ADHD Flashcards
What is the classification in the DSM-5 (2013) for ADHD?
Attention Deficit Hyperactivity Disorder.
What is the prevalence of ADHD among children and adolescents?
3-10%.
What is the prevalence of ADHD in the adult population?
2-5%.
How is ADHD prevalence characterized across the human population?
It is universal among the human population.
What is the reported prevalence of ADHD in the USA?
2-20%.
What is the reported prevalence of ADHD in the UK?
3-9%, indicating a 50% increase.
What is the male-to-female ratio (M:F) for ADHD prevalence?
3-4:1
What is the aetiology of ADHD?
- Genetic / hereditary (genes DAT1, DRD4 etc)
- Peri-natal problems (prem & low birth weight)
- In utero exposure to tobacco smoke
What are the neurodevelopmental disorders listed in the DSM-5?
- ADHD
- ASD
- Communication Disorders
- Intellectual Disability
- Specific learning disability
- Motor disorders (Tics, stereotypical
movement & DCD)
What are the key updates regarding ADHD in the DSM-5?
- Several symptoms must be present in each setting, symptoms must be present prior to age 12 years.
- and there is a lower threshold for diagnosis in adults and adolescents.
Can ADHD be diagnosed in individuals with comorbid ASD according to DSM-5?
Yes, ADHD can be diagnosed with comorbid ASD
What is the minimum duration for ADHD symptoms according to DSM-5?
Symptoms must be present for at least 6 months.
Symptoms must be present for at least 6 months.
Symptoms must be inconsistent with the individual’s developmental level.
What negative impacts must ADHD symptoms have according to DSM-5?
Symptoms must have a negative impact on social, school, or work functioning.
What must ADHD symptoms not solely be a manifestation of, according to DSM-5?
Symptoms must not be solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks (e.g., learning disabilities).
By what age must ADHD symptoms be present for a diagnosis according to DSM-5?
Symptoms must be present before the age of 12 years.
What are the movement-related behaviors in hyperactivity/impulsivity?
- Fidgets, squirms
- Leaves seat
- Runs or climbs
- Unable to play quietly
- on the go/driven by a motor
What are the verbal behaviors associated with hyperactivity/impulsivity?
- Talks excessively
- Blurts out answers
- Interrupts
What are the behaviors related to impaired self-control in hyperactivity/impulsivity?
- Difficulty waiting turn
- Impaired response inhibition, impulse control, or the capacity to delay gratification
- Inability to stop and think before acting/doing
What impulsive behavior might a child with ADHD exhibit in social situations?
Interrupting others during conversations.
What does it mean when a child is described as “on the go/driven by a motor”?
They are constantly active and unable to stay still.
What cognitive challenge might children with ADHD experience before acting?
They may have an inability to stop and think before acting or doing something.
What difficulties with attention are commonly seen in inattention?
- Fails to give close attention/careless
- Can’t sustain attention
- Does not listen
What are the task management issues associated with inattention?
- Cannot follow through/tasks incomplete
- Difficulty organizing tasks
- Avoids mental effort
What are the behaviors related to forgetfulness and distraction in inattention?
- Often loses things
- Easily distracted
- Forgetful
What is a common issue with task completion for individuals with ADHD?
They may start tasks but cannot follow through, leading to incomplete work.
What organizational challenge might a child with ADHD face?
Difficulty organizing tasks and activities.
How do individuals with ADHD typically respond to tasks that require mental effort?
They may avoid tasks that require significant mental effort.
What other behaviours seen in ADHD ?
- Insatiability (impossible to satisfy)
- Poor co-ordination
- Delayed development of internal language and rule following
- Difficulties with regulation of emotions, motivation and arousal
- Diminished problem solving ability and flexibility
What is a symptom of inattention during the preschool years?
- Short play
*Incomplete activities - Not listening
How does inattention manifest during primary school years?
- Brief activities
- Changes activity
- Forgetful,
- disorganised
- distracted
What are the signs of inattention in adolescence?
- Less persistence
- Lack of focus on details
- planning
How does inattention present in adulthood?
- Incomplete details
- Forget appts
- Lack of foresight
What is a symptom of overactivity during the preschool years?
Whirlwind ( chaos)
How does overactivity manifest during primary school years?
- Restless
- hyperactive
What are the signs of overactivity in adolescence?
Fidgety
How does overactivity present in adulthood?
Subjective feelings of restlessness.
What is a symptoms of impulsivity during the preschool years?
- Does not
listen - No sense of
danger
How does impulsivity manifest during primary school years?
Acts out of turn, interrupts, and intrusive thoughtless.
What are the signs of impulsivity in adolescence?
poor self-control, and reckless risk-taking.
How does impulsivity present in adulthood?
