ADHD

Question 1

what is ADHD?

Answer 1

ADHD is an issue of innatention, hyperactivity and impulsivity
also called hyperkinetic disorder
Chornic conditions that develops during childhood but persists in adulthood -can be severly limiting for their
also likely to have other psych disorders like ODD

Question 2

Risk factors and aetiology of ADHD?

Answer 2

Very common- 5% of children -but up to 11% in some studies
Most people have combined -75%. 20% have innatentive only. 15% hyperactive impulsive only
Pathopysh unclear yet - mix of genetics and environement

4 types - Innatentive, Hyperactvie-impulsive, combined (factors of both), unspecified
Innatentve and HI have checklists of criteria, if meet both -> combined
If meet neither but still an issue -> unspecified

RF-
M>F
FHx
Epilepsy
LBW
Smoking, alcohol and stress when pregnant

Question 3

Sx and Sx of ADHD (not the criterias -what leads to thinking of ADHD)

Answer 3

Often comes from intuition -
school absences, academic failure, disruptive behaviours, inattention, and poor peer interactions
Parents reporting hyperactive child, diffculties sleeping, consider when parents report “psych” issues

Learning disabilities -like Dyslexia, etc

Important to do full Hx -maternal/preg hx, previous psych Hx, PMH, social Hx
and try and vary Hx sources -mum and dad, school, etc

MSE -over signs of hyperactivity (restless motor signs etc)
or inattention in conversation, memory issues

Careful -can often be very calm in 1-on-1 situation with dr so not take it diagnostically

Question 4

Criterias of ADHD

Answer 4

USE DSM-5 ADHD criteria OR ICP 10

DSM -
A) these presented before 12
b) present in more than 2 settings
c) evidence of not functioning well
d) not explain by psych issues

e)
6 or more of either or both
innatentive:
makes careless mistakes, difficulties sustaining attention, seems to not lsiten when spoken too, doesnt follow through on instruction and doesnt finish homework etc, difficulties organising, reluctance in doing things that need sustained attention (homework), loses things needed for tasks, easily distracted by stimuli, forgetful

Hyperactive-Impulsive:
hyper :
figets and squirms in seat, leaves seat/class when innapropirate, run/jumps around innapropriate, difficulties doing activities quietly, on the go/acts fast, talks excessively
Impulsive:
blurts out answers before q is finished, difficulties waiting turn, intterupes/intrudes others

ICD 10 criteria nearly identical

ADHD rating scale -out of 18 using DSM criterias
The Vanderbilt Scale-also

Question 5

Ix and complications, prognosis of ADHD

Answer 5

Ix -none -ensure no psych or heart conditions

MEDICATION –anorexia, insomnia, anxiety, depression, tics, heart issue, psych issues, substance abuse, headaches,

overtime sx tend to remit in adulthood

but still higher risk of difficulties at work/school, conduct disorders, maladaptive relationships, teen pregnancies, injuries etc

Question 6

Management of ADHD

Answer 6

Big work on psychosocial education and approach -often need to set up a personal education plan with parents -
talk with shcools
Parents training in behavioral management

ensure parents have ressourced to ADHD support groups

can involve paediatricians

behavioral therapy -can help as adjunct

if none of this is working and sx are severe enough, discuss with MH specialist/paediatrician
if very young –give methylphenidate - the one with most evidence supporting it works or. guafandine

older child -
1st line-pethypheniadte or amfetamine
2nd line -the one not used in first
3rd -amoxetine
4th guadanfine/clonidine
5th -TCA antidepressant