ADHD

Question 1

Define 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

Explain the aetiology/risk factors for 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

Summarise the epidemiology of ADHD.

Answer 3

1-2%, M>F

Common comorbidity with conduct disorders, LDs, depression and antisocial disorders.

Question 4

What are the signs and symptoms of ADHD?

Answer 4

Definition – hyperkinetic disorder (ICD-10)

• >6 months
• Onset <7 years old – cannot be diagnosed de novo in adults
• Significant distress/social impairment

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

Question 5

What is the rating scale used to diagnose ADHD?

Answer 5

Conners rating scale

Question 6

What are some investigations 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 for ADHD?

Answer 7

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

Medication:

• Methylphenilate – DA release stimulant/DAT blocker
• Atomoxetine – NA reuptake inhibitor

Question 8

What are complications associated with ADHD? What is the prognosis of ADHD?

Answer 8

90% conduct dissrder if untreated

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

Substance misuse