CASA's Management Of ADHD: A Regulators Problems And Perspectives

Transcription

1 CASA's Management Of ADHD: A Regulators Problems And Perspectives Pooshan Navathe David Fitzgerald Michael Drane Peter Clem

2 Disclaimer I receive a salary from the Commonwealth of Australia. I have no financial relationships to disclose. I will not be discussing drugs and off label use. I will try to fairly represent the Policy and Practice of the Civil Aviation Safety Authority (Australia), and to clearly indicate where I am straying into personal/professional opinion for which I, and I alone, am responsible

3 Problems about diagnosis Definitions of ADHD and hyperkinetic disorder based on maladaptively high levels of impulsivity, hyperactivity & inattention. impulsivity signifies premature & thoughtless actions; hyperactivity a restless and shifting excess of movement; inattention is a disorganised style preventing sustained effort

4 Problems about diagnosis ADHD distinguished from normal range by number severity of symptoms association with significant impairment

5 Range of behaviours Range Severity Impairment Judgements vary Links to funding in schools Flavour of the month!

6 What s in a name? DSM-IV ADHD ICD-10 Hyperkinetic disorder (HKD) Both based on the same list of 18 symptoms 9 inattentive, 6 hyperactive, 3 impulsive The criteria for hyperkinetic disorder are more stringent that those for ADHD As such, DSM- IV ADHD is some 20 times more prevalent than ICD-10 HKD ADHD more prevalent in USA than Europe?

7 Subtypes Childhood Adolescent Childhood remaining in adulthood Adult onset

8 Problems about assessment Multiple independent inputs Medical records from date of diagnosis Medicare records Current assessment by Rx paediatrician or psychiatrist History of condition Academic employment records & history Traffic & criminal Special INV (QEEG) or neuropsychological testing

9 Specialist report History of condition Confirmation of diagnosis & current status (as per DSM-IV criteria) Co-morbidities, including AOD Requirement and response to Rx Current functional status collateral information from school, family, workplace etc.

10 Instruments ADHD Rating Scale IV -- Home Version ADHD Rating Scale IV -- School Version Child Attention Profile (CAP) Home Situations Questionnaire School Situations Questionnaire Parents' Rating Scale for the Attention Deficit Hyperactivity Disorder Werry-Weiss-Peters Activity Rating Scale Wender Utah Rating Scale (for adults) Adult ADHD/ADD Quiz The SNAP-IV Teacher and Parent Rating Scale Adult ADHD Self-Report Scale (ASRS-v1.1) Screener Childhood ADHD Symptoms Scale Self-Report Attention-Deficit Scales for Adults (ADSA) Conners' Continuous Performance Test II for Windows (CPT II V.5) Gordon Diagnostic System (GDS) Test of Everyday Attention for Children (TEA-Ch) Test of Variables of Attention (TOVA) Conners' Rating Scales Revised (CRS R) Brown Attention-Deficit Disorder Scales Brown Attention-Deficit Disorder Scales for Children

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12 Problems about Rx Performance improves on medication Really?

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14 Concordance

15 Concordance

16 Problems about ID remission Duration - 6m? Remission of symptoms = neuropsych reversal? Rx holidays?

17 CASA position Symptoms Symptoms + Rx No symptoms + Rx No symptoms + remission + No Rx X X X

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