I want ppt of pharmacological and non pharmacological treatment of adhd..in detail..want to present in front of hod
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ADHD treatment dopamine norepinephrine prefrontal cortex mechanism
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ADHD non-pharmacological behavioral therapy children
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mkdir -p /home/daytona/workspace/adhd-ppt && ls /home/daytona/workspace/adhd-ppt…
Writing File
~/adhd-ppt/adhd_ppt.js
const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "ADHD: Pharmacological and Non-Pharmacological Treatment";
pres.author = "Department of Psychiatry";
// ─── COLOR PALETTE ────────────────────────────────────────────────────────────
const C = {
navy: "1A2F5E", // dominant dark
blue: "1E6FA5", // mid accent
teal: "1A8A7B", // secondary accent
orange: "E87A20", // highlight / pop
cream: "F5F0E8", // light bg
white: "FFFFFF",
gray: "6B7280",
lgray: "E8EDF2",
red: "C0392B",
green: "27AE60",
purple: "7B2D8B",
gold: "D4A017",
};
// ─── HELPER: Slide title bar ───────────────────────────────────────────────────
function addTitleBar(slide, title, subtitle = "") {
// Top accent bar
slide.addShape(pres.shapes.RECTANGLE, {
x: 0, y: 0, w: 10, h: 0.9,
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slide.addShape(pres.shapes.RECTANGLE, {
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slide.addText(title, {
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fontSize: 22, bold: true, color: C.white, valign: "middle", margin: 0
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if (subtitle) {
slide.addText(subtitle, {
x: 0.3, y: 0.96, w: 9.4, h: 0.35,
fontSize: 12, color: C.blue, italic: true, margin: 0
});
}
}
// ─── HELPER: Footer ────────────────────────────────────────────────────────────
function addFooter(slide, text = "ADHD: Management Strategies | Department of Psychiatry") {
slide.addShape(pres.shapes.RECTANGLE, {
x: 0, y: 5.32, w: 10, h: 0.3,
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slide.addText(text, {
x: 0.2, y: 5.33, w: 9.6, h: 0.28,
fontSize: 9, color: C.gray, italic: true, margin: 0
});
}
// ─── HELPER: Section divider slide ────────────────────────────────────────────
function sectionSlide(title, subtitle, colorL = C.navy, colorR = C.blue) {
const sl = pres.addSlide();
sl.addShape(pres.shapes.RECTANGLE, {
x: 0, y: 0, w: 4.5, h: 5.625,
fill: { color: colorL }, line: { color: colorL }
});
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x: 4.5, y: 0, w: 5.5, h: 5.625,
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});
sl.addShape(pres.shapes.RECTANGLE, {
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sl.addText(title, {
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fontSize: 32, bold: true, color: C.white, valign: "middle", align: "left", margin: 0
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sl.addText(subtitle, {
x: 4.8, y: 2.1, w: 4.8, h: 1.5,
fontSize: 16, color: C.white, italic: true, valign: "middle", align: "left", margin: 0
});
return sl;
}
// ─── SLIDE 1: TITLE SLIDE ─────────────────────────────────────────────────────
{
const sl = pres.addSlide();
sl.addShape(pres.shapes.RECTANGLE, {
x: 0, y: 0, w: 10, h: 5.625,
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sl.addShape(pres.shapes.RECTANGLE, {
x: 0, y: 3.5, w: 10, h: 2.125,
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sl.addShape(pres.shapes.RECTANGLE, {
x: 0, y: 3.48, w: 10, h: 0.07,
fill: { color: C.orange }, line: { color: C.orange }
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sl.addText("ATTENTION DEFICIT\nHYPERACTIVITY DISORDER", {
x: 0.6, y: 0.5, w: 8.8, h: 2.0,
fontSize: 38, bold: true, color: C.white, align: "center", valign: "middle",
charSpacing: 2, margin: 0
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sl.addText("Pharmacological & Non-Pharmacological Treatment", {
x: 0.6, y: 2.55, w: 8.8, h: 0.65,
fontSize: 22, color: C.gold, align: "center", italic: true, margin: 0
});
sl.addText("A Comprehensive Review", {
x: 0.6, y: 3.6, w: 8.8, h: 0.5,
fontSize: 16, color: C.white, align: "center", margin: 0
});
sl.addText("Department of Psychiatry | 2026", {
x: 0.6, y: 4.2, w: 8.8, h: 0.4,
fontSize: 13, color: C.lgray, align: "center", margin: 0
});
}
// ─── SLIDE 2: OVERVIEW & DEFINITION ──────────────────────────────────────────
{
const sl = pres.addSlide();
sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
addTitleBar(sl, "What is ADHD?");
addFooter(sl);
// Left column
sl.addShape(pres.shapes.RECTANGLE, {
x: 0.3, y: 1.2, w: 4.5, h: 3.9,
fill: { color: C.white }, line: { color: C.lgray },
shadow: { type: "outer", color: "000000", blur: 5, offset: 2, angle: 135, opacity: 0.1 }
});
sl.addText("Definition", { x: 0.4, y: 1.25, w: 4.3, h: 0.4, fontSize: 14, bold: true, color: C.navy, margin: 0 });
sl.addText([
{ text: "ADHD is a ", options: {} },
{ text: "neurodevelopmental disorder", options: { bold: true } },
{ text: " characterised by persistent patterns of:", options: {} }
], { x: 0.45, y: 1.65, w: 4.2, h: 0.6, fontSize: 11, color: C.navy, margin: 0 });
const defItems = [
"Inattention",
"Hyperactivity",
"Impulsivity",
];
defItems.forEach((item, i) => {
sl.addShape(pres.shapes.ROUNDED_RECTANGLE, {
x: 0.5, y: 2.3 + i * 0.65, w: 4.0, h: 0.52,
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sl.addText(item, {
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fontSize: 13, bold: true, color: C.white, valign: "middle", margin: 0
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});
sl.addText("Onset before age 12 | Persists into adulthood\nPrevalence: ~5% children, ~2.5% adults", {
