10% Disruptive, Impulse-Control and Conduct Disorders; Neurodevelopmental Disorders

Question 1

(PPP 586)

diagnostic criteria for ADHD related to age

Answer 1

symptom onset before 12 yrs of age

must be present for at least 6 months

Question 2

(PPP 586)

ADHD s/s must occur in at least _____

Answer 2

….2 SETTINGS

i.e. school, home, recreational activities

Question 3

(PPP 586)

multimodal approach to ADHD management:

Answer 3

behavior modification (social skills training, classroom modifications, parent psychoeducation)
stimulants (first line tx of choice)

Question 4

(PPP 586)

first line pharm treatment of ADHD (list three)

Answer 4

methylphenidate
amphetamine/dextroamphetamine
dexmethylphenidate

Question 5

(PPP 586)

nonstimulant tx of ADHD and it’s MOA and SE

Answer 5

ATOMOXETINE

norepinephrine reuptake inhibitor

SE: dry mouth, decreased appetite, insomnia

Question 6

(PPP 586)

adjunctive meds for ADHD

Answer 6

alpha agonists = guanfacine, clonidine
bupropion
venlafaxine

Question 7

(PPP 587)

four diagnostic criteria for autism spectrum disorder

Answer 7

social interaction difficulties

impaired communication

restricted repetitive stereotyped behavior

other signs (failure to develop social relationships, failure to prefer parents over other adults, savantism)

Question 8

(PPP 587)

management for autism spectrum disorder (3 items)

Answer 8

referral for neuropsych testing
behavioral modification strategies
meds

Question 9

(PPP 587)

when are symptoms for autism spectrum disorder usually recognized?

Answer 9

b/w ages 12-24 months

Question 10

(PPP 579)

conduct disorder =

Answer 10

persistent pattern of behaviors that
DEVIATE SHARPLY FROM AGE-APPROPRIATE NORMS and
VIOLATES THE RIGHTS OF OTHERS AND ANIMALS

Question 11

(PPP 579)

conduct disorders are more common in -

Answer 11

males

high incidence of ADHD and oppositional defiance disorder

Question 12

(PPP 579)

conduct disorders may progress to

Answer 12

antisocial personality disorder

Question 13

(PPP 579)

six diagnostic criteria for conduct disorders

Answer 13

1 - violation of the rights of others or age-appropriate societal norms
- at least 3 behaviors over last yr, at least 1 incident w/in last 6 months
2 - aggression to humans or animals
3 - destruction of property
4 - serious violations of rules (runs away from home, engages in truancy before 13 yrs)
5 - deceitfulness or theft
6 - <18 yrs

Question 14

(PPP 579)

management of conduct disorders

Answer 14

behavioral modification
community/family involvement
parent management training (enforcing rules and setting limits)

Question 15

(PPP 580)

oppositional defiant disorder =

Answer 15

disorder in which children are generally defiant towards authority but is NOT associated with physical aggression, violating others’ basic rights or breaking laws (unlike conduct disorder)

Question 16

(PPP 580)

timeline for diagnostic criteria for oppositional defiant disorder

Answer 16

at least 4 symptoms present

at least 6 months (with at least one individual that is not a sibling)

Question 17

(PPP 580)

three diagnostic criteria for oppositional defiant disorder

Answer 17

angry or irritable mood (loses temper, anger or resentment, blames others for misbehaviors)

argumentative or defiant behavior (breaks rules, often blames others for behavior, argues with authority, deliberately annoys others)

vindictiveness (spiteful at least 2 times/past 6 mo)

Question 18

(RoshReview)
which of the following side effects is most likely with the primary alternative nonstimulant medication if a pt or family prefers this course of pharm intervention?

a) growth suppression
b) insomnia
c) motor tic development
d) nausea

Answer 18

D) NAUSEA

ATOMOXETINE SE's:
n/v
wt loss
priapism
psychosis with aggressive behavior
sleep problems
hepatotoxicity
xerostomia
insomnia
drowsiness

Question 19

(RoshReview)

what ADHD therapeutic works by blocking the reuptake of norepinephrine and dopamine into presynaptic neurons?

Answer 19

methylphenidate

Question 20

(RoshReview)

MOA of methylphenidate

Answer 20

reuptake of norepinephrine and dopamine into presynaptic neurons

Question 21

(RoshReview)

“what ADHD meds have been associated with priapism?”

Answer 21

methylphenidate and

atomoxetine

Question 22

(RoshReview)

T/F: “methylphenidate is more likely to cause priapism than amphetamine stimulants”

Answer 22

TRUE

Question 23

(RoshReview)

what are side effects of ADHD stimulant treatments?

Answer 23

DECREASED APPETITE
INSOMNIA
ELEVATIONS IN HR, BP
DECREASE IN HEIGHT VELOCITY
HA
irritability
mood lability

Question 24

(RoshReview)

what is the timeline for monitoring ADHD pts who are placed on stimulant medication? and why?

Answer 24

regularly
1 month after starting meds
every 3 months once stable on dosage

evaluate HEIGHT, WEIGHT, v/s, mood, adherence to tx

Question 25

(RoshReview)

when do we recommend ADHD stimulant medication drug holidays for children?

Answer 25

if child is found to have poor growth, crossing two major percentiles while on stimulant

Question 26

(RoshReview)

what are alternative treatments to stimulants for ADHD?

Answer 26

atomoxetine and

alpha-2 adrenergic agonists (guanfacine and clonidine)