ADHD

Question 1

What is ADHD?

Answer 1

Severe form of long-lasting hyperactivity associated with inattention and increased propensity for impulsiveness. These arise before the age of 6

Question 2

What is the aetiology of ADHD?

Answer 2

50% concordance in MX twins. Increased comorbidity with substance abuse and conduct disorder. Maternal smoking, low BW, psychosocial factors.

Changes in the frontal temporal lobe metabolism, and D2/NA dysregulation in PFC. DRD4/DAT1 receptors for D2 metabolism

Question 3

What is the epidemiology of ADHD?

Answer 3

1-2%, M>F. Common comorbidity with CD, LDs, depression and antisocial.

Question 4

What is in the history and examination of ADHD?

Answer 4

Includes symptoms of:

· Inattention (6+): Fails to sustain, follow through commands, careless errors, loses things, forgetting, poor planning.

· Hyperactivity (3+) fidgeting, leaving seat, running around, noisy

· Impulsiveness: 1+ blurt out answer, does not wait in line, interrupting etc

Conners rating scale used.

Question 5

What is the ICD10 definition of hyperkinetic disorder?

Answer 5

o >6 months

o Pervasive X different situations

o Onset <7 years old – cannot be diagnosed de novo in adults

o Significant distress/social impairment

Variable according to family culture, social culture

Question 6

What investigations do you do for ADHD?

Answer 6

Psychometric testing, Conners scoring scales, collecting information from parents and teachers for symptoms over more than one setting. Specialist led.

Question 7

What is the management of ADHD?

Answer 7

Information and support, behavioral control (reward and punishment strategies)

Mediaction

· methylphenilate – DA release stimulant/DAT blocker,

· atomoxetine – NA reuptake inhibitor

Question 8

What is the complications and prognosis of ADHD?

Answer 8

90% conduct dosrder if untreated.

Learning difficulties and low self esteem leading to spiral into worse behavior

Substance misute