x: 0.45, y: 4.3, w: 4.2, h: 0.65, fontSize: 10, color: C.gray, italic: true, margin: 0
});
// Right column
sl.addShape(pres.shapes.RECTANGLE, {
x: 5.1, y: 1.2, w: 4.6, h: 3.9,
fill: { color: C.white }, line: { color: C.lgray },
shadow: { type: "outer", color: "000000", blur: 5, offset: 2, angle: 135, opacity: 0.1 }
});
sl.addText("DSM-5 Subtypes", { x: 5.2, y: 1.25, w: 4.3, h: 0.4, fontSize: 14, bold: true, color: C.navy, margin: 0 });
const subtypes = [
{ label: "Predominantly Inattentive", color: C.blue },
{ label: "Predominantly Hyperactive-Impulsive", color: C.teal },
{ label: "Combined Presentation", color: C.orange },
];
subtypes.forEach((s, i) => {
sl.addShape(pres.shapes.RECTANGLE, { x: 5.2, y: 1.75 + i * 0.7, w: 0.12, h: 0.45, fill: { color: s.color }, line: { color: s.color } });
sl.addText(s.label, { x: 5.4, y: 1.73 + i * 0.7, w: 4.1, h: 0.5, fontSize: 12, bold: true, color: s.color, valign: "middle", margin: 0 });
});
sl.addText("Key Facts", { x: 5.2, y: 3.95, w: 4.3, h: 0.35, fontSize: 12, bold: true, color: C.navy, margin: 0 });
const facts = ["75% heritability", "Male:Female = 3–4:1 (children)", "Most common childhood psychiatric disorder", ">75% adults have ≥1 comorbidity"];
facts.forEach((f, i) => {
sl.addText("▸ " + f, { x: 5.2, y: 4.3 + i * 0.22, w: 4.2, h: 0.22, fontSize: 10, color: C.gray, margin: 0 });
});
}
// ─── SLIDE 3: NEUROBIOLOGY ────────────────────────────────────────────────────
{
const sl = pres.addSlide();
sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
addTitleBar(sl, "Neurobiology of ADHD", "Dopamine & Norepinephrine deficiency in the Prefrontal Cortex");
addFooter(sl);
// Brain image
const brainUrls = ["https://cdn.orris.care/cdss_images/pmc_clinical_VQA_041385269e15da7ea7ce53d1b9ed6cdcece153a2cdebbd2439b4e49eefa256cf.jpg"];
try {
const imgData = JSON.parse(execSync(`node /home/daytona/skills/shared/scripts/fetch_images.js "${brainUrls[0]}"`).toString());
if (imgData[0] && imgData[0].base64) {
sl.addImage({ data: imgData[0].base64, x: 5.4, y: 1.05, w: 4.3, h: 4.0 });
}
} catch(e) {}
const neuroPoints = [
{ title: "Dopamine (DA) Deficit", body: "Reduced DA in prefrontal cortex → impaired executive function, reward processing, motor control", color: C.blue },
{ title: "Norepinephrine (NE) Deficit", body: "Low NE in PFC → poor working memory, attention regulation, signal-to-noise ratio", color: C.teal },
{ title: "Delayed PFC Maturation", body: "Synaptic pruning in PFC occurs ~3 years late in ADHD; explains childhood onset", color: C.purple },
{ title: "Genetic Component", body: "~75% heritability; genes affecting DAT1, DRD4, DRD5, SNAP25 implicated", color: C.navy },
{ title: "Circuit Disruption", body: "Hypofunction in prefrontal-striatal circuits → symptoms of inattention, hyperactivity", color: C.orange },
];
neuroPoints.forEach((p, i) => {
sl.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 1.2 + i * 0.77, w: 4.9, h: 0.68, fill: { color: C.white }, line: { color: C.lgray } });
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sl.addText(p.title, { x: 0.5, y: 1.2 + i * 0.77, w: 4.6, h: 0.27, fontSize: 11, bold: true, color: p.color, valign: "bottom", margin: 0 });
sl.addText(p.body, { x: 0.5, y: 1.48 + i * 0.77, w: 4.6, h: 0.38, fontSize: 9.5, color: C.gray, margin: 0 });
});
}
// ─── SECTION DIVIDER: PHARMACOLOGICAL ─────────────────────────────────────────
sectionSlide("SECTION 1", "Pharmacological Treatment of ADHD", C.navy, C.blue);
// ─── SLIDE 4: TREATMENT OVERVIEW ─────────────────────────────────────────────
{
const sl = pres.addSlide();
sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
addTitleBar(sl, "Pharmacological Treatment: Overview");
addFooter(sl);
const drugs = [
{ cat: "FIRST LINE\nStimulants", items: ["Methylphenidate (MPH)", "Amphetamine salts (AMP)", "Dextroamphetamine", "Lisdexamfetamine"], color: C.blue, icon: "1" },
{ cat: "SECOND LINE\nNon-Stimulants", items: ["Atomoxetine (ATX)", "Viloxazine", "Bupropion", "TCAs (desipramine)"], color: C.teal, icon: "2" },
{ cat: "THIRD LINE\nAlpha-Agonists", items: ["Clonidine (Kapvay)", "Guanfacine XR (Intuniv)", "Adjunct to stimulants"], color: C.purple, icon: "3" },
];
drugs.forEach((d, i) => {
const x = 0.3 + i * 3.25;
sl.addShape(pres.shapes.RECTANGLE, {
x, y: 1.2, w: 3.0, h: 4.1,
fill: { color: C.white }, line: { color: d.color },
shadow: { type: "outer", color: "000000", blur: 6, offset: 2, angle: 135, opacity: 0.12 }
});
sl.addShape(pres.shapes.RECTANGLE, { x, y: 1.2, w: 3.0, h: 0.75, fill: { color: d.color }, line: { color: d.color } });
sl.addText(d.cat, { x: x + 0.05, y: 1.2, w: 2.9, h: 0.75, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
d.items.forEach((item, j) => {
sl.addShape(pres.shapes.ELLIPSE, { x: x + 0.18, y: 2.07 + j * 0.65, w: 0.22, h: 0.22, fill: { color: d.color }, line: { color: d.color } });
sl.addText(item, { x: x + 0.45, y: 2.03 + j * 0.65, w: 2.4, h: 0.3, fontSize: 11, color: C.navy, valign: "middle", margin: 0 });
});
});
sl.addText("Stimulants are first-line based on decades of proven safety and efficacy (FDA-approved for children and adults)", {
x: 0.3, y: 5.03, w: 9.4, h: 0.25, fontSize: 9.5, italic: true, color: C.gray, margin: 0
});
}
// ─── SLIDE 5: METHYLPHENIDATE ─────────────────────────────────────────────────
{
const sl = pres.addSlide();
sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
addTitleBar(sl, "Methylphenidate (MPH)", "The Gold Standard First-Line Stimulant");
addFooter(sl);
// Left side
sl.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 1.15, w: 5.5, h: 4.0, fill: { color: C.white }, line: { color: C.lgray } });
const mechSections = [
