ADHD Flashcards
what is the etiology of ADHD
genetic- highly hereditary and polygenic
Neurological - acquired - development of the brain secondary to injury may contribute
environmental - toxins
usually likely due to a combination
what is the epidemiology of ADHD
most common neurodevelopmental disorder in children and adolescents
M>F
risk increases 2-8x if first degree relative with ADHD
what are commonly associated problems with ADHD
low self-esteem
mood lability
conduct disorder
learning disorders
clumsiness/poor coordination
communication disorders
drug abuse
school failure
physical trauma as a result of impulsivity
what are the signs and symptoms of ADHD
avoidance of activities that require sustained focus
decreased awareness of consequences
decreased motivation
disorganization
fidgeting
forgetfulness
frequent talking
what do signs and symptoms help to differentiate between
inattentive and hyperactive type ADHD
What can be impaired with ADHD
executive function - includes processes involved in forward planning, including abstract reasoning, mental flexibility, inhibition control and working memory
how is ADHD diagnosed
must depend on external reports (parents, teachers, employers) - symptoms must be present in multiple settings and lead to impairment of everyday activities
must assess emotional, behavioral, developmental or physical conditions that may be co-occuring
DMS-5 Criteria
what is the criteria for inattentive ADHD
(6 or more in children, 5 or more in adult)
unable or fails to give close attention to detail
trouble sustaining attention (work and play)
does not pay attention when spoke to directly
does not follow through on directions
organizing tasks and/or activities is difficult
avoids sustained mental effort
external stimuli easily distracts individual
forgetful in daily activity
what is the criteria for hyperactive-impulsive ADHD
(6 or more in children, 5 or more in adult)
fidgeting (hands, feet, chair squirming)
leaves seat when being seated is expected
runs/climbs inappropriately (feels restless)
difficulty with QUIET leisure activities
often “on the go” or “driven by a motor”
talks excessively
blurts out answers
difficulty awaiting turns
interrupts or intrudes on others
what are adult symptoms of ADHD
difficulty concentrating
difficulty completing task (executive function impairments)
mood swings
impatience
difficulty maintaining relationships
what are the screening tools for ADHD
-Conner’s comprehensive Behavior Rating Scale - age 6-18
-Vanderbilt ADHD Diagnostic Rating Scale (VARDS) - age 6-12
-Strengths and Weaknesses of Attention Deficit/Hyperactivity Disorder Symptoms and Normal Behavior Scale (SWAN) - age 6-17
-SNAP-IV Teacher and Parent Rating Scale (SNAP-IV) - age 5-18
What is Conner’s Comprehensive Behavior Rating Scale
very long
not only used for ADHD, used to assist in diagnosis
Evaluates 9 areas: emotional distress, aggressive behaviors, language difficulty, math difficulty, hyperactivity-impulsivity, social problems, separation fears, perfectionism, compulsive behaviors
What is key for the physical exam of a child concerned to have ADHD
Hearing and vision screening
When would a ECG be recommended for a patient prior to starting ADHD treatment
heart diseases
palpitations
syncope
seizure disorder
family history of sudden cardiac death
Wolff-Parkinson-White Syndrome (WPW syndrome)
Hypertrophic cardiomyopathy
Long QT syndrome
Not required usually prior to starting meds
what is the goals of treatment of ADHD
improve cognitive function
develop internal/external coping strategies
restructure environment to optimize functioning
identification of ADHD complexity and decide if referral is warranted
establish reasonable goal for treatment
what are the two primary treatment types for ADHD
Behavioral therapy
Medications (stimulant and non-stimulants)
what is the first line treatment in children less than 6 years of age
non-pharmacologic
behavior management training for patient and parent
classroom intervention (proactive behavior strategies)
accountability and treatment goals
adequate sleep
regular physical activity
what are the pharmacologic treatments for ADHD
stimulants: response varies, dose dependent on severity/tolerance; amphetamines and methyphenidates
non-stimulants: Atomoxetine(strattera) - stimulates norepi, Wellbutrin (bupropion), venlafaxine (effexor), Tricyclic antidepressants
what are common first line stimulants to use for a patient with ADHD
initiate with short acting:
- dextroamphetamine (dexedrine, dextrostat, adderall) or Lisdexamfetamine (Wyvanse)
Methyphenidate (ritalin, Methylin, Concerta)
Dextromethyphenidate(focalin)
what are common non-stimulant treatment options for ADHD
Atomoxetine (strattera) - not controlled - stimulates norepinepherine
Bupropion(wellbutrin)
Venlafaxine(effexor) - SNRI
Tricyclic antidepressants - imipramine prefferred
what is the benefit of non-stimulant treatment options for ADHD
help to modulate emotions
often used with concurrent diagnosis
adjunctive agents: alpha-2-agnoists, Beta-blockers, anti-epileptics
what are the indications of use of non-stimulant treatment options for ADHD
impulsivity, hyperactivity, conduct problems or tics
what is the typical follow up for a patient with ADHD
at least every 3-6 months
review if there have been any medication side effects
review medication compliance
follow at least 3 symptoms and evaluate for symptom effect with treatment
review contract if utilized
what is important to discuss with the patient/Family with ADHD diagnosis
explain the diagnosis and symptoms
will not be used for obtaining disability benefits
review side effects and any needed monitoring for treatment
stimulant meds wont be prescribed on first visit
contract if utilized - controlled substance contract
scale or instrument to document progress
lost or stolen Rx for stimulants will not be replaced.
what are adverse effects of stimulants
interfere with sleep and appetite, can affect growth and weight gain
what medication is indicated in severer ODD
Riperidone (risperdal) (Second generation antipsychotic)
