[14] Hyperkinetic Disorder Flashcards
What is hyperkinetic disorder commonly referred to as?
ADHD (attention deficit hyperactivity disorder)
What is hyperkinetic disorder characterised by?
An early onset, persistent pattern of inattention, hyperactivity and impulsivity that are more frequent and severe than in individuals at a comparable stage of development, and present in more than one situation
Who presents with hyperkinetic disorder?
- Children who are having difficulties at school or home
- Adults are now presenting, wondering if they have unidentified ADHD
What can the aetiology of ADHD be divided into?
- Genetic
- Neurochemical
- Neurodevelopmental
- Social
What indicates that there is a genetic link in ADHD?
Twin and adoption studies, with a concordance rate of 82% for monozygotic twins
What genes are thought to play a role in the aetiology of ADHD?
DRD4 and DRD5 genes
What is the neurochemical aetiology of ADHD?
There are reports of a link between hyperkinetic disorder and the genes coding for the dopamine system, suggesting an abnormality in the dopaminergic pathways
What is the neurodevelopmental aetiology of ADHD?
Neurodevelopmental abnormalities of the pre-frontal cortex are hypothesised
Why is the pre-frontal cortex hypothesised to be involved in ADHD development?
Because of the symptoms of recklessness, inattention, and learning difficulties
What social factors are associated with the development of ADHD?
There is an association with social deprivation and family conflict, as well as parental cannabis and alcohol exposure
What is the prevalence of ADHD in the UK?
Around 2.4% of children
What is the age of onset of ADHD?
Commonly between 3 and 7 years
What are the risk factors for ADHD? qMal
- Male gender
- Family history
- Social deprivation
- Family conflict
- Parental cannabis and alcohol exposure
What are the three core features of hyperkinetic disorder?
- Inattention
- Hyperactivity
- Impulsitivity
What are the features of inattention in hyperkinetic disorder?
- Not listening when spoken too
- Highly distractable, moving from one activity to the next
- Reluctant to engage in activities that require persistent mental effort, e.g. school work which contains careless mistakes
- Forgetting or regularly losing belongings
What are the features of hyperactivity in hyperkinetic disorder?
- Restlessness and figeting or tapping with hands or feet
- Recklessness
- Running and jumping about in inappropriate places
- Difficulty in engaging in quiet activities
- Excessive talking or noisiness
What are the features of impulsivity in hyperkinetic disorder?
- Difficulty waiting their turn
- Interrupting others
- Prematurely blurting out answers
- Temper tantrums and aggression
- Disobedient
- Running into street without looking
What are the ICD-10 criteria for the diagnosis of hyperkinetic disorder?
- Demonstrable abnormality of attention, activity and impulsivity at home, for the age and developmental level of the child.
- Demonstrable abnormality of attention and activity at school or nursery (if applicable), for the age and developmental level of the child.
- Directly observed abnormality of attention or activity. This must be excessive for the child’s age and developmental level.
- Does not meet criteria for a pervasive developmental disorder, mania, depressive or anxiety disorder.
- Onset before the age of 7 years.
- Duration of at least 6 months.
- IQ above 50.
What investigation is done into hyperkinetic disorder?
- History
- MSE
- Blood tests, including TFT
- Hearing tests
- Rating scales
Why is a collateral history from teachers important in hyperkinetic disorders?
As problem behaviours may vary in different settings
What is often used as an information source when adults are seeking a diagnosis of ADHD?
- School reports
- Collateral history from parents
How is hearing tested in ADHD?
- Examination of middle/inner ear with otoscope
- Consider pure tone audiogram
What rating scales may be used in hyperkinetic disorder?
- Conner’s rating scale
- Strengths and Difficulties questionnaire
What are the differential diagnoses of hyperkinetic disorder?
- Learning disability/dyslexia
- Oppositional defiant disorder
- Conduct disorder
- Autism
- Sleep disorders
- Mood disorder, particularly bipolar
- Anxiety disorder
- Hearing impairment
What % of hyperkinetic disorder patients have co-morbidities?
70%
What co-morbidities might a person with hyperkinetic disorder have?
- Learning difficulties, e.g. ASD, dyslexia
- Dyspraxia
- Tourette’s syndrome
- Mood/anxiety disorders
What % of hyperkinetic children have co-existing conduct disorder?
50%
What is conduct disorder?
A repetitive and severe pattern of antisocial behaviour including aggression, destruction of property, deceitfulness/stealing, and major violations of age-appropriate social expectations.
What are the risk factors for hyperkinetic disorders?
- Male gender
- Childhood abuse
- Poor socioeconomic status
- Parental psychiatric disorders
What is oppositional defiant disorder characterised by?
Defiant and disruptive behaviour against authoriative figures
How does oppositional defiant disorder compare to conduct disorder?
Oppositional defiant disorder is less severe than conduct disorder in that violations of law and physical abuse of others are far less common
Who can make a diagnosis of hyperkinetic disorder?
Specialists
What does treatment for hyperkinetic disorder depend on?
Whether the patient is pre-school, school-age, or adult, as well as the severity of symptoms
Give two examples of support groups available for parents and teachers affected by ADHD
- add+up
- ADDISS
What should be done if there is a clear link between food or drink consumed and behaviour?
Parents should be advised to keep a food diary, and a referral to a dietician can be made if appropriate
What is the first line treatment of ADHD in pre-school children?
Parent-training and education programmes (psychoeducation)
What is meant by parent-training in ADHD?
A type of behavioural therapy, with parents being helped to reinforce positive behaviour and to find alternative ways of managing disruptive behaviour
Are drug treatments recommended in ADHD in pre-school children?
No
What are the options in the management of ADHD in school-age childrens?
- Psychoeducation and CBT (and/or social skills training)
- Drug treatment
Where is drug treatment first-line in ADHD?
In severe ADHD in school-age children
What drug is most commonly used in ADHD?
Methylphenidate (Ritalin)
What kind of drug is Ritalin?
CNS stimulant
What drugs can be used in ADHD if Ritalin is ineffective?
Atomoxetine, or if this fails, dexamfetamine
What are the side effects of CNS stimulants such as Ritalin?
- Headache
- Insomnia
- Loss of appetite
- Weight loss
Is there a link between extended stimulant use and growth retardation?
No
