ADHD Flashcards
What is ADHD?
A neurodevelopmental disorder characterised by inattention, hyperactivity, and impulsivity
What is the main demographic for ADHD?
Young children (average age of diagnosis = 7)
Predominantly male
In the DSM-V, what is the main criteria for ADHD diagnosis?
5 or more symptoms of inattention and/or hyperactivity-impulsivity
By what age should several symptoms present for diagnosis of ADHD in the DSM?
12
(Most symptoms typically develop around age 4 but may not be visible)
Where must symptoms be observed for diagnosis in the DSM and ICD?
DSM: two or more settings
ICD: more than one setting and a single situation
Symptoms must interfere with or reduce quality of at least one of….
▪️Social functioning
▪️Educational functioning
▪️Occupational functioning
What are symptoms of inattention?
▪️Lack of attention to detail
▪️Difficulty sustaining attention
▪️Listening issues
▪️Trouble completing tasks
▪️Problems organising tasks
▪️Avoids sustained mental effort
▪️Loses and misplaces things
▪️Easily distracted
▪️Forgetful
What are symptoms of hyperactivity?
▪️Fidgeting
▪️Can’t stay seated
▪️Feeling restless
▪️Difficulty engaging in activities quietly
▪️Excessive talking
What are symptoms of impulsivity?
▪️Difficulty waiting in line
▪️Blurts out answer before end of question
▪️Interrupts others when busy/working
How is ADHD classed in the ICD-10?
Disturbance of Activity and Attention
Under Hyperkinetic Disorders
How does the ICD diagnostic criteria for ADHD differ from the DSM?
Much stricter:
▪️6 symptoms of inattention
▪️3 symptoms of hyperactivity
▪️1 symptom of impulsivity
▪️Onset no later than 7
Is it good to have wider diagnostic criteria and make more diagnoses?
Maybe or are we just diagnosing normal variation and overmedicating?
What was typically though to happen to ADHD through adulthood?
It improves
Can you develop ADHD in later life?
No
Why might ADHD not present until later into earlier adulthood?
The increase in responsibilities and challenges as we leave childhood may make subthreshold ADHD more apparent
How might ADHD impact adult life?
▪️Quality of life & self-esteem
▪️Family life
▪️Work productivity
▪️Love & interpersonal relationships
▪️Further education
▪️Activities of daily living (e.g. driving)
▪️Criminality
According to the DSM-5, what features might be associated with ADHD?
▪️Development traits (e.g. mild delays in langue, motor, or social)
▪️Emotional symptoms (e.g. mood lability, frustration, irritability)
▪️Education problems
▪️Cognitive deficits (particularly in WM, EF, or attention)
How might ADHD mimic anxiety?
▪️Worrying about performance
▪️Excessive mind-wandering
▪️Overwhelmed and restless
▪️Avoidance of situations
▪️Sleeping problems
How might ADHD mimic depression?
▪️Unstable mood and Irritability
▪️Poor concentration
▪️Low self-esteem
▪️Impatience
▪️Personality disorder
▪️Chronic trait-like psychopathology linked to behavioural problems, emotional instability, impulsive behaviour, and poor social relationships
How mignt ADHD mimic bipolar disorder?
▪️Restlessness
▪️Sleep disturbance
▪️Mood instability
▪️Ceaseless unfocused mental activity
▪️Distractibility
What is the rough prevalence of childhood ADHD?
5-8%
How does the prevalence of Hyperkinetic disorder according the ICD-10 compare to the rough prevalence of ADHD?
Much lower (0.5-0.8%)
What is the prevalence of ADHD in adulthood and why does it differ to childhood?
2.5-3.2%
Likely lower as symptoms go away with age
How does the trajectory of functional impairment due to ADHD differ to the trajectory of the full diagnostic criteria?
It does not decline as much, suggesting that although many people stop meeting the criteria as they age (15%), they are still suffering from functional impairment (65%)
Why might functional impairment not show as much improvement with age?
Childhood is an important time for the development of many abilities and skills, disruption of which can have lifelong effects
How heritable is ADHD?
Relatively high (0.7-0.8)
What environmental factors may increase the supposed heritability of ADHD?
▪️More likely to have an assessment if family member has it
▪️Learning behaviours from parents
How does ADHD heritability compare to other psychiatric conditions, according to Pettersson’s sibling study?
It had the highest heritability (0.8)
What did Demomtis (2019) find in the GWAS meta-analysis of ADHD?
12 independent significant loci
Complex genetics!
According to NICE, what are the three key compenents of a specialist ADHD assessment?
▪️Full clinical and psychosocial assessment
▪️Full developmental and psychiatric history
▪️Observer report (e.g. teacher)
! Mix of rating scales and observational data !
How long is the typical wait for an NHS adult ADHD assessment?
~2 years
What might cause bias in the assessment of ADHD?
▪️Self-report scales
▪️Restrospective information on childhood behaviour for adult diagnosis
▪️Private assessment
▪️Observations from family
What is the CAADID?
Conners’ Adult ADHD Diagnostic Interview for DSM-IV
One of the best and most comprehensive assessments for ADHD in adulthood
What are the two parts of the CAADID
- Patient history questionnaire
- Diagnostic criteria interview
Why is sibling data useful for neurodevelopmental conditions like ADHD?
Comparing within families, where rare genetic links may be commonly seen together, can highlight how much heritability is accounted for by rare variants as is often the case in neurodevelopmental conditions
How is the interrater reliability of the DSM-IV criteria?
Pretty good
What is the DIVA?
Diagnostic Interview for ADHD in Adults
A free, structured diagnostic interview that takes ~90 mins
What is the main limitation of the DIVA questionnaire?
The questions can be quite leading and give examples, making it more likely that people will overestimate their symptoms
What is the first line of ADHD management in adults?
Information and lifestyle advice
▪️Cognitive flowchart?
▪️How does it impact their life?
▪️What changes can you, people in your life, and your workplace make to improve things?
What are the first line pharmacological treatments for ADHD?
▪️Lisdexamfetamine OR
▪️Methylphenidate
How long should you wait before switching from one to the other if it doesn’t work?
6 weeks
What medication can he given if they respond to lisdexamfetamine but cannot tolerate the side effects?
Dexamfetamine
When should dexamfetamine be used?
Only if lisdexamfetamine is working but the individual cannot tolerate the side effects
When should atomoxetine be used?
Only if non of the other medications are effective or can be tolerated
What medication can be used if neither lisdexamfetamine or methylphenidate are effective or tolerable?
Atomoxetine
Why is it especially important toonitor weight loss in children on ADHD medication?
It may lead to stunted growth
What should you monitor for when prescribing ADHD medication?
▪️Weight
▪️HR and BP
▪️Tics
▪️Sexual dysfunction
▪️Seizures
▪️Sleep
▪️Worsening behaviour
▪️Stimulant diversion
▪️Psychiatric symptoms
What could you offer if medications are helpful but have a few unwanted effects?
Drug holidays or only taking them when needed
Why should you monitor for tic development?
▪️Commonly comorbid with ADHD
▪️Stimulants increase dopamine in synapses which may lead to extra movements