- Accidents
- Impatience
- and premature decision-making.
What does the specifier “Combined” mean in ADHD?
the individual exhibits symptoms of hyperactivity, impulsivity, and inattention. The person shows a mix of behaviors.
What does “Predominantly inattentive” signify in ADHD?
The person primarily struggles with inattention without significant hyperactive or impulsive behaviors
What characterizes the “Predominantly hyperactive/impulsive” specifier in ADHD?
individuals who primarily show hyperactive and impulsive behaviors without significant inattention
Why are females with ADHD often underdiagnosed and misdiagnosed?
They are often being mistaken for having mood disorders due to their high levels of inattention and less disruptive behavior compared to males.
What are the typical symptoms of ADHD in females?
- high levels of inattention and lower levels of hyperactivity.
- less distruptive
How do hormonal changes in adolescence affect females with ADHD?
Hormonal changes during adolescence, particularly related to estrogen, can impact the expression of ADHD symptoms in females, potentially exacerbating inattention and emotional regulation issues.
What is the risk of substance abuse in females with ADHD?
Greater risk of substance abuse.
How do females with ADHD respond to treatment?
Females with ADHD generally respond well to medication and behavioral interventions
How do environmental demands affect females with ADHD?
As environmental demands increase, the symptoms of ADHD in females may become more apparent/obvious.
Who should conduct the assessment for ADHD?
Pediatricians, child psychologists, general practitioners (GPs), or healthcare providers (HCPs) with expertise in ADHD.
What types of history are important in the ADHD assessment?
- Full developmental history,
- medical history (including cardiac history),
- and psycho-social history to understand the child’s background and any relevant factors.
- Co-existing conditions
- School information
What role does school information play in the ADHD assessment?
It provides insights into the child’s behavior and performance in an academic setting, helping to identify patterns of inattention or hyperactivity.
What are psychometric assessments used for in ADHD evaluation?
- Used to evaluate cognitive and behavioral functioning, helping to exclude learning disabilities
- provide a clearer picture of the child’s abilities
What rating scales are commonly used in ADHD assessments?
SNAP (Swanson, Nolan, and Pelham)
What is the SNAP scale used for?
Commonly used to gather standardized information about the child’s behavior from parents and teachers
What criteria must be met for an ADHD diagnosis?
The diagnosis must meet the DSM V or ICD 10 criteria and demonstrate moderate impairment in more than one setting
During assessment for ADHD who else must be spokenn to eccept for parents and teachers?
The child
In addition to the assessment of the child who else must be assessed ?
Parents
What does the Stroop Test measure?
It measures attention, specifically selective attention, by assessing how well individuals can manage conflicting information.
How does the Stroop Test utilize reading and color naming?
The test takes advantage of our ability to read words more quickly and automatically than to name colors, creating a conflict that challenges attention.
What is the main challenge presented by the Stroop Test?
The main challenge is to manage one’s attention and inhibit the automatic response of reading the word instead of naming the color of the ink.
Example : a word BLUE but writen in red ( u have to say the actual colour instead of reading the word Blue )
Why is the Stroop Test significant in understanding ADHD?
It highlights difficulties with attention control and response inhibition, which are common challenges for individuals with the disorder.
What vital signs should be monitored during the physical examination of ADHD patients?
HR and BP
Why is it important to assess for exercise syncope, breathlessness, and cardiac symptoms in ADHD patients?
These symptoms can indicate underlying cardiovascular issues that stimulant medications may exacerbate.
When should an ECG be performed in ADHD patients?
If there is a family history of serious cardiac disease or sudden death.
What type of risk assessment should be conducted during the physical examination?
Risk assessment for substance misuse and drug diversion.
What physical measurements should be taken during the examination?
Weight and height
How does monitoring weight and height contribute to the physical examination?
It helps identify potential growth delays associated with ADHD medications
What are the two main categories of treatment for ADHD?
pharmacology and non-pharmacology.
What types of medications are included in the pharmacological treatment for ADHD?
stimulants and non-stimulants
What are some non-pharmacological approaches to managing ADHD?
- Psychosocial management
- Dietary interventions
- Psychological interventions
What is the purpose of psycho-education in ADHD management?
Psycho-education aims to inform parents, children, and schools about ADHD, its effects, and effective management strategies
What does phycho-social management include ?
- Psycho-education: parent/child/school
- Develop therapeutic alliance
- Promote consistent parenting
- Parent-child relational work
- Address parents’ ADHD etc
- Behavioural intervention (+ve reinforcement etc)
- Group therapy (social skills
- OT and S.A.L.T (Speech and Language Therapy)
What does parent-child relational work involve?
Parent-child relational work involves strategies to strengthen the relationship between parents and children, improving communication and understanding.
