ADHD

Question 1

What is the triad of difficulties in ADHD?

Answer 1

inattention
hyperactivity
impulsivity

Question 2

What does the triad of difficulties in ADHD usually co-occur with?

Answer 2

other impairing symptoms relating to self-regulation e.g. executive functioning, emotional regulation

Question 3

How does adult ADHD differ from typical ADHD in children/.

Answer 3

less obvious symptoms of hyperactivity or impulsivity and more inattentive symptoms

Question 4

What is the prevalence estimate of ADHD worldwide and is it thought to be over/under diagnosed?

Answer 4

approx. 5% and remains underdiagnosed and undertreated

Question 5

Why do they think adults who present when older no longer meet diagnostic criteria for adhd?

Answer 5

Possibly because there is improvement in cortical thickness that allows the brain to compensate for cognitive deficits

Question 6

What factors increase risk of ADHD?

Answer 6

Genetic predisposition (biggest precursor but may be turned on by one or more psychosocial factors)
perinatal precipitants
psychosocial adversity
together these may cause neuroanatomical brain changes leading to adhd features

Question 7

What genes are thought to be involved in ADHD?

Answer 7

serotonin and dopamine transporter genes

Question 8

What are the approx. percentages of risk of ADHD when parent has it and when sibling has it?

Answer 8

parent - 60%

sibling - 15%

Question 9

List some perinatal factors in ADHD?

Answer 9

smoking and alcohol during pregnancy
prematurity
perinatal hypoxia
delivery problems

Question 10

List some examples of psychosocial adversity that can increase risk of ADHD.

Answer 10

marital problems
low social class
large family size
emotional trauma

Question 11

What does the typical brainmap pattern show in children with ADHD?

Answer 11

Underactive function in the frontal lobe

Question 12

What is the neurochemistry of ADHD?

Answer 12

Excessively efficient dopamine-removal system (higher concentration of dopamine transporters)
Reduction of norepinephrine (can affect attention when acting as stress hormone)
Reduction of serotonin

Question 13

What are the diagnostic criteria for child ADHD?

Answer 13

6 or more symptoms of inattentiveness
6 or more symptoms of hyperactivity & impulsiveness
Present before age 5
Reported by parents, school & seen in clinic
Symptoms affect daily life

Question 14

What are the diagnostic criteria for adult ADHD?

Answer 14

5 or more of symptoms of inattentiveness
5 or more of symptoms of hyperactivity and impulsiveness
historical concerns since young age
affects different areas of life

Question 15

What are the psychosocial interventions for mild, moderate and severe ADHD in children?

Answer 15

parent training
social skills training
sleep & diet 
behavioural classroom management strategies
educational interventions

Question 16

What are the psychosocial interventions for mild, moderate and severe ADHD in children?

Answer 16

parent training
social skills training
sleep & diet 
behavioural classroom management strategies
educational interventions

Question 17

What are the 1st line pharmacological treatments for moderate to severe ADHD?

Answer 17

1st line: stimulants - methylphenidate, dexamfetamine, lisdexamfetamine

Question 18

What are the 2nd line pharmacological treatments for moderate to severe ADHD?

Answer 18

2nd line: SNRI - atomoxetine

Question 19

What are the 3rd line pharmacological treatments for moderate to severe ADHD?

Answer 19

3rd line: alpha agonist - clonidine, guanfacine

Question 20

What are the 1st line pharmacological treatments for moderate to severe ADHD?

Answer 20

4th line: antidepressants - imipramine or antipsychotics = risperidone

Question 21

What are the mechanisms of action of methylphenidate and dexamphetamine?

Answer 21

Methylphenidate: blocks dopamine transporter so increases dopamine by decreasing dopamine reuptake
Dexamphetamine: as above but also increases norepinephrine and serotonin

Question 22

What is the mechanism of action of SNRIs in ADHD?

Answer 22

Increase norepinephrine by blocking its transporter

Question 23

What is the mechanism of action of alpha agonists in ADHD?

Answer 23

Reduce sympathetic stimulation

Question 24

ADHD is almost as common in adults as it is in children. True/false

Answer 24

True