{ h: "Mechanism of Action", body: "Blocks dopamine transporter (DAT) and norepinephrine transporter (NET) → increases DA and NE in PFC synaptic cleft → improved signal-to-noise ratio in prefrontal circuits", color: C.blue },
{ h: "Formulations", body: "Short-acting (2–4h): Ritalin IR 5–20 mg BD/TDS\nIntermediate (8–12h): Ritalin LA, Metadate CD\nLong-acting (10–14h): Concerta (OROS) 18–54 mg OD\nTransdermal patch: Daytrana (onset 2h, wear 9h)", color: C.teal },
{ h: "Dosing", body: "Start low, titrate slowly. Children: 0.3–1 mg/kg/day.\nMax: 60 mg/day (children), 80 mg/day (adults)\nSingle daily dosing preferred for compliance", color: C.purple },
{ h: "Efficacy", body: "Effect size 0.8–1.0 (large). 70–80% response rate.\nReduces hyperactivity, impulsivity, inattention.", color: C.green },
];
let yy = 1.25;
mechSections.forEach((s) => {
sl.addText(s.h, { x: 0.45, y: yy, w: 5.2, h: 0.28, fontSize: 11, bold: true, color: s.color, margin: 0 });
sl.addText(s.body, { x: 0.45, y: yy + 0.27, w: 5.2, h: 0.65, fontSize: 9.5, color: C.navy, margin: 0 });
yy += 0.97;
});
// Right side - Side effects
sl.addShape(pres.shapes.RECTANGLE, { x: 6.0, y: 1.15, w: 3.7, h: 4.0, fill: { color: C.white }, line: { color: C.lgray } });
sl.addText("Side Effects & Monitoring", { x: 6.1, y: 1.22, w: 3.5, h: 0.35, fontSize: 12, bold: true, color: C.red, margin: 0 });
const sideEffects = [
{ cat: "Common", items: ["↓ Appetite, weight loss", "Insomnia", "Headache", "Abdominal pain", "Irritability/rebound"], color: C.orange },
{ cat: "Cardiovascular", items: ["↑ HR & BP (mild)", "Monitor with CHD", "ECG if indicated"], color: C.red },
{ cat: "Monitor", items: ["Height/weight 6-monthly", "BP & HR", "Tic surveillance", "Drug holidays (summer)"], color: C.blue },
{ cat: "Contraindications", items: ["Glaucoma, anxiety", "Tic disorders (relative)", "Substance abuse Hx"], color: C.purple },
];
let yr = 1.65;
sideEffects.forEach((s) => {
sl.addText("▌ " + s.cat, { x: 6.1, y: yr, w: 3.5, h: 0.24, fontSize: 10, bold: true, color: s.color, margin: 0 });
yr += 0.25;
s.items.forEach((item) => {
sl.addText(" • " + item, { x: 6.1, y: yr, w: 3.5, h: 0.22, fontSize: 9.5, color: C.navy, margin: 0 });
yr += 0.21;
});
yr += 0.07;
});
}
// ─── SLIDE 6: AMPHETAMINES ────────────────────────────────────────────────────
{
const sl = pres.addSlide();
sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
addTitleBar(sl, "Amphetamines", "First-Line Stimulants (Schedule II)");
addFooter(sl);
const boxes = [
{
title: "Mechanism", color: C.blue,
x: 0.3, y: 1.15, w: 3.0, h: 4.0,
body: "• Blocks DAT & NET (like MPH)\n• Also acts as a FALSE SUBSTRATE — enters presynaptic terminal via DAT\n• Displaces DA from vesicles (VMAT inhibition)\n• Reverses DAT → massive DA/NE efflux into synapse\n→ Stronger & longer dopaminergic effect than MPH"
},
{
title: "Key Agents & Doses", color: C.teal,
x: 3.55, y: 1.15, w: 3.0, h: 4.0,
body: "Adderall XR (mixed AMP salts)\n5–30 mg OD, max 40 mg/day\n\nDextroamphetamine\n2.5–10 mg BD, max 40 mg/day\n\nLisdexamfetamine (Vyvanse)\nPro-drug → cleaved to d-AMP in body\n20–70 mg OD — lower abuse potential\nAlso FDA-approved for binge-eating\n\nDexedrine (d-AMP)\n5–10 mg BD–TDS"
},
{
title: "Clinical Notes", color: C.purple,
x: 6.8, y: 1.15, w: 2.9, h: 4.0,
body: "• May be more effective for some patients than MPH\n• Greater DA release in nucleus accumbens at high doses → higher abuse potential\n• Lisdexamfetamine: slow enzymatic activation reduces abuse\n• Similar side-effect profile to MPH\n• Monitor growth, HR, BP\n• Schedule II — DEA controlled"
}
];
boxes.forEach(b => {
sl.addShape(pres.shapes.RECTANGLE, { x: b.x, y: b.y, w: b.w, h: b.h, fill: { color: C.white }, line: { color: b.color } });
sl.addShape(pres.shapes.RECTANGLE, { x: b.x, y: b.y, w: b.w, h: 0.5, fill: { color: b.color }, line: { color: b.color } });
sl.addText(b.title, { x: b.x + 0.05, y: b.y, w: b.w - 0.1, h: 0.5, fontSize: 13, bold: true, color: C.white, valign: "middle", align: "center", margin: 0 });
sl.addText(b.body, { x: b.x + 0.12, y: b.y + 0.6, w: b.w - 0.24, h: b.h - 0.7, fontSize: 10, color: C.navy, margin: 0 });
});
}
// ─── SLIDE 7: ATOMOXETINE ─────────────────────────────────────────────────────
{
const sl = pres.addSlide();
sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
addTitleBar(sl, "Atomoxetine (Strattera)", "Non-Stimulant — Selective Norepinephrine Reuptake Inhibitor (NRI)");
addFooter(sl);
// Mechanism image
const atomImgUrl = "https://cdn.orris.care/cdss_images/6e251f2d6fef44be4f9d80788aac45bc548b6002745d6937971d8617336c2065.png";
try {
const imgData = JSON.parse(execSync(`node /home/daytona/skills/shared/scripts/fetch_images.js "${atomImgUrl}"`).toString());
if (imgData[0] && imgData[0].base64) {
sl.addImage({ data: imgData[0].base64, x: 6.2, y: 1.15, w: 3.5, h: 3.0 });
}
} catch(e) {}
const atomSections = [
{ h: "Mechanism of Action", body: "Selective NET inhibitor — blocks NE reuptake in PFC\n→ ↑ NE and DA in prefrontal cortex (NETs also transport DA)\nNo action on nucleus accumbens DATs → minimal abuse potential\nNot a controlled substance (DEA schedule IV/unscheduled)", color: C.teal },
{ h: "Dosing", body: "Start: 0.5 mg/kg/day → increase after 3 weeks → target 1.2 mg/kg/day\nMax: 1.4 mg/kg/day or 100 mg/day (whichever lower)\nOnce or twice daily — full effect in 4–6 weeks", color: C.blue },
{ h: "Advantages", body: "• No abuse potential — safe in substance use history\n• Effective for ADHD + anxiety comorbidity\n• Once daily dosing; 24-hour coverage\n• No drug holidays needed", color: C.green },
