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Psychiatry3 > ADHD > Flashcards

ADHD Flashcards

1
Q

What is the classification in the DSM-5 (2013) for ADHD?

A

Attention Deficit Hyperactivity Disorder.

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2
Q

What is the prevalence of ADHD among children and adolescents?

A

3-10%.

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3
Q

What is the prevalence of ADHD in the adult population?

A

2-5%.

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4
Q

How is ADHD prevalence characterized across the human population?

A

It is universal among the human population.

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5
Q

What is the reported prevalence of ADHD in the USA?

A

2-20%.

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6
Q

What is the reported prevalence of ADHD in the UK?

A

3-9%, indicating a 50% increase.

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7
Q

What is the male-to-female ratio (M:F) for ADHD prevalence?

A

3-4:1

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8
Q

What is the aetiology of ADHD?

A
  • Genetic / hereditary (genes DAT1, DRD4 etc)
  • Peri-natal problems (prem & low birth weight)
  • In utero exposure to tobacco smoke
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9
Q

What are the neurodevelopmental disorders listed in the DSM-5?

A
  • ADHD
  • ASD
  • Communication Disorders
  • Intellectual Disability
  • Specific learning disability
  • Motor disorders (Tics, stereotypical
    movement & DCD)
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10
Q

What are the key updates regarding ADHD in the DSM-5?

A
  • 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.
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11
Q

Can ADHD be diagnosed in individuals with comorbid ASD according to DSM-5?

A

Yes, ADHD can be diagnosed with comorbid ASD

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12
Q

What is the minimum duration for ADHD symptoms according to DSM-5?

A

Symptoms must be present for at least 6 months.

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13
Q

Symptoms must be present for at least 6 months.

A

Symptoms must be inconsistent with the individual’s developmental level.

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14
Q

What negative impacts must ADHD symptoms have according to DSM-5?

A

Symptoms must have a negative impact on social, school, or work functioning.

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15
Q

What must ADHD symptoms not solely be a manifestation of, according to DSM-5?

A

Symptoms must not be solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks (e.g., learning disabilities).

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16
Q

By what age must ADHD symptoms be present for a diagnosis according to DSM-5?

A

Symptoms must be present before the age of 12 years.

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17
Q

What are the movement-related behaviors in hyperactivity/impulsivity?

A
  • Fidgets, squirms
  • Leaves seat
  • Runs or climbs
  • Unable to play quietly
  • on the go/driven by a motor
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18
Q

What are the verbal behaviors associated with hyperactivity/impulsivity?

A
  • Talks excessively
  • Blurts out answers
  • Interrupts
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19
Q

What are the behaviors related to impaired self-control in hyperactivity/impulsivity?

A
  • Difficulty waiting turn
  • Impaired response inhibition, impulse control, or the capacity to delay gratification
  • Inability to stop and think before acting/doing
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20
Q

What impulsive behavior might a child with ADHD exhibit in social situations?

A

Interrupting others during conversations.

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21
Q

What does it mean when a child is described as “on the go/driven by a motor”?

A

They are constantly active and unable to stay still.

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22
Q

What cognitive challenge might children with ADHD experience before acting?

A

They may have an inability to stop and think before acting or doing something.

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23
Q

What difficulties with attention are commonly seen in inattention?

A
  • Fails to give close attention/careless
  • Can’t sustain attention
  • Does not listen
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24
Q

What are the task management issues associated with inattention?

A
  • Cannot follow through/tasks incomplete
  • Difficulty organizing tasks
  • Avoids mental effort
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25
Q

What are the behaviors related to forgetfulness and distraction in inattention?

A
  • Often loses things
  • Easily distracted
  • Forgetful
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26
Q

What is a common issue with task completion for individuals with ADHD?

A

They may start tasks but cannot follow through, leading to incomplete work.

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27
Q

What organizational challenge might a child with ADHD face?

A

Difficulty organizing tasks and activities.

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28
Q

How do individuals with ADHD typically respond to tasks that require mental effort?

A

They may avoid tasks that require significant mental effort.

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29
Q

What other behaviours seen in ADHD ?

A
  • 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
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30
Q

What is a symptom of inattention during the preschool years?

A
  • Short play
    *Incomplete activities
  • Not listening
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31
Q

How does inattention manifest during primary school years?

A
  • Brief activities
  • Changes activity
  • Forgetful,
  • disorganised
  • distracted
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32
Q

What are the signs of inattention in adolescence?

