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Diagnosing ADHD

To be diagnosed with attention-deficit/hyperactivity disorder (ADHD), individuals must meet the following criteria, adapted from DSM-5.1

An update to the defining criteria:
ADHD-RS-5 vs ADHD-RS-4

The ADHD-RS-5 is a rating scale specifically for children and adolescents with ADHD that has been updated to correspond with the DSM-5. The ADHD-RS-5 has several versions which correspond to different age groups (5-10 and 11-17) as well as different settings (home and school) and can also measure how ADHD symptoms can affect behavior such as hyperactivity-impulsivity, restlessness, and inattention.

Image of teenage boy in class
Image of teenage boy in class

The diagnoses of ADHD in pediatrics

In order to be diagnosed with ADHD, 6 or more symptoms of inattention and/or hyperactivity/impulsivity must have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities.1

What to look for

 

Symptoms of inattention1

  • Makes careless mistakes/lacks attention to detail
  • Lacks sustained attention in tasks or play activities
  • Poor listener, even in the absence of obvious distraction
  • Fails to follow through on tasks and instructions
  • Difficulty with organization, time management, and deadlines
  • Avoids tasks requiring sustained mental effort
  • Loses things necessary for tasks or activities
  • Easily distracted (including unrelated thoughts)
  • Forgetful in daily activities
 

Symptoms of hyperactivity/impulsivity1

  • Fidgets, taps hands, or squirms in seat
  • Leaves seat in situations when remaining seated is expected
  • Excessive running/climbing, or feelings of restlessness
  • Difficulty with quiet, leisure activities
  • Often “on the go”; acting as if “driven by a motor”
  • Excessive talking
  • Blurts out answers before questions are even completed
  • Difficulty waiting turn
  • Interrupts or intrudes on others
Image of teenage girl on computer

Several ADHD symptoms must be present in 1 or more settings.1

In order to diagnose ADHD, symptoms must be persistent; confirmation of substantially impacting symptoms across settings typically cannot be accurately assessed without consulting observers who have seen the individual in the setting.

Symptoms may vary depending on setting/context. Below, you will find some examples of how ADHD may affect children and adolescents at home, at school, and in social settings:

Image of teenage girl on computer
Icon: House

At home1

  • Is forgetful doing chores
  • Has difficulty keeping materials and belongings in order
  • Reluctant to engage in tasks that require sustained mental effort, such as homework
  • Several inattentive or hyperactive impulsive symptoms are present in one or more set­tings (e.g., at home, school, or work; with friends or relatives; in other activities)
Icon: School

At school1

  • Does not follow through on instructions and fails to complete assignments
  • Overlooks or misses details in homework or schoolwork
  • Often squirms in seat and leaves seat in classroom inappropriately
  • There is clear evidence that the symptoms interfere with, or reduce the quality of, so­cial, academic, or occupational functioning
Icon: Outside

In social settings1

  • Does not seem to listen when spoken to directly
  • Cannot wait for turn in conversation
  • May intrude into, or take over, what others are doing during play activities

These are not the complete diagnostic criteria. Please see DSM-5 for full diagnostic criteria. It is important to note that diagnosis should be based on a complete clinical history of the patient.

IMPORTANT SAFETY INFORMATION

INDICATION

Qelbree is indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in pediatric patients ages 6 to 17.

IMPORTANT SAFETY INFORMATION

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

In clinical studies, higher rates of suicidal thoughts and behaviors were reported in pediatric [read more] patients with ADHD treated with Qelbree than in patients treated with placebo. Closely monitor all Qelbree-treated patients for clinical worsening and for emergence of suicidal thoughts and behaviors.

In clinical studies, higher rates of suicidal thoughts and behaviors were reported in pediatric patients with ADHD treated with Qelbree than in patients treated with placebo. Closely monitor all [read more]Qelbree-treated patients for clinical worsening and for emergence of suicidal thoughts and behaviors.

IMPORTANT SAFETY INFORMATION (CONT’D)

CONTRAINDICATIONS

  • Concomitant administration of a monoamine oxidase inhibitor (MAOI), or dosing within 14 days after discontinuing an MAOI, because of an increased risk of hypertensive crisis
  • Concomitant administration of sensitive CYP1A2 substrates or CYP1A2 substrates with a narrow therapeutic range

WARNINGS & PRECAUTIONS

  • Heart rate, blood pressure increases: Qelbree can cause an increase in diastolic blood pressure and heart rate. Assess these measures prior to starting therapy, following increases in dosage, and periodically during therapy
  • Activation of mania or hypomania: Noradrenergic drugs may induce a manic or mixed episode in patients with bipolar disorder. Prior to initiating treatment with Qelbree, screen patients to determine if they are at risk for bipolar disorder. Screening should include a detailed psychiatric history, including a personal or family history of suicide, bipolar disorder, and depression
  • Somnolence and fatigue: Patients should not perform activities requiring mental alertness, such as operating a motor vehicle or hazardous machinery, due to potential somnolence (including sedation or lethargy) and fatigue, until they know how they will be affected by Qelbree

ADVERSE REACTIONS

The most common adverse reactions (≥ 5% and at least twice the rate of placebo for any dose) were somnolence, decreased appetite, fatigue, nausea, vomiting, insomnia, and irritability.