{ h: "Side Effects", body: "• GI: nausea, decreased appetite, abdominal pain\n• Cardiovascular: ↑ HR, ↑ BP\n• Mood changes; rare: suicidal ideation (black box — monitor)\n• Hepatotoxicity (very rare)", color: C.red },
];
let yas = 1.2;
atomSections.forEach((s) => {
sl.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: yas, w: 5.6, h: 0.06, fill: { color: s.color }, line: { color: s.color } });
sl.addText(s.h, { x: 0.3, y: yas + 0.08, w: 5.6, h: 0.28, fontSize: 11, bold: true, color: s.color, margin: 0 });
sl.addText(s.body, { x: 0.3, y: yas + 0.36, w: 5.6, h: 0.6, fontSize: 9.5, color: C.navy, margin: 0 });
yas += 1.0;
});
sl.addText("Atomoxetine: preferred when stimulants are CI, comorbid anxiety, tic disorders, or history of substance abuse\n— Kaplan & Sadock's Comprehensive Textbook of Psychiatry", {
x: 0.3, y: 5.05, w: 9.4, h: 0.3, fontSize: 9, italic: true, color: C.gray, margin: 0
});
}
// ─── SLIDE 8: ALPHA-2 AGONISTS ────────────────────────────────────────────────
{
const sl = pres.addSlide();
sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
addTitleBar(sl, "α₂-Adrenergic Agonists: Clonidine & Guanfacine", "Third-Line Monotherapy | Useful Adjuncts to Stimulants");
addFooter(sl);
const agData = [
{
drug: "Clonidine (Kapvay)", color: C.blue, x: 0.3,
items: [
"α₂A & α₂C agonist",
"↑ NE in PFC → strengthens pyramidal neuron firing",
"Available: IR & ER (extended release)",
"Dose: 0.1–0.4 mg/day in divided doses",
"Useful: ADHD + tics or aggressive behaviour",
"SE: Sedation, ↓BP, dry mouth, rebound HTN on abrupt stop",
"Monitor BP & HR; taper slowly on discontinuation",
]
},
{
drug: "Guanfacine XR (Intuniv)", color: C.teal, x: 5.1,
items: [
"More selective α₂A agonist",
"Directly stimulates post-synaptic α₂A receptors in PFC",
"↑ PFC pyramidal neuron signal — improves working memory",
"Dose: 1–4 mg/day OD (XR); 4–7 mg/day (adults)",
"Less sedating than clonidine",
"SE: Sedation, ↓BP, bradycardia",
"Can be combined with stimulants for augmentation",
]
}
];
agData.forEach(d => {
sl.addShape(pres.shapes.RECTANGLE, { x: d.x, y: 1.15, w: 4.5, h: 4.15, fill: { color: C.white }, line: { color: d.color } });
sl.addShape(pres.shapes.RECTANGLE, { x: d.x, y: 1.15, w: 4.5, h: 0.52, fill: { color: d.color }, line: { color: d.color } });
sl.addText(d.drug, { x: d.x + 0.1, y: 1.15, w: 4.3, h: 0.52, fontSize: 14, bold: true, color: C.white, valign: "middle", margin: 0 });
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});
});
}
// ─── SLIDE 9: OTHER PHARMACOLOGICAL ──────────────────────────────────────────
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sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
addTitleBar(sl, "Other Pharmacological Agents", "Viloxazine, Bupropion, TCAs & Emerging Therapies");
addFooter(sl);
const others = [
{
drug: "Viloxazine (Qelbree)", mech: "Selective NRI + 5-HT modulator",
notes: "FDA-approved 2021 for children 6–17y\nOnce daily, no CV monitoring burden\nEffective for inattention and emotional dysregulation",
dose: "100–400 mg/day OD",
color: C.purple, x: 0.3, y: 1.18
},
{
drug: "Bupropion (Wellbutrin)", mech: "Weak NRI + DAT inhibitor (NDRI)",
notes: "Off-label for ADHD; particularly useful when comorbid depression\nLower efficacy than stimulants\nAvoid in eating disorders / seizure Hx",
dose: "150–300 mg/day",
color: C.blue, x: 0.3, y: 2.75
},
{
drug: "TCAs (Desipramine, Nortriptyline)", mech: "Potent NRI action",
notes: "Used when stimulants contraindicated; especially ADHD + enuresis\nRisk of QTc prolongation — ECG mandatory\nNot preferred in children",
dose: "25–100 mg/day",
color: C.red, x: 0.3, y: 4.28
},
{
drug: "Modafinil", mech: "Wakefulness promoter, DA/NE modulation",
notes: "Off-label; some evidence in ADHD\nUseful when stimulants not tolerated\nLess evidence than first-line agents",
dose: "100–400 mg OD",
color: C.teal, x: 5.4, y: 1.18
},
{
drug: "Emerging: Mazindol CR", mech: "DAT/NET inhibitor, non-amphetamine",
notes: "Under investigation for adult ADHD\nPhase II/III trials underway\nMay offer efficacy without abuse liability",
dose: "Investigational",
color: C.orange, x: 5.4, y: 2.75
},
{
drug: "Antipsychotics (risperidone, aripiprazole)", mech: "D2/5-HT2A antagonism",
notes: "NOT for ADHD core symptoms\nUsed only for severe aggression, ODD/CD comorbidity\nMonitor metabolic effects",
dose: "Low doses adjunct",
color: C.gray, x: 5.4, y: 4.28
},
];
others.forEach(o => {
sl.addShape(pres.shapes.RECTANGLE, { x: o.x, y: o.y, w: 4.8, h: 1.37, fill: { color: C.white }, line: { color: o.color } });
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sl.addText("Dose: " + o.dose, { x: o.x + 0.2, y: o.y + 1.13, w: 4.5, h: 0.2, fontSize: 8.5, italic: true, color: C.gray, margin: 0 });
});
}
// ─── SLIDE 10: MPH FORMULATIONS TABLE ────────────────────────────────────────
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sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
addTitleBar(sl, "Methylphenidate Formulations at a Glance");
addFooter(sl);
const rows = [
["Formulation", "Release Type", "Duration", "Dose Range", "Notes"],
["Ritalin IR", "Immediate", "2–4 h", "5–20 mg BD/TDS", "Classic; flexible dosing"],
["Ritalin LA", "Bi-modal (50/50)", "8–12 h", "10–60 mg OD", "Sprinkle capsule available"],
["OROS (Concerta)", "Osmotic (22/78%)", "10–12 h", "18–54 mg OD", "Once-daily; compliance"],
["Medikinet CR", "Bi-modal (50/50)", "8 h", "5–60 mg OD", "With food"],
["Jornay PM", "Delayed + ER", "~22 h", "20–100 mg at night", "Morning symptom control"],
["Daytrana Patch", "Transdermal", "Up to 12 h", "10–30 mg/day", "Remove at 9h; dermatitis risk"],
["Dexmethylphenidate (Focalin XR)", "Extended", "12–14 h", "5–40 mg OD", "d-isomer only; potent"],
];