A
  • Less persistence
  • Lack of focus on details
  • planning
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33
Q

How does inattention present in adulthood?

A
  • Incomplete details
  • Forget appts
  • Lack of foresight
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34
Q

What is a symptom of overactivity during the preschool years?

A

Whirlwind ( chaos)

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35
Q

How does overactivity manifest during primary school years?

A
  • Restless
  • hyperactive
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36
Q

What are the signs of overactivity in adolescence?

A

Fidgety

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37
Q

How does overactivity present in adulthood?

A

Subjective feelings of restlessness.

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38
Q

What is a symptoms of impulsivity during the preschool years?

A
  • Does not
    listen
  • No sense of
    danger
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39
Q

How does impulsivity manifest during primary school years?

A

Acts out of turn, interrupts, and intrusive thoughtless.

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40
Q

What are the signs of impulsivity in adolescence?

A

poor self-control, and reckless risk-taking.

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41
Q

How does impulsivity present in adulthood?

A
  • Accidents
  • Impatience
  • and premature decision-making.
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42
Q

What does the specifier “Combined” mean in ADHD?

A

the individual exhibits symptoms of hyperactivity, impulsivity, and inattention. The person shows a mix of behaviors.

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43
Q

What does “Predominantly inattentive” signify in ADHD?

A

The person primarily struggles with inattention without significant hyperactive or impulsive behaviors

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44
Q

What characterizes the “Predominantly hyperactive/impulsive” specifier in ADHD?

A

individuals who primarily show hyperactive and impulsive behaviors without significant inattention

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45
Q

Why are females with ADHD often underdiagnosed and misdiagnosed?

A

They are often being mistaken for having mood disorders due to their high levels of inattention and less disruptive behavior compared to males.

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46
Q

What are the typical symptoms of ADHD in females?

A
  • high levels of inattention and lower levels of hyperactivity.
  • less distruptive
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47
Q

How do hormonal changes in adolescence affect females with ADHD?

A

Hormonal changes during adolescence, particularly related to estrogen, can impact the expression of ADHD symptoms in females, potentially exacerbating inattention and emotional regulation issues.

48
Q

What is the risk of substance abuse in females with ADHD?

A

Greater risk of substance abuse.

49
Q

How do females with ADHD respond to treatment?

A

Females with ADHD generally respond well to medication and behavioral interventions

50
Q

How do environmental demands affect females with ADHD?

A

As environmental demands increase, the symptoms of ADHD in females may become more apparent/obvious.

51
Q

Who should conduct the assessment for ADHD?

A

Pediatricians, child psychologists, general practitioners (GPs), or healthcare providers (HCPs) with expertise in ADHD.

52
Q

What types of history are important in the ADHD assessment?

A
  • 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
53
Q

What role does school information play in the ADHD assessment?

A

It provides insights into the child’s behavior and performance in an academic setting, helping to identify patterns of inattention or hyperactivity.

54
Q

What are psychometric assessments used for in ADHD evaluation?

A
  • Used to evaluate cognitive and behavioral functioning, helping to exclude learning disabilities
  • provide a clearer picture of the child’s abilities
55
Q

What rating scales are commonly used in ADHD assessments?

A

SNAP (Swanson, Nolan, and Pelham)

56
Q

What is the SNAP scale used for?

A

Commonly used to gather standardized information about the child’s behavior from parents and teachers

57
Q

What criteria must be met for an ADHD diagnosis?

A

The diagnosis must meet the DSM V or ICD 10 criteria and demonstrate moderate impairment in more than one setting

58
Q

During assessment for ADHD who else must be spokenn to eccept for parents and teachers?

A

The child

59
Q

In addition to the assessment of the child who else must be assessed ?

A

Parents

60
Q

What does the Stroop Test measure?

A

It measures attention, specifically selective attention, by assessing how well individuals can manage conflicting information.

61
Q

How does the Stroop Test utilize reading and color naming?

A

The test takes advantage of our ability to read words more quickly and automatically than to name colors, creating a conflict that challenges attention.

62
Q

What is the main challenge presented by the Stroop Test?

A

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 )

63
Q

Why is the Stroop Test significant in understanding ADHD?

A

It highlights difficulties with attention control and response inhibition, which are common challenges for individuals with the disorder.

64
Q

What vital signs should be monitored during the physical examination of ADHD patients?

A

HR and BP

65
Q

Why is it important to assess for exercise syncope, breathlessness, and cardiac symptoms in ADHD patients?

