ADHD Flashcards
DSM-5 definition
Persistent pattern of inattention or hyperactivity-impulsivity that clearly interferes with or reduces academic, social, or occupational functioning/development
Must occur for >6 months
Symptoms are present before age 12 and must be present in more than one setting
Must have ≥ 6 symptoms of inattention or hyperactivity-impulsivity
Criteria changes to ≥ 5 for inattention if developed after age 17
inattention
Fails to focus on details, careless mistakes
Difficulty maintaining attention
Inability to listen when spoken to directly
Inability to follow instruction
Fails to finish schoolwork/other tasks
Trouble organizing schoolwork/other activities
Avoids/dislikes/reluctant to engage in activities requiring continuous attention
Loses items necessary for activities
Easily diverted by external stimuli
Frequently forgets daily activities
Hyperactivity/impulsivity
Fidgets with hands or feet; squirms in seat
Inability to remain seated when necessary
Runs/climbs in unacceptable situations
Unable to play or engage in quiet, leisure activities
Often “on the go” or acts as if “driven by a motor”
Excessively talks
Impulsively blurts out answers
Difficulty waiting their turn
Interrupts activities or conversations of others; intrudes or takes over for them
infancy symptoms
Difficulty being soothed; fidgety, crying
Feeding problems; poor sucking, crying during feedings, needing to be fed frequently
Short periods of sleep; little sleep
When crawling, constant motion
School age symptoms
Constantly “on the go”; unable to stay seated; explosive and irritable
Not able to play quietly or politely
Easily distracted; doesn’t complete tasks
Impulsive, unable to wait their turn
May appear accident-prone
Disorganized – constantly forgetting
Adolescence symptoms
Procrastination
Disorganization
Forgetfulness
Inattention
Over-reactive
Reckless behaviors; risky driving
Hyperactivity in adulthood
Inability to sit still through class/work meetings
Excessive talking
Need to get to places quickly
Impulsivity in adulthood
Frequent job changes
Low frustration tolerance
Unstable relationships with friends/family
inattentive in adulthood
Poor time management/motivation
Forgetfulness
Excessive mistakes
Poor concentration
Neuropsychiatric EEG-based Assessment Aid system
Medical device that can assist in ADHD diagnosis between ages 6-17
Test is 15-20 minutes long and measures ratio between theta and beta waves
A higher theta/beta ratio has been found in children and adolescents with ADHD
EEG should be used
to rule out absence seizures
Risk factors
Family hx of ADHD
Perinatal stress
Very low birth weight
Maternal smoking during pregnancy
TBI
Severe early oxygen deprivation
Adverse parent-child relationships
Heritability
4-8 fold increase if 1st degree relative
1/3 of parents with ADHD will have a child with ADHD
Twin studies: 90% concordance
Siblings of hyperactive children are twice as likely to get dx with ADHD
Dopamine gene polymorphisms
DA transporter gene
NE transporter gene
Dopamine Pathophysiology
Dysfunction in DAT
Leads to decreased DA
Impairs attention, mood and arousal regulation, and ability to resist distractions
Two most common co morbidities
Oppositional defiant disorder
Conduct Disorder
Associated comorbidities
Oppositional defiant disorder
Conduct Disorder
Disruptive mood dysregulation disorder
Substance use/misuse is quite common
Psychiatric conditions
Learning disorders
Sleep disorders
First line treatment
MPH or AMP
age 4-5 -behavioral therapy
second line treatment
Ages 4-5: MPH
Ages 6-18: Atomoxetine, GXR, CLON-XR
Third line treatment
Bupropion, TCA, or alpha2-agonist (4th line)
Need for medication can be assessed if
symptom free for 1 year
T/F drug holidays should be attempted frequently
True
Family-focused non-pharm
Parents attend 10-20 sessions (1-2 hours) with occasional booster sessions
Includes behavioral parenting training (strategies to use at home to improve compliance with commands) and behavioral interventions (positive reinforcement, time-out, response cost, token economy)
