ADHD Flashcards
DSM
3 ADD 1980
3R ADD becomes ADHD 1987
4 ADHD (hyperactive, inattentive, combined subtypes) 1994
classic triad of ADHD
inattention
hyperactivity
impulsitivity
changes in DSM-5
- examples have been added
- cross-situational requirement has been strengthened
- onset changed to age 12
- presentation specifiers
- comorbid diagnosis with ASD
- symptom threshold change has been made for adults
- replaced in the neurodevelopmental disorders chapter
DSM functional criteria
- 6 or 9 symptoms in either or both categories of inattention and hyperactivity
- inattentive; hyperactive-impulsive; or combined type
- persisting for at least 6 months
- some symptoms present bef 12 y/o
- impairment in 2 or more settings: social/academic/occupational impairment
differential diagnosis psychiatric
mood or psychotic disorder
anxiety disorder
LD
mental retardation/ borderline IQ
ODD/ conduct behavior
pervasive developmental disorder
substance abuse
axis II disorders
psychosocial Cx eg abuse parenting etc
differential diagnosis medical
seizure disorder
chronic otitis media
hyperthyroidism
sleep apnea
drug-induced inattentional syndrome
head injury
hepatic illness
toxic exposure
narcolepsy
chronic otitis media
middle ear infection
hepatic illness
liver disease
narcolepsy
loss of the brain’s ability to regulate sleep wake cycle
epidemiology - percentage
most common diagnosed
3-7% of school children
epidemiology - ratio
male : famale.
[2 - 9] : [1]
girl vs boy
girls typically show less hyperactivity, fewer conduct problems, and less externalizing behavior
HOWEVER, Combined type: girls show more disruptive behavior
ADHD
attention-deficit/hyperactivity disorder
epidemiology - percent for adults
at least 30-50% maintain diagnosis for >=15 yrs
strongest predictor of poor prognosis
pre-pubertal aggression
worldwide prevalence of ADHD
3-7%
ADHD is familial
- sibling risk increases 2-5x
- 3-5 increased likelihood that parent is affected 9-35%
comorbidity axis 1 disorder
2/3 present with >=1 co-morbid axis i disorder
comorbidity
> =84% of children with ADHD demonstrate psychopathology as adults
educational impairments
substance abuse
employment problems
greater sexual-reproductive risks
greater motor vehicle risks
adolescent and adults outcomes of adhd
less schooling and lower grades
higher expel rates
worse on exec function tests
fewer friends
lower self-esteem
higher arrest rates
lower occupational rank
higher termination rates
rule of thirds
1/3 complete resolution
1/3 continued inattn, some impulsitivity
1/3 early ODD/CD, poor academic achievement, substance abuse, antisocial adults
age related changes
3-5 pre school - hyperactive/ impulsive
6-12 school age - combination symptoms
13-18 adolescence - more inattn w/ restlessness
18+ adult - largely inattn w/ periodic impulsivity
brain image
smaller brain volumes in all regions
no gender diff
volumetric abnormalities persist with age
correlate with severity of adhd
potential non-genetic causes
perinatal stress
low birth weight
traumatic brain injury
maternal smoking during pregnancy
severe early deprivation (extreme)