const colW = [2.2, 1.4, 1.0, 1.5, 2.7];
const startX = 0.2;
const startY = 1.2;
const rowH = 0.55;
const colX = [];
let cx = startX;
colW.forEach(w => { colX.push(cx); cx += w + 0.07; });
rows.forEach((row, ri) => {
const isHeader = ri === 0;
const bg = isHeader ? C.navy : (ri % 2 === 0 ? C.white : C.lgray);
const textColor = isHeader ? C.white : C.navy;
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});
});
});
}
// ─── SECTION DIVIDER: NON-PHARMACOLOGICAL ─────────────────────────────────────
sectionSlide("SECTION 2", "Non-Pharmacological Treatment of ADHD", C.teal, "1A5F7A");
// ─── SLIDE 11: NON-PHARM OVERVIEW ────────────────────────────────────────────
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sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
addTitleBar(sl, "Non-Pharmacological Treatment: Overview", "Evidence-based psychosocial interventions — essential adjuncts to medication");
addFooter(sl);
sl.addText("Key Principle: Medications treat core symptoms; non-pharmacological treatments address functional impairment, comorbidities, and skills deficits", {
x: 0.3, y: 1.05, w: 9.4, h: 0.42,
fontSize: 12, italic: true, color: C.teal, margin: 0
});
const categories = [
{ label: "Behavioural\nInterventions", icon: "🧠", color: C.blue },
{ label: "Cognitive\nBehavioural Therapy", icon: "💬", color: C.teal },
{ label: "Parent\nTraining", icon: "👨👩👧", color: C.purple },
{ label: "Educational\nInterventions", icon: "📚", color: C.orange },
{ label: "Dietary &\nLifestyle", icon: "🥗", color: C.green },
{ label: "Neurofeedback &\nDigital Tools", icon: "💻", color: C.navy },
];
categories.forEach((c, i) => {
const col = i % 3;
const row = Math.floor(i / 3);
const x = 0.3 + col * 3.2;
const y = 1.6 + row * 1.7;
sl.addShape(pres.shapes.ROUNDED_RECTANGLE, {
x, y, w: 3.0, h: 1.5, fill: { color: c.color }, rectRadius: 0.1,
shadow: { type: "outer", color: "000000", blur: 6, offset: 2, angle: 135, opacity: 0.15 }
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sl.addText(c.label, { x: x + 0.1, y: y + 0.25, w: 2.8, h: 1.0, fontSize: 14, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
});
}
// ─── SLIDE 12: BEHAVIORAL INTERVENTIONS ──────────────────────────────────────
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sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
addTitleBar(sl, "Behavioural Interventions", "Most Evidence-Based Non-Pharmacological Treatment");
addFooter(sl);
const behItems = [
{
title: "Behaviour Modification / Token Economy",
body: "• Reward charts, point systems, token economies\n• Immediate contingency management — rewards given quickly\n• Most effective in classroom and home settings\n• Reduces disruptive behaviour; improves task completion",
color: C.blue
},
{
title: "Contingency Management",
body: "• Positive reinforcement for desired behaviours\n• Response cost — loss of tokens for rule violations\n• Time-out used judiciously (not punitive)\n• Works best with structured, consistent implementation",
color: C.teal
},
{
title: "Parent-Implemented Behaviour Therapy",
body: "• Daily report card linking school performance to home rewards\n• Structured routines, visual schedules\n• Clear, concise commands; praise immediately after compliance\n• Foundation: Barkley's Defiant Children programme",
color: C.purple
},
{
title: "Summer Treatment Programmes (STP)",
body: "• Intensive 8-week behavioural intervention\n• Combines social skills, sports, academic tutoring\n• Evidence: MTA study (1999) — combined treatment superior\n• Especially beneficial for comorbid ODD/conduct disorder",
color: C.orange
},
];
behItems.forEach((item, i) => {
const col = i % 2;
const row = Math.floor(i / 2);
const x = 0.3 + col * 4.85;
const y = 1.15 + row * 1.95;
sl.addShape(pres.shapes.RECTANGLE, {
x, y, w: 4.6, h: 1.82,
fill: { color: C.white }, line: { color: item.color }
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sl.addText(item.title, { x: x + 0.1, y, w: 4.4, h: 0.4, fontSize: 11, bold: true, color: C.white, valign: "middle", margin: 0 });
sl.addText(item.body, { x: x + 0.1, y: y + 0.45, w: 4.4, h: 1.32, fontSize: 9.5, color: C.navy, margin: 0 });
});
}
// ─── SLIDE 13: CBT ────────────────────────────────────────────────────────────
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const sl = pres.addSlide();
sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
addTitleBar(sl, "Cognitive Behavioural Therapy (CBT)", "Particularly Effective for Adolescents & Adults with ADHD");
addFooter(sl);
const cbts = [
{ title: "Core Components", color: C.teal, items: ["Psychoeducation about ADHD", "Time management & planning skills", "Organisational strategies", "Cognitive restructuring (negative self-talk)", "Problem-solving training", "Emotion regulation techniques"] },
{ title: "Evidence Base", color: C.blue, items: ["RCTs show moderate effect size (0.4–0.6)", "Safren et al. protocol: gold standard for adult ADHD", "Particularly effective for residual symptoms after medication", "CBT + medication > medication alone", "Group CBT: cost-effective, adds peer support", "EMDR emerging for emotional dysregulation"] },
{ title: "Mindfulness-Based CBT", color: C.purple, items: ["Mindfulness-based cognitive therapy (MBCT)", "Improves attention regulation and impulse control", "Reduces emotional reactivity", "Growing evidence base in adult ADHD", "8-week programme (Zylowska et al.)", "Complements pharmacotherapy"] },
];
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sl.addText(c.title, { x: x + 0.1, y: 1.15, w: 2.8, h: 0.48, fontSize: 13, bold: true, color: C.white, valign: "middle", align: "center", margin: 0 });
