104: ADHD

Question 1

What are the DSM5 Criteria for ADHD?

What are the subtypes of ADHD?

Answer 1

= Persistent Pattern of inattention or hyperactivity-impulsivity interfering with function/development
= Persisted for >6mo
= At least 6 sx in either/both categories before age 12 and in at least 2 categories, interfering with functioning, not better explained by another disorder

A. Inattentive Sx
- Careless mistakes, attention difficulty, poor listening, poor organization, dislikes tasks with mental effort, easily distracted, forgetful
B. Hyperactive-Impulsive Sx
- Fidgety/Squirmy, leaves seat, restlessness, difficulty playing quietly, excessive talking, difficulty waiting turn, interrupts often

Subtypes

• Predominantly Inattentive
• Predominantly Hyperactive-Impulsive
• Combined Presentation

Question 2

Describe the epidemiology, clinical course, and top 3 comorbidities of ADHD?

Answer 2

E: M>F 2.4:1, 3-11% school-aged children
CC: Persists into adulthood, 60% adults report some sx after 18yo
CoM: 2/3 ADHD kids have at least one other disorder:
1. Oppositional & Defiant Disorder (ODD) - behavior problem
2. Anxiety (SoAD, SeAD, GAD)
3. Depression

Question 3

Describe the etiology/RF and neurobiology of ADHD

Answer 3

Genetic: multiple genes and environment interaction
RF: pregnancy (smoking, alcohol, drug use), lead exposure, brain injury at young age, premature delivery/low birth weight

Neurobio: Differences in Prefrontal cortex (executive fx, planning) and Striatum (motivation)
Smaller brain volumes consistent throughout regions of brain and development

Question 4

What are the pharmacological tx of ADHD? (2 groups, 2 subgroups/meds)

• Mech
• SE
• Contraindications

Answer 4

1. Stimulants (Methylphenidate and Amphetamines)
   - stimulate underactive/underdeveloped areas of brain, increase available NE/DA (block reuptake)
   - SE: weight loss (less appetite), insomnia, HA, nausea, irritability, emotional blunting, hallucinations, abuse potential
   - CI: can cause CV events (rare) - +FamHx of arrhythmias
2. Non-Stimulants
   Atomoxetine
   - SNRI (antidepressant for ADHD and Anxiety)
   - SE: hypotension (dizzy, fainting), sedation, drowsiness, depression

Alpha2 Agonists (Clonidine, Guanfacine)

• use: adjunctive tx
• SE: Sedation, fatigue, nausea, GI upset, irritability, increased suicide ideation

Question 5

What are the non-pharm tx of ADHD?

Answer 5

1. Behavioral Modification/Parent Training (how to give commands, praise appropriate behavior)
2. Academic Accommodations: 504 Plan/IEP - school testing accommodations