ADHD

Question 1

If you have ADHD how likely is it that your kid will have ADHD

Answer 1

50%

I don’t think we need to know this number just pointing out it’s very heritable

Question 2

Cormorbidities with ADHD

Answer 2

Mood disorder
ODD
CD
Substance abuse***
Learning disability

Question 3

DDx for ADHD

Answer 3

Thyroid
Head trauma 
Sleep disorder 
FASD
Medications 
Anemia
Hearing or vision disorders

Question 4

List three scales you can use to diagnose ADHD

Answer 4

Snap 4
Weiss symptom record
Adult ADHD self reporting scale (ASRS)

Question 5

NNT for stimulatns

Answer 5

5 for >30% reduction in symptoms

DOn’t think we need to know this number but as a soos point they work very well

Question 6

DSM criteria for diagnosis

Answer 6

Children need 6
Adults need 5

Poor attention to detail 
Poor attention to one task 
Not listing 
Not following through 
Poor organization 
Avoid work that requires sustained mental focus 
Loses things 
Distracted easily 

Fidgets 
Leaves seat 
Runs and climbs
Doesn't engage in leisure quietly 
Excessive talking 
On the go or driven by motor 
Doesn't like waiting their turn 
Inturrupts others 

Need ssome symptoms before the age of 12

Question 7

What should you check before starting someone on a stimulant

Answer 7

Height 
Weight 
HR
BP 
ECG

Question 8

Non pharm management

Answer 8

Parental training 
Social skills training 
Diet (no real evidence) 
Exercise 
Sleep
Behavioral peer training 
Clear instruction (make eye contact and gentle physical contact and then get them to repeat the instructions) 
Educational accommodations 

Endeavor Rx video game
Manual transmission car

Omega 3
Melatonin for sleep

Question 9

Main safety risk for someone with ADHD

Answer 9

Driving
2-4 x more likely to be in accident

Recomment manual transmission

Question 10

List three medication classes for treatment of ADHD

Answer 10

1. Amphetamine (adderall, dexedrine)
2. Methylphenidate (Concerta)
3. SNRI (atomoxetine/Strattera)
4. Selective lapha 2 andrenergic receptor agonists (Guanfacine)

Question 11

What to ask about before prescribing ADHD medicaiton

Answer 11

Sudden cardiac death in the family
Cardiac disease
Pregnancy
BIpolar

Question 12

Contraindications for stimulants

Answer 12

Glaucoma
Hyperthyroid untreated
HTN
Mannia

Question 13

What to prescribe if someone has ADHD and a history of substance abuse

Answer 13

Atomoxetine

Question 14

What extra caution to take for atomoxetine

Answer 14

Asthma

Question 15

Someone is on Concerta 18 and they come to you saying it’s not working. What do you do? What would you do before changing medications

Answer 15

Increase dose

If that doesn’t work try other 1st line medications
Make sure they’ve been on it for enough time
Review targets they are hoping for and expectations
Check for adherence, comorbidities, lifestyle changes

DATER (Dose, All 1st lines, Time, Examine targets, Review)