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sl.addShape(pres.shapes.ELLIPSE, { x: x + 0.18, y: 1.77 + j * 0.57, w: 0.15, h: 0.15, fill: { color: c.color }, line: { color: c.color } });
sl.addText(item, { x: x + 0.4, y: 1.73 + j * 0.57, w: 2.5, h: 0.5, fontSize: 10, color: C.navy, valign: "middle", margin: 0 });
});
});
}
// ─── SLIDE 14: PARENT TRAINING ────────────────────────────────────────────────
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const sl = pres.addSlide();
sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
addTitleBar(sl, "Parent Training & Family Interventions", "Critical for Children — First-Line in Preschool ADHD");
addFooter(sl);
sl.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 1.15, w: 9.4, h: 0.5, fill: { color: C.purple }, line: { color: C.purple } });
sl.addText("Parent Training in Behaviour Management (PTBM) is a FIRST-LINE intervention for preschool children (age 4–5) and recommended before stimulant medication", {
x: 0.4, y: 1.18, w: 9.2, h: 0.44, fontSize: 11, bold: true, color: C.white, valign: "middle", margin: 0
});
const ptData = [
{
title: "What Parents Learn", color: C.blue,
items: ["Positive reinforcement techniques", "Setting clear, consistent expectations", "Planned ignoring of minor misbehaviour", "Effective use of time-out", "Praise and reward schedules", "Managing transitions and routines"]
},
{
title: "Evidence-Based Programmes", color: C.teal,
items: ["Barkley's Defiant Children (gold standard)", "The Incredible Years (Webster-Stratton)", "Triple P – Positive Parenting", "Parent-Child Interaction Therapy (PCIT)", "COPE (Community Parent Ed.)", "CHADD parent training curriculum"]
},
{
title: "Family Therapy Goals", color: C.purple,
items: ["Reduce family conflict and stress", "Improve parent-child relationship", "Parental psychoeducation about ADHD", "Sibling and family education", "Marital support for parents", "Crisis management skills"]
}
];
ptData.forEach((d, i) => {
const x = 0.3 + i * 3.2;
sl.addShape(pres.shapes.RECTANGLE, { x, y: 1.75, w: 3.05, h: 3.4, fill: { color: C.white }, line: { color: d.color } });
sl.addShape(pres.shapes.RECTANGLE, { x, y: 1.75, w: 3.05, h: 0.42, fill: { color: d.color }, line: { color: d.color } });
sl.addText(d.title, { x: x + 0.1, y: 1.75, w: 2.9, h: 0.42, fontSize: 11, bold: true, color: C.white, valign: "middle", align: "center", margin: 0 });
d.items.forEach((item, j) => {
sl.addText("✓ " + item, { x: x + 0.1, y: 2.27 + j * 0.47, w: 2.9, h: 0.42, fontSize: 10, color: C.navy, valign: "middle", margin: 0 });
});
});
}
// ─── SLIDE 15: EDUCATIONAL INTERVENTIONS ─────────────────────────────────────
{
const sl = pres.addSlide();
sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
addTitleBar(sl, "Educational & School-Based Interventions", "Managing ADHD in the Academic Environment");
addFooter(sl);
const eduItems = [
{ cat: "Classroom Accommodations", color: C.orange, items: ["Preferential seating (front, away from distractions)", "Reduced workload / extended time on tests", "Frequent breaks; movement opportunities", "Chunking assignments into smaller tasks", "Visual schedules and checklists on desk"] },
{ cat: "Teacher Strategies", color: C.blue, items: ["Clear, brief, repeated instructions", "Non-verbal cueing (tap on desk, eye contact)", "Immediate and specific positive feedback", "Daily Report Card (DRC) linking to home", "Flexible seating options (fidget tools)"] },
{ cat: "Special Education Support", color: C.teal, items: ["IEP (Individualised Education Programme)", "504 Plan accommodations in US", "Resource room / learning support periods", "Educational psychologist assessment", "Psychoeducational programmes for study skills"] },
{ cat: "Social Skills Training", color: C.purple, items: ["Structured peer interaction groups", "Role-playing social scenarios", "Problem-solving and conflict resolution", "Anger management programmes", "ADHD-specific social skills curriculum"] },
];
eduItems.forEach((e, i) => {
const col = i % 2;
const row = Math.floor(i / 2);
const x = 0.3 + col * 4.85;
const y = 1.15 + row * 1.95;
sl.addShape(pres.shapes.RECTANGLE, { x, y, w: 4.6, h: 1.82, fill: { color: C.white }, line: { color: e.color } });
sl.addShape(pres.shapes.RECTANGLE, { x, y, w: 4.6, h: 0.4, fill: { color: e.color }, line: { color: e.color } });
sl.addText(e.cat, { x: x + 0.1, y, w: 4.4, h: 0.4, fontSize: 11, bold: true, color: C.white, valign: "middle", margin: 0 });
e.items.forEach((item, j) => {
sl.addText("• " + item, { x: x + 0.1, y: y + 0.45 + j * 0.26, w: 4.4, h: 0.26, fontSize: 9.5, color: C.navy, margin: 0 });
});
});
}
// ─── SLIDE 16: DIETARY & LIFESTYLE ───────────────────────────────────────────
{
const sl = pres.addSlide();
sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
addTitleBar(sl, "Dietary, Lifestyle & Complementary Interventions");
addFooter(sl);
const lifeItems = [
{
title: "Exercise & Physical Activity", color: C.green,
body: "• Aerobic exercise ↑ DA and NE in PFC acutely\n• 30 min/day vigorous activity reduces ADHD symptoms\n• Improves executive function, working memory, attention\n• Evidence: effect size ~0.6 (moderate-large)\n• Recommended: swimming, running, team sports"
},
{
title: "Sleep Hygiene", color: C.blue,
body: "• ADHD highly comorbid with sleep disorders (>50%)\n• Consistent sleep/wake schedule; limit screens before bed\n• Melatonin (0.5–3 mg) for sleep onset difficulties\n• Adequate sleep essential — sleep deprivation worsens ADHD\n• Address restless leg syndrome if present"
},
{
title: "Dietary Modifications", color: C.orange,
body: "• Omega-3 supplementation: modest evidence (EPA+DHA)\n• Elimination diet: restricted for food additives/colorings\n• Iron supplementation if ferritin low (<30 ng/mL)\n• Avoid sugar excess — limited evidence but reduces reactivity\n• Zinc, magnesium supplementation under investigation"
},
{
title: "Neurofeedback (EEG Biofeedback)", color: C.purple,
body: "• Trains brain to produce more theta/alpha waves\n• Multiple sessions (30–40+) required\n• Effect size ~0.5 for attention outcomes\n• Not yet recommended as first-line — limited RCT data\n• Growing evidence — potentially blinded-therapist trials"
},
{
title: "Digital & Technology-Based Interventions", color: C.teal,
body: "• FDA-cleared: EndeavorRx (video game for ADHD 8–12y)\n• Cognitive training apps: Cogmed, Working Memory Training\n• Reminder apps, task management tools\n• Digital CBT platforms for adults\n• Wearable devices for focus monitoring"
},
{
title: "Mindfulness & Yoga", color: C.navy,
body: "• Mindfulness meditation improves attention regulation\n• Yoga reduces hyperactivity and improves impulse control\n• Growing RCT evidence in children and adolescents\n• Non-stigmatising and accessible\n• Often combined with CBT for maximum benefit"
}
];
lifeItems.forEach((item, i) => {
const col = i % 3;
const row = Math.floor(i / 3);
const x = 0.25 + col * 3.25;
const y = 1.15 + row * 2.0;
sl.addShape(pres.shapes.RECTANGLE, { x, y, w: 3.1, h: 1.85, fill: { color: C.white }, line: { color: item.color } });
sl.addShape(pres.shapes.RECTANGLE, { x, y, w: 3.1, h: 0.38, fill: { color: item.color }, line: { color: item.color } });
sl.addText(item.title, { x: x + 0.1, y, w: 2.9, h: 0.38, fontSize: 10.5, bold: true, color: C.white, valign: "middle", margin: 0 });
sl.addText(item.body, { x: x + 0.08, y: y + 0.42, w: 2.94, h: 1.4, fontSize: 9, color: C.navy, margin: 0 });
});
}
// ─── SLIDE 17: MTA STUDY & EVIDENCE ──────────────────────────────────────────
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const sl = pres.addSlide();
sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
addTitleBar(sl, "MTA Study: Landmark Evidence", "Multimodal Treatment of ADHD (MTA) — N=579, Age 7–9.9 years");
addFooter(sl);
// MTA 4 arms
const mtaArms = [
{ arm: "Medication Management Only", result: "Large improvement in core symptoms\n(Best for ADHD symptoms alone)", color: C.blue },
{ arm: "Intensive Behavioural Treatment Only", result: "Moderate improvement\n(Better for anxiety, academic & social skills)", color: C.teal },
{ arm: "Combined Treatment\n(Medication + Behaviour)", result: "Greatest overall improvement\nBest for comorbidities & functional outcomes", color: C.green },
{ arm: "Routine Community Care", result: "Least improvement\n(58% on medication — lower dose)", color: C.orange },
];
mtaArms.forEach((arm, i) => {
const x = 0.3 + (i % 2) * 4.85;
const y = 1.15 + Math.floor(i / 2) * 1.55;
sl.addShape(pres.shapes.RECTANGLE, { x, y, w: 4.6, h: 1.42, fill: { color: C.white }, line: { color: arm.color } });
sl.addShape(pres.shapes.RECTANGLE, { x, y, w: 0.18, h: 1.42, fill: { color: arm.color }, line: { color: arm.color } });
sl.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: x + 0.25, y: y + 0.08, w: 0.45, h: 0.45, fill: { color: arm.color }, rectRadius: 0.05 });
sl.addText(`${i+1}`, { x: x + 0.25, y: y + 0.08, w: 0.45, h: 0.45, fontSize: 18, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
sl.addText(arm.arm, { x: x + 0.8, y: y + 0.06, w: 3.7, h: 0.52, fontSize: 11, bold: true, color: arm.color, margin: 0 });
sl.addText(arm.result, { x: x + 0.8, y: y + 0.6, w: 3.7, h: 0.75, fontSize: 10, color: C.navy, margin: 0 });
});
sl.addShape(pres.shapes.RECTANGLE, { x: 0.3, y: 4.38, w: 9.4, h: 0.7, fill: { color: C.navy }, line: { color: C.navy } });
sl.addText("Conclusion: Combined Treatment (medication + behavioural) is SUPERIOR for children with ADHD + comorbidities, and equivalent for those without comorbidities when only ADHD symptoms are measured. Medication alone had largest effect on core ADHD symptoms at 14 months.", {
x: 0.5, y: 4.38, w: 9.0, h: 0.7, fontSize: 10, color: C.white, valign: "middle", margin: 0
});
}
// ─── SECTION DIVIDER: TREATMENT ALGORITHM ─────────────────────────────────────
sectionSlide("SECTION 3", "Treatment Algorithm & Special Situations", C.purple, "6A1A7A");
// ─── SLIDE 18: TREATMENT ALGORITHM ────────────────────────────────────────────
{
const sl = pres.addSlide();
sl.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.cream }, line: { color: C.cream } });
addTitleBar(sl, "Treatment Algorithm — ADHD Management");
addFooter(sl);
const steps = [
{ step: "STEP 1", title: "Assessment & Diagnosis", body: "DSM-5 criteria, rating scales (ADHD-RS, Conners), multi-informant assessment, rule out comorbidities, CGAS baseline", color: C.blue },
{ step: "STEP 2", title: "Psychoeducation", body: "Educate patient, family, school about ADHD; discuss treatment options; set realistic goals; address stigma", color: C.teal },
{ step: "STEP 3", title: "Non-Pharm Interventions (Start Always)", body: "Parent training, school accommodations, behavioural strategies, lifestyle modifications — implemented alongside or before medication", color: C.green },
{ step: "STEP 4", title: "First-Line Pharmacotherapy", body: "Stimulants (MPH or AMP): start low, titrate q1–2 weeks. ≥4 weeks trial at optimal dose before declaring failure. Consider lisdexamfetamine for abuse risk", color: C.orange },
{ step: "STEP 5", title: "If Stimulant Fails / Not Tolerated", body: "Switch stimulant class → atomoxetine → viloxazine → alpha-2 agonists → consider combination strategies", color: C.purple },
