wait their turn. They have to have immediate satisfaction to their needs. “Look at me, I’m here, take care of me, let’s get this done, I don’t care about anything else.”
It’s very interesting, the ADHD brain needs novelty. “Give me something new. Give it to me quickly, and let’s move on.”
Theresa Cerulli, MD: Right, absolutely. Some everyday activities, having to stand in line in elementary school to go out to recess. It’s some everyday things that are really challenging.
Transcript Edited for Clarity