ADHD

Question 1

What is ADHD?

Answer 1

Attention deficit hyperactivity disorder

Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development

Question 2

What is ICD10 criteria for ADHD?

Answer 2

Present before age 7

Evident in more than one setting (e.g. school and home)

Cause significant impairment in functioning

Not better explained by another disorder (e.g. anxiety, mood disorder)

Question 3

Who is most commonly affected by ADHD?

Answer 3

Twice as common in boys

Question 4

What causes ADHD?

Answer 4

Genetic
Pregnancy-related factors (maternal smoking, premature birth and low birth weight)
Environmental factors

Question 5

If a child displays symptoms at school but calm at home what does this suggest?

Answer 5

Not ADHD

Environmental effect

Symptoms should be consistent across settings

Question 6

What are the features of ADHD?

Answer 6

Short attention span
Distracted easily
Moves quickly between activities
Fidgeting
Impulsive
Loses interest quickly

Question 7

What test can be used to support referral?

Answer 7

Adult ADHD Self-Report Scale (ASRS)

Question 8

What managing strategies are used for parents?

Answer 8

Positive approach
Structured routines
Clear boundaries
Plenty of physical activity
Healthy diet (foods can exacerbate symptoms)

Question 9

How do ADHD medications work?

Answer 9

Central nervous system stimulants

Makes up executive function deficits e.g. to increase inhibition

Question 10

What needs to be monitored when using ADHD medications?

Answer 10

Heart rate
BP
Weight
Mood changes

Question 11

Why are girls with ADHD harder to diagnose?

Answer 11

Display less symptoms

Less impulsive
Fidget less

More likely to just lose attention or interest

Question 12

What are some co-occurring disorders with ADHD?

Answer 12

• Oppositional defiant disorder
• Conduct disorder
• Substance abuse
• Mood disorders e.g. depression and mania
• Autism
• Dyslexia
• Dyscalculia
• Dyspraxia

Question 13

How is ADHD diagnosed?

Answer 13

ICD-11
Symptoms of inattention and or hyperactivity/impulsivity
- Before 12
- Occurred in two or more settings
- Present for at least 6 months
- Clearly interferes with or reduces quality of social, academic or occupational functioning
- Symptoms not caused by another mental disorder or due to a substance

Question 14

Give examples of hyperactivity-impulsivity symptoms

Answer 14

• Excessive motor activity, discomfort with being quiet or sitting still
• Difficulty engaging in activities quietly, talks too much
• Blurts out answers in school, comments at work, difficulty waiting turn in conversation, games or activities, interrupts conversations or games
• Tendency to respond to immediate stimuli without deliberation or consideration of risks and consequences e.g. reckless driving

Question 15

How is ADHD treated?

Answer 15

CBT

lisdexamphetamine/dexamphetamine or methylphenidate first line

If 6 week trial shows no response
Atomoxetine

Question 16

What needs to be monitored in ADHD?

Answer 16

• Height and weight
• HR and BP, compare with normal range for age before and after each dose change and every 6 months
• Tics- consider risk/benefit, reduce dose (consider atomoxetine)
• Sexual dysfunction with atomoxetine
• Seizures
• Sleep
• Worsening behaviour
• Stimulant diversion