ADHD Flashcards
what is ADHD?
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
Risk factors and aetiology of ADHD?
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
Sx and Sx of ADHD (not the criterias -what leads to thinking of ADHD)
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
Criterias of ADHD
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
Ix and complications, prognosis of ADHD
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
Management of ADHD
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