What type of therapy helps with social skills in ADHD?
Group therapy (social skills).
What type of training focuses on improving attention and working memory?
Cognitive training.
What is the purpose of cognitive training in ADHD management ?
Attention and working memory training
List the behavioural interventions used in psychological treatment of ADHD.
- Parent training
- Parent-child training
- Parent-child plus teacher training
- CBT with child
What type of diet requires better evidence?
Restricted elimination diets (You stop eating certain foods for a few weeks and then slowly reintroduce them one at a time)
What is the effect of excluding artificial food colors for those with food sensitivities?
Larger Rx effect (if food sensitivities).
What type of supplementation may lead to a small reduction in ADHD symptoms?
Free fatty acid supplementation (EPA/DHA).
What general dietary advice does NICE recommend for individuals with ADHD?
A healthy balanced diet and exercise.
What does the guidance say about removing artificial food colorants and additives?
It discourages removal from the diet.
What stance is taken on fatty acid supplementation in dietary treatment for ADHD?
fatty acid supplementation is opposed
What should be done if a link between diet and ADHD symptoms is observed?
Need a food diary and dietician referral.
What caution is noted regarding dietary interventions for ADHD?
Lack of concrete evidence.
what stimulant is used in the treatment of ADHD ?
Methylphenidate
What is an example of a short-acting/immediate-release stimulant used for ADHD?
Methylphenidate (Ritalin)
(Duration: 3-4 hours)
What is an example of an intermediate-release stimulant used for ADHD?
Methylphenidate (Ritalin LA)
(Duration: 8 hours)
What is an example of a long-acting/modified-release stimulant used for ADHD?
Methylphenidate (Concerta XL)
Duration: 12 hours
What are examples of non-stimulant medications used for ADHD?
- Atomoxetine
- Extended-release guanfacine (ER)
- Extended-release clonidine (ER)
What type of medication is Atomoxetine?
A selective noradrenaline reuptake inhibitor (SNRI).
What secondary effect may Atomoxetine have?
It may cause a secondary increase in dopamine levels.
In which cases is Atomoxetine particularly indicated?
ADHD with comorbid anxiety disorders and history of substance misuse (diversion).
How does the onset of action for Atomoxetine compare to stimulants?
It has a slower onset of action but can be taken once daily.
What is the starting dose range for Atomoxetine?
- 0.5 mg/kg/day to 1.2 mg/kg/day
- maximum 2.1 mg/kg/day.
What are Clonidine and Guanfacine classified as?
Alpha-2 agonists
Which is more selective and has fewer adverse effects, Clonidine or Guanfacine?
Guanfacine.
For which patients is Guanfacine particularly effective?
Patients with comorbid tic disorders.
What is Lisdexamphetamine?
An inactive component (prodrug) that is gradually converted into an active form of dextroamphetamine.
How long can the effects of Lisdexamphetamine last?
Up to 13 hours, thus not needing repeated doses during the day.
Why is the effect of Lisdexamphetamine prolonged ?
Due to its gradual conversion
Which medications are recommended within their licensed indications for ADHD?
Methylphenidate, dexamphetamine, and atomoxetine.
What factors influence the choice of medication for ADHD?
– Co-morbid conditions (eg tics/epilepsy)
– Tolerability, adverse effects
– Convenience of dosing ( compliance/schools)
– Potential for diversion
– Patient/ parent preference
What should be considered if more than one medication is suitable?
Prescribe the medication with the lowest cost.
What should be monitored for loss of appetite in patients on ADHD medication and how often?
Measure weight before starting medication and then every 3-4 months
What is a potential side effect related to growth in children taking ADHD medication?
Growth delay
How should the growth be monitored in kids with ADHD and how often ?
measure height before starting medication and then every 3-4 months.
What should be gathered before prescribing medication regarding sleep?
Information on insomnia.
How often should cardiovascular side effects be monitored in patients on ADHD medication?
Monitor blood pressure and pulse every 3-6 months.
What specific hepatotoxicity concerns are associated with Atomoxetine?
Increase in hepatic enzymes, bilirubin, and jaundice.
What is a serious potential side effect of ADHD medications that requires monitoring?
Emergent suicidal behaviors.
What tools can be used to assess sleep disturbances in patients?
Sleep diary and polysomnography if a sleep breathing disorder is suspected
What actions should be taken if sleep disturbances are noted?
Monitor, stop medication, add a small dose if rebound occurs, add melatonin, or change the stimulant.
When should a patient be referred to psychiatry?
If unsure of diagnosis, parents request a second opinion, the patient is under 6 years old, has a complex diagnosis, or shows poor response to treatment.
What is the maximum dose of methylphenidate recommended by a GP?
Maximum 1 mg/kg/day.