A

These symptoms can indicate underlying cardiovascular issues that stimulant medications may exacerbate.

66
Q

When should an ECG be performed in ADHD patients?

A

If there is a family history of serious cardiac disease or sudden death.

67
Q

What type of risk assessment should be conducted during the physical examination?

A

Risk assessment for substance misuse and drug diversion.

68
Q

What physical measurements should be taken during the examination?

A

Weight and height

69
Q

How does monitoring weight and height contribute to the physical examination?

A

It helps identify potential growth delays associated with ADHD medications

70
Q

What are the two main categories of treatment for ADHD?

A

pharmacology and non-pharmacology.

71
Q

What types of medications are included in the pharmacological treatment for ADHD?

A

stimulants and non-stimulants

72
Q

What are some non-pharmacological approaches to managing ADHD?

A
  • Psychosocial management
  • Dietary interventions
  • Psychological interventions
73
Q

What is the purpose of psycho-education in ADHD management?

A

Psycho-education aims to inform parents, children, and schools about ADHD, its effects, and effective management strategies

74
Q

What does phycho-social management include ?

A
  • 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)
75
Q

What does parent-child relational work involve?

A

Parent-child relational work involves strategies to strengthen the relationship between parents and children, improving communication and understanding.

76
Q

What type of therapy helps with social skills in ADHD?

A

Group therapy (social skills).

77
Q

What type of training focuses on improving attention and working memory?

A

Cognitive training.

78
Q

What is the purpose of cognitive training in ADHD management ?

A

Attention and working memory training

79
Q

List the behavioural interventions used in psychological treatment of ADHD.

A
  • Parent training
  • Parent-child training
  • Parent-child plus teacher training
  • CBT with child
80
Q

What type of diet requires better evidence?

A

Restricted elimination diets (You stop eating certain foods for a few weeks and then slowly reintroduce them one at a time)

81
Q

What is the effect of excluding artificial food colors for those with food sensitivities?

A

Larger Rx effect (if food sensitivities).

82
Q

What type of supplementation may lead to a small reduction in ADHD symptoms?

A

Free fatty acid supplementation (EPA/DHA).

83
Q

What general dietary advice does NICE recommend for individuals with ADHD?

A

A healthy balanced diet and exercise.

84
Q

What does the guidance say about removing artificial food colorants and additives?

A

It discourages removal from the diet.

85
Q

What stance is taken on fatty acid supplementation in dietary treatment for ADHD?

A

fatty acid supplementation is opposed

86
Q

What should be done if a link between diet and ADHD symptoms is observed?

A

Need a food diary and dietician referral.

87
Q

What caution is noted regarding dietary interventions for ADHD?

A

Lack of concrete evidence.

88
Q

what stimulant is used in the treatment of ADHD ?

A

Methylphenidate

89
Q

What is an example of a short-acting/immediate-release stimulant used for ADHD?

A

Methylphenidate (Ritalin)
(Duration: 3-4 hours)

90
Q

What is an example of an intermediate-release stimulant used for ADHD?

A

Methylphenidate (Ritalin LA)
(Duration: 8 hours)

91
Q

What is an example of a long-acting/modified-release stimulant used for ADHD?

A

Methylphenidate (Concerta XL)
Duration: 12 hours

92
Q

What are examples of non-stimulant medications used for ADHD?

A
  • Atomoxetine
  • Extended-release guanfacine (ER)
  • Extended-release clonidine (ER)
93
Q

What type of medication is Atomoxetine?

A

A selective noradrenaline reuptake inhibitor (SNRI).

94
Q

What secondary effect may Atomoxetine have?

A

It may cause a secondary increase in dopamine levels.

95
Q

In which cases is Atomoxetine particularly indicated?

A

ADHD with comorbid anxiety disorders and history of substance misuse (diversion).

96
Q

How does the onset of action for Atomoxetine compare to stimulants?

A

It has a slower onset of action but can be taken once daily.

97
Q

What is the starting dose range for Atomoxetine?

A
  • 0.5 mg/kg/day to 1.2 mg/kg/day
  • maximum 2.1 mg/kg/day.
98
Q

What are Clonidine and Guanfacine classified as?

A

Alpha-2 agonists

99
Q

Which is more selective and has fewer adverse effects, Clonidine or Guanfacine?

A

Guanfacine.

100
Q

For which patients is Guanfacine particularly effective?

A

Patients with comorbid tic disorders.

101
Q

What is Lisdexamphetamine?

A

An inactive component (prodrug) that is gradually converted into