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Child & Youth Mental Health Algorithm - GPSC

Child & Youth Mental Health Algorithm - GPSC

Tools/ResoucesADHDMH

Tools/ResoucesADHDMH Screening QuestionsRisk Identification TablesNOSupportNeededYESRefer for Psychoor BehaviouralTherapyFunctionalTeFACFAContinue treatmentEducate remaintenance &relapseSet “well checks”every 3-6 mosPsychotherapyPsychoeducation ToolsNon Specific SupportsCBIS ToolsFollow-up &MonitoringImprovement?ConsiderMedicationYESMeds as perprotocolEvaluation Tools:ADHDAnxietyDepressionSuicide RiskSubstance AbuseScreenReferral FlagsEvaluate need throughoutinvolvementEmergency: Suicidalintent or plan, acutepsychosisSubstantial2 nd or further episodeMeds Tolerated:Increase & Monitor asper protocolYESModerateMeds not Tolerated:Maintain dose x 2wkRefer if not improvedResourcesMinimal or NoneIf used, increase meds graduallyMonitor weekly until consultUrgent: Severe symptoms& deterioration infunction, suicidalideation, other majorpsychiatric conditionsUsual: additional therapy,evaluation, treatmentnon-responders, othermedicatl concerns, medside effects, 2 nd or furtherepisode

DSM-IV TR criteriaDSM-IV-TR. Primary Inattentive type symptomsA. At least 6 of the 9 symptoms of inattention listed below must have persisted for at least 6 months to a degreethat is maladaptive and inconsistent with the patient's developmental level.a. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or otheractivitiesb. Often has difficulty sustaining attention in tasks or play activitiesc. Often does not seem to listen when spoken to directlyd. Often does not follow through with instructions and often fails to finish schoolwork, chores, or duties inthe workplace (not due to oppositional behaviour or failure to understand instructions)e. Often has difficulty organizing tasks and activitiesf. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (eg,schoolwork, homework);g. often loses things necessary for tasks or activities (eg, school assignments, pencils, books, tools, toys)h. Often is easily distracted by extraneous stimuli (eg, toys, school assignments, pencils, books, tools)i. Often is forgetful in daily activitiesB. Some hyperactive-impulsive or inattentive symptoms that caused impairment are present before age 7 yearsC. Symptoms must be present in 2 or more situations (eg, school, work, home).D. The disturbance causes clinically significant distress or impairment in social, academic, or occupational function.E. Behaviour does not exclusively occur during the course of pervasive developmental disorder, premenstrualdysphoric disorder, schizophrenia, or other psychotic disorder. No mood disorder, anxiety dissociative disorder, orpersonality disorder accounts for the behaviour.DSM-IV-TR. Primary Hyperactivity / Impulsivity type symptomsA) At least 6 of the 9 symptoms of hyperactivity (symptoms 1-6) and impulsivity (symptoms 7-9) listed belowhave persisted for at least 6 months to a degree that is maladaptive and inconsistent with the patient'sdevelopmental level.Hyperactivitya. Often fidgets with hands or feet or squirms in seatb. Often leaves seat in classroom or in other situations in which remaining seated isexpectedc. Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents and adults,may be limited to subjective feelings of restlessness)d. Often has difficulty quietly playing or engaging in leisure activitiese. Often on the go or often acts as if driven by a motorf. Often talks excessivelyImpulsivityg. Often blurts out answers before questions have been completedh. Often has difficulty awaiting turni. Often interrupts or intrudes on others (e.g., butts into conversations or games)B) Some hyperactive-impulsive or inattentive symptoms that caused impairment are present before age 7 yearsC) Symptoms must be present in 2 or more situations (e.g., school, work, and home).D) The disturbance causes clinically significant distress or impairment in social, academic, or occupationalfunction.Behaviour does not exclusively occur during the course of pervasive developmental disorder, premenstrual dysphoricdisorder, schizophrenia, or other psychotic disorder. No mood disorder, anxiety dissociative disorder, or personalitydisorder accounts for the behaviour

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