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YEAR 4 MENTAL HEALTH > ADHD > Flashcards

ADHD Flashcards

1
Q

Prevalence of ADHD?

A

3-4% UK prevalence
M:F = 3:1
80% of cases are genetically inherited

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2
Q

Why is ADHD more commonly diagnosed in boys than girls?

A

Boys more often present with disruptive behaviour
Girls commonly have inattentive subtype and lower comorbidity with OCD and conduct disorder

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3
Q

Define ADHD

A

Attention deficit hyperactivity disorder is defined as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

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4
Q

Causes of ADHD?

A

Genetic (up to 80% of cases)
Environmental factors - low birth weight, maternal smoking during pregnancy, preterm delivery, iron deficiency, alcohol exposure during pregnancy, adverse maternal mental health.

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5
Q

What co-morbid disorders is ADHD associated to?

A

Oppositional defiant disorder
Conduct disorder
Substance abuse
Mood disorders - depression, mania.
ASD, dyslexia, dyspraxia.

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6
Q

What are the three core diagnostic criteria for ADHD?

A

Impulsivity
Inattention
Hyperactivity

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7
Q

Suspect ADHD if there are at least six (five in adults) inattention ymptoms and/or at least six (five in adults) hyperactivity-impulsivity symptoms that have …

  1. started before what age?
  2. occured in…?
  3. present for how long?
  4. interfered with what?
  5. exclusivity?
A
  1. started before 12 years old
  2. occured in two or more settings - e.g. home and school
  3. been present for at least 6 months
  4. clearly interefered with/reduced quality of social, academic or occupational functioning
  5. not occured exclusively during course of another psychotic disorder, and are not explained better by another disorder (e.g. ODD or conduct disorder)
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8
Q

Name the inattention symptoms of ADHD

A

Unable to:
* listen/attend closely to detail (so make careless mistakes)
* sustain attention/concentrate in play activities
* follow instruction or finish a task
* finish homework
* organise tasks needing sustained application
* avoid distractions -i.e. easily distracted by external stimilus

  • loses/forgets things
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9
Q

Name the hyperactivity symptoms of ADHD

A
  • Squirming/fidgeting (tapping hands or feet)
  • on the go all the time
  • talks incessantly
  • running / climbing in situations where inappropriate. Presents as restlessness in adults.
  • no quiet hobbies
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10
Q

Name the impulsivity symptoms of ADHD

A
  • interrupts others
  • blurts answers
  • cannot take turns / hard to wait turns
  • poor road safety
  • intrudes on others
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11
Q

What are differentials for ADHD?
(and state why)

A
  • Anxiety disorders - inattention due to worry or rumination
  • Depressive disorders - poor concentration
  • ASD - social disengagement, isolation, indifference to facial and tonal communication. In children, impulsivity/tantrums/can’t tolerate change from routine
  • Personality disorders - similar symptoms but PD has fear of abandonment, extreme uncertainty etc
  • Oppositional defiant disorder - aversion behaviour seen in this and ADHD
  • Conduct disorder - hyperactivity and impulsivity behaviour is present, but in conduct disorder this elads to violation of societal norms.
  • Specific learning disorders - inattention relating to tasks
  • Bipolar disorder - inattention, impulsivity
  • Fetal alcohol syndrome
  • Auditory or visual impairment - can cause behavioural problems at school
  • Seizure disorder - absence seizures lead to episodic impairment of focus and attention
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12
Q

How would you investigate suspect ADHD?

A

Detailed assessment by specialist
* take Hx from pt
* take collateral hx e.g. from parent / teachers
* rating scales - e.g. Conners ADHD Rating Scale
* screen for co-morbidity and organic causes - urine drug screen, EEG, brain imaging CT or MRI.

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13
Q

How is ADHD managed?

A
  • assess social and educational impact of symptoms
  • Behavioural interventions e.g. encouraging realistic expectations, positive reinforcement of desired behaviours, consistent contingency management across home and school, breaking down tasks, reducing distraction
  • cover occupational issues if adut
  • for child - refer to CAMHS if needed
  • pharmacological = prescribe an amfetamine e.g dexamfetamine. OR methyphenidate
  • advise on normal healthy diet and regular exercise e.g fish oils
  • CBT
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14
Q

What advice would you give child and parents after prescribing methyphenidate for ADHD?

A

Reduces appetite so can suppress growth
So, do not take on weekends/holidays

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15
Q

Why should you prescribe methylphenidate with caution?

A

It is a controlled drug
Has street value as a drug of misuse.
Need to check for signs of substance misuse/ diversion of drug

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16
Q

What are side effects of amphetamines?

A

Amphetamines can keep patients up - so should only be taken in morning to last for the day.

Side effects = make people anxious, can become psychotic. Increase people’s HR, feel on edge.

YEAR 4 MENTAL HEALTH (16 decks)

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