6. ADHD

Question 1

ADHD DSM5 criteria

Answer 1

6+ symptoms inattention and/or hyperactivity/impulsivity for at least 6 MO
present prior to 12YO
several symptoms present in 2+ settings
clear evidence of symptoms interfering with social, academic, occupational functioning
sx not better explained by another MI
Specify combined, predominanty inattentive or predominantly hyperative impulsive (F90.2, F90.0, F90.1 respectively)

Question 2

ADHD in adults

Answer 2

31-66% of adults continue to have sx
inattention sx more apparent
underemployed
ongoing problem with self-regulation, prone to marital discord, more speeding difficulties likely

Question 3

etiology

Answer 3

genetic predisposition, 50% likelihood from parent
prenatal risks: prenatal complications, prematurity, low birth weight, prenatal exposure to tobacco, prenatal exposure to alcohol
neurobiology: deficiency in dopamine and norepinephrine, developmental delays of cortical thickness in middle prefrontal cortex

Question 4

executive function affected in ADHD

Answer 4

working memory
internalisation of speech
affect/arousal regulation
analysis and synthesis

Question 5

ADHD neuroanatomy

Answer 5

prefrontal cortex:
orbital- behavioural inhibition
dorsolateral- verbal and nonverbal working memory, analysis and synthesis
ventromedial- self regulation of affect, arousal, motivation

motor cortex

Question 6

assessment aims

Answer 6

identify presenting problem
confirm ADHD symptoms
risk and resilience factors
differential diagnosis
presence of comorbid conditions
severity of presenting problems

Question 7

multimodal interventions

Answer 7

psychoed
medication
parent training
classroom behaviour management
social skills training
self control/emotion regulation
CBT for adult

Question 8

stimulant medication

Answer 8

methylphenidates, dexamphetamines
75% of children show improvements in symptoms
no improvement in social skills or conduct problems

Question 9

methylphenidates

Answer 9

ritalin
ritalin LA
concerta
biphentin

Question 10

dexamphetamine

Answer 10

dexedrine
vivanse
adderall

Question 11

overtime parents of ADHD children become

Answer 11

less responsive
more negative
more directive (commands)
more stressed

Question 12

Addressing parent-child relationship

Answer 12

one on one time
praise
active ignoring
giving effective commands
rewards
time out
making a plan

Question 13

one on one time

Answer 13

goals: improve attention, build a positive history
emphasise narration
scheduled at regular times each day
almost any activity- not watching tv or playing video games, chosen by child not suggested by parent
if not a scheduled time, parent can approach child while playing alone and ask to join in
part of household for indefinite period

Question 14

praise

Answer 14

increase desired behaviour
follow through
praise things done without asking
praise independent play

Question 15

active ignoring

Answer 15

reduce behaviour by ignoring it
successful ignoring strategies
extinction bursts

Question 16

giving effective commands

Answer 16

use sparingly
be willing to enforce
attend to what you say and how you say it
children who don’t follow instructions often get more instructions than the average child
so use sparingly

Question 17

rewards

Answer 17

using incentives to increase desired behaviour
choosing rewards
timing of rewards
keys to success
should be earned at a rate of about 80%- too many or often and child will not work as hard to improve

Question 18

time out

Answer 18

mild discipline interrupting pleasant activity
when to use, how to use, benefits explained
child quickly removed from situation and placed in quiet boring spot
decrease target behaviour
stops moderate misbehaviour (rude, aggressive, destructive), not good for mild behaviours like sulking or whining
works best in context of frequent use of attention praise and rewards
only teacher what not to do not what to do
some behaviours (aggressive, violation of house rules) warrant timeout without warning
use sparingly
place for timeout: calm and quiet, free from distraction, centrally located, out of the way of others
praise compliance on completion
ignore annoyance after timeout as long as misbehaviour not continuing

Question 19

making a plan

Answer 19

identify routine challenges
discuss being caught off guard
make a plan for outings
manage concerns in public

Question 20

less effective instruction

Answer 20

‘let’s’ at the satart
vague
questions rather than telling
multiple instructions strung together

Question 21

types of problem solving

Answer 21

proactive vs collaborative

Question 22

CB model of adult ADHD

Answer 22

history of: failure, underachievement and relationship problems
core neuropsychiatric impairment in: attention, inhibition, self regulation/ impulsivity
failure to utilise compensatory strategies: organising, planning, managing procrastination/avoidnace distractibility
functional impairment
negative thoughts and beliefs
mood disturbances

Question 23

Adult ADHD therapy

Answer 23

psychoeducation- ADHD, organisation/planning
reducing distractability
adaptive thinking- CBT model to target task avoidance (most often)
additional skills (e.g. procrastination)