DOSING SAFETY INFORMATION

  • Swallow Qelbree capsules whole or sprinkle entire contents on a teaspoonful of applesauce and consume all within 2 hours, without regard to meals. Do not cut, crush, or chew the capsules
  • Severe renal impairment: Initiate Qelbree at 100 mg once daily and increase by 50 mg to 100 mg at weekly intervals to a maximum recommended dosage of 200 mg once daily
  • Prior to initiating treatment, following increases in dosage, and periodically during therapy, measure heart rate and blood pressure
  • Qelbree is a strong CYP1A2 inhibitor. Coadministration with moderately sensitive CYP1A2 substrates (eg, clozapine and pirfenidone) is not recommended. If coadministered, dose reduction may be warranted
  • Qelbree is a weak inhibitor of CYP2D6 and CYP3A4, which increases exposure of those substrates (eg, dextromethorphan and alfentanil) when coadministered with Qelbree. Monitor patients for adverse reactions and adjust dosages of substrates as clinically indicated
    • For a more complete list of drug-to-drug interactions, including clinical effects and examples, please see table 2 in section 7 of the full Prescribing Information

PREGNANCY & LACTATION

  • Qelbree may cause maternal harm. It is not known if Qelbree passes into breastmilk or if Qelbree has an effect on the breastfed infant. Discontinue Qelbree if the risks of therapy during pregnancy outweigh the benefits

Please see full Prescribing Information, including Boxed Warning.

References:

1. American Psychiatric Association. Attention-deficit and disruptive behavior disorders. In: Diagnostic and Statistical Manual of Mental Disorders, 5th ed (DSM-5®). Arlington, VA: American Psychiatric Association; 2013.

IMPORTANT SAFETY INFORMATION

INDICATION

Qelbree is indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in pediatric patients ages 6 to 17.

IMPORTANT SAFETY INFORMATION

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

In clinical studies, higher rates of suicidal thoughts and behaviors were reported in pediatric [read more] patients with ADHD treated with Qelbree than in patients treated with placebo. Closely monitor all Qelbree-treated patients for clinical worsening and for emergence of suicidal thoughts and behaviors.

In clinical studies, higher rates of suicidal thoughts and behaviors were reported in pediatric patients with ADHD treated with Qelbree than in patients treated with placebo. Closely monitor all [read more]Qelbree-treated patients for clinical worsening and for emergence of suicidal thoughts and behaviors.

IMPORTANT SAFETY INFORMATION (CONT’D)

CONTRAINDICATIONS

  • Concomitant administration of a monoamine oxidase inhibitor (MAOI), or dosing within 14 days after discontinuing an MAOI, because of an increased risk of hypertensive crisis
  • Concomitant administration of sensitive CYP1A2 substrates or CYP1A2 substrates with a narrow therapeutic range

WARNINGS & PRECAUTIONS

  • Heart rate, blood pressure increases: Qelbree can cause an increase in diastolic blood pressure and heart rate. Assess these measures prior to starting therapy, following increases in dosage, and periodically during therapy
  • Activation of mania or hypomania: Noradrenergic drugs may induce a manic or mixed episode in patients with bipolar disorder. Prior to initiating treatment with Qelbree, screen patients to determine if they are at risk for bipolar disorder. Screening should include a detailed psychiatric history, including a personal or family history of suicide, bipolar disorder, and depression
  • Somnolence and fatigue: Patients should not perform activities requiring mental alertness, such as operating a motor vehicle or hazardous machinery, due to potential somnolence (including sedation or lethargy) and fatigue, until they know how they will be affected by Qelbree

ADVERSE REACTIONS

The most common adverse reactions (≥ 5% and at least twice the rate of placebo for any dose) were somnolence, decreased appetite, fatigue, nausea, vomiting, insomnia, and irritability.

DOSING SAFETY INFORMATION

  • Swallow Qelbree capsules whole or sprinkle entire contents on a teaspoonful of applesauce and consume all within 2 hours, without regard to meals. Do not cut, crush, or chew the capsules
  • Severe renal impairment: Initiate Qelbree at 100 mg once daily and increase by 50 mg to 100 mg at weekly intervals to a maximum recommended dosage of 200 mg once daily
  • Prior to initiating treatment, following increases in dosage, and periodically during therapy, measure heart rate and blood pressure
  • Qelbree is a strong CYP1A2 inhibitor. Coadministration with moderately sensitive CYP1A2 substrates (eg, clozapine and pirfenidone) is not recommended. If coadministered, dose reduction may be warranted
  • Qelbree is a weak inhibitor of CYP2D6 and CYP3A4, which increases exposure of those substrates (eg, dextromethorphan and alfentanil) when coadministered with Qelbree. Monitor patients for adverse reactions and adjust dosages of substrates as clinically indicated
    • For a more complete list of drug-to-drug interactions, including clinical effects and examples, please see table 2 in section 7 of the full Prescribing Information

PREGNANCY & LACTATION

  • Qelbree may cause maternal harm. It is not known if Qelbree passes into breastmilk or if Qelbree has an effect on the breastfed infant. Discontinue Qelbree if the risks of therapy during pregnancy outweigh the benefits

Please see full Prescribing Information, including Boxed Warning.