81B ADHD

Question 1

ADHD diagnostic criteria

Answer 1

1) 6 or more symptoms of (adults need 5)
 A) inattention   
 and/or
 B) hyperactivity-impulsivitity 
2) >= 6 months; present before age 7
3) symptoms inconsistent with developmental level
4) impairment in 2 or more settings (?)
5) clinical significant impairment in at least one domain of functioning 
 A) social
 B) academic
 C) occupational

Question 2

ADHD Inattention symptoms

Answer 2

careless mistakes
difficulty paying attention
doesn't follow through
not organized
loses shit
forgetful

Question 3

ADHD hyperactice symptoms

Answer 3

Fidgety
doesn't stay seated
runs/climbs at odd time
noisy
talks too much

Question 4

ADHD Impulsive symptoms

Answer 4

Blurts out answers
difficulty awaiting turn
interrupts

Question 5

Core features of ADHD

Answer 5

• poor self-regulation and impulsive
• seeks immediate reinforcement with no tolerance of delay
• poor motivation when bored

Question 6

Who gets ADHD

Answer 6

Boys, mostly inattentive type

Question 7

brain structure/function in ADHD

Answer 7

smaller executive functioning areas and dopaminergic underactivity, but imagining not diagnostic

Question 8

ADHD Course

Answer 8

• majority have symptoms into adolescence and half into adulthood; poor school performance, self esteem, etc.
• W/ Oppositional defiant disorder/Conduct disorder –> hoodlum

Question 9

ADHD Assessment

Answer 9

Parent/spouse interview
Patient interview
School assessments
Teacher
physical w/in year + medical hx and ROS

Question 10

Additional ADHD testing

Answer 10

**Only if indicated
Thyroid, lead, EEG (seizures), vision, hearing, sleep
IQ if grades suck
Speech/language if delayed

Question 11

ADHD Treatment - NIMH MTA study results

Answer 11

systematic medication with or without behavioral treat is best for…
1) core ADHD symptoms
2) aggression
3) oppositional-defiant behaviors
4) social functioning
use behavioral therapy/skills remediation for other specific areas

Question 12

ADHD stimulant treatment evidence

Answer 12

safe and efficient
96% of kids improve
non-responders to one improve on the other

Question 13

ADHD stimulant types

Answer 13

Methylphenidate (dl- and d-)
Amphetamine
 1) dextroamphetamine
 2) mixed amphetamine salts
 3) lisdexamfetamine

Question 14

ADHD stimulant action

Answer 14

stimulate under active parts of brain
increase focus, motivation, productivity
increase dopamine and NE in prefrontal cortex
decrease motor activity, less disruption

Question 15

ADHD stimulant side effects

Answer 15

Irritability
Headaches
Abdominal pain
reduced appetite

Question 16

ADHD stimulant abuse

Answer 16

only at high doses via snorting/injection

no tolerance

Question 17

Nonstimulants for ADHD

Answer 17

Atomoxetine - 2nd line; increases dopamine and NE in prefrontal cortex
A-adreneric agonists - 2nd line
1) guanfacine
2) clonidine