ADHD

Question 1

ADHD
-epidemiology
-pathophysiology

Answer 1

2x as common as autism - 2.4%
Male
Often diagnosed at 3-7

Genetics
Prenatal exposure to alcohol, smoking
Premature, significantly low birth weight
Postnatal injury to prefrontal regions of brain

Leading to impaired brain development
-dysfunction in dopaminergic activity in prefrontal cortex
-dysfunction in adrenergic activity in locus coeruleus
This affects cortical regions involved in attention, impulse control, stimulus integration

Question 2

ADHD
-what it is

Answer 2

Persistent inattention/hyperactivity/impulsivity at home and school for the age and developmental stage of the child

Question 3

ADHD diagnosis
-criteria in children and teens

Answer 3

Children and teens - 6+ features of inattentiveness/hyperactivity/impulsiveness
Symptomatic
-continuous for 6 months
-before 12
-in min 2 settings

Symptoms make their lives difficult on a social/academic/occupational level
Not part of another developmental disorder/condition

Adults - 5+ features of inattentiveness/hyperactivity/impulsiveness
Must prove that symptoms were present from childhood

Moderate impact on daily functioning such as
-underachieving at work/studies
-dangerous driving
-difficulty making/keeping friends
-difficulty in relationships

Question 4

8 Features of inattention

Answer 4

Overlooks attention to details
Difficulty maintaining attention
Not listening when spoken to directly
Easily distracted
Time-management problems
Dislikes tasks needing sustained mental effort
Loses things needed for tasks
Difficulty finishing tasks
Forgetful in ADL

Question 5

8 Features of hyperactivity/impulsivity

Answer 5

Fidgets
Leaves seat easily
Difficulty playing quietly
Always on the go
Talks a lot
Blurts out responses mid-question
Difficulty waiting their turn
Interrupts others

Question 6

ADHD management in children

Answer 6

Diagnosed by psychiatrist/paediatrician/trained individual
Patient wishes, and affect of ADHD on their lives taken into account to offer a tailored plan of action

1st line if mild/moderate
- parent education groups
- consistent discipline and parenting input
- use of reward systems and clear boundaries

If severe, can add meds if 5+
-all are cardiotoxic => baseline ECG

Methylphenidate 6wk trial
SE
-abdo pain
-nausea, dyspepsia
-palpitations
CI
-epilepsy, tics
-severe HTN
-heart vascular conditions
Monitoring
-weight and height every 6 months (appetite suppressant)

-if inadequate => lisdexamfetamine
-if lisdexamfetamine SE intolerable => dexamfetamine

Question 7

Management in adults
-1st line meds

Answer 7

1st line - Methylphenidate/lisdexamfetamine
switch between these 2 if no benefit is seen after a trial of the other

Question 8

ADHD assessment

Answer 8

Referred to either
-child/adult psychiatrist
-paediatrician
-trained HCP in diagnosis of ADHD

Physical examination - rule out other possible causes
Interviews
Interviews/reports from significant people
-parents
-partners
-teachers