{ step: "STEP 6", title: "Address Comorbidities", body: "Treat anxiety (SSRI + CBT), depression (SSRI), tics (alpha-agonist), ODD/CD (behavioural therapy + parent training), SUD (specialist referral)", color: C.red },
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// ─── SLIDE 19: SPECIAL SITUATIONS ─────────────────────────────────────────────
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{ title: "ADHD + Tics / Tourette's", body: "Alpha-agonists (guanfacine, clonidine) preferred\nAtomoxetine also effective\nStimulants not absolutely CI — reassess individually\nHabit Reversal Therapy (HRT) for tics", color: C.blue },
{ title: "ADHD + Anxiety", body: "Atomoxetine preferred over stimulants\nCBT for anxiety essential\nSSRI can be added if anxiety persists\nAvoid high-dose stimulants worsening anxiety", color: C.teal },
{ title: "ADHD + Depression", body: "Treat depression first if severe (SSRI)\nBupropion: dual benefit (ADHD + depression)\nCBT addresses both\nMonitor for mood effects of stimulants", color: C.purple },
{ title: "ADHD + Substance Use Disorder", body: "Atomoxetine / viloxazine preferred (non-controlled)\nLisdexamfetamine if stimulant needed (lower abuse)\nBehavioural therapy for SUD essential\nAvoid immediate-release stimulants", color: C.red },
{ title: "ADHD in Preschoolers (Age 4–5)", body: "Behaviour therapy FIRST-LINE (PTBM)\nMedication only if severe / insufficient response to PTBM\nMPH at lower doses if medication needed\nParent training is primary intervention", color: C.orange },
{ title: "Adult ADHD", body: "Stimulants remain first-line (MPH, AMP, lisdexamfetamine)\nCBT essential for time management, organisation\nAtomoxetine option if SUD concern\nComorbidity screening mandatory", color: C.navy },
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// ─── SLIDE 20: MONITORING ─────────────────────────────────────────────────────
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{ param: "Height & Weight", freq: "Every 6 months", why: "Stimulants → appetite suppression, growth effects", action: "Drug holiday in summer if significant growth suppression" },
{ param: "Blood Pressure & HR", freq: "Every visit", why: "Stimulants and atomoxetine → CV effects", action: "Dose reduction / switch if persistent hypertension" },
{ param: "ADHD Symptoms", freq: "Every visit (rating scales)", why: "Assess efficacy of treatment", action: "Adjust dose / switch agent if inadequate response" },
{ param: "Sleep", freq: "Each visit", why: "Stimulants → insomnia; ADHD + sleep disorders common", action: "Timing adjustment, sleep hygiene, melatonin if needed" },
{ param: "Mood & Suicidality", freq: "Each visit", why: "Atomoxetine: black box warning for suicidal ideation", action: "Particularly in first weeks of ATX therapy; close monitoring" },
{ param: "Tics", freq: "Each visit", why: "Stimulants may worsen tics in some patients", action: "Switch to ATX or alpha-agonist if tics worsen" },
{ param: "Academic & Social Function", freq: "3–6 monthly", why: "Primary treatment goal: functional improvement", action: "CGAS, Vanderbilt teacher/parent rating scales" },
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// ─── SLIDE 21: KEY TAKEAWAYS ──────────────────────────────────────────────────
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{ num: "01", text: "ADHD is a neurodevelopmental disorder with strong genetic basis (75%); delayed PFC maturation causes core symptoms of inattention, hyperactivity, and impulsivity" },
{ num: "02", text: "Stimulants (methylphenidate, amphetamines) are FIRST-LINE with large effect sizes (0.8–1.0); 70–80% response rate" },
{ num: "03", text: "Atomoxetine is first-line NON-STIMULANT (NRI); preferred with anxiety, tics, or SUD history; 4–6 week onset" },
{ num: "04", text: "Behavioural therapy and parent training are FIRST-LINE for preschoolers and essential adjuncts at all ages" },
{ num: "05", text: "COMBINED treatment (medication + behavioural) is SUPERIOR for children with comorbidities (MTA Study)" },
{ num: "06", text: "Monitor: height/weight, BP/HR, sleep, mood, and symptoms at every visit; address comorbidities early" },
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// ─── SLIDE 22: REFERENCES & THANK YOU ─────────────────────────────────────────
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const refs = [
"1. Stahl SM. Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, 5th Ed. Cambridge University Press, 2021. (Chapter 11: ADHD)",
"2. Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 10th Ed. Wolters Kluwer, 2017. (Chapter 44.1: ADHD)",
"3. Taylor D, et al. The Maudsley Prescribing Guidelines in Psychiatry, 15th Ed. Wiley-Blackwell, 2023.",
"4. Lippincott Illustrated Reviews: Pharmacology, 8th Ed. Wolters Kluwer, 2023. (Chapter 22: CNS Stimulants)",
"5. MTA Cooperative Group. Arch Gen Psychiatry. 1999;56(12):1073–86. (Multimodal Treatment of ADHD)",
"6. American Academy of Pediatrics. ADHD Clinical Practice Guidelines. Pediatrics. 2019;144(4):e20192528.",
"7. NICE Guideline NG87. Attention deficit hyperactivity disorder: diagnosis and management. Updated 2019.",
"8. Safren SA, et al. Cognitive-Behavioral Therapy for ADHD in Adults. Guilford Press, 2017.",
"9. Biederman J, Faraone SV. Lancet 2005;366:237–248. (ADHD: Review)",
"10. Faraone SV et al. Nat Rev Dis Primers 2021;7:6. (ADHD: Primer)",
];
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// ─── WRITE FILE ───────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/adhd-ppt/ADHD_Treatment_Presentation.pptx" })
.then(() => console.log("✅ PPTX created successfully!"))
.catch(err => console.error("❌ Error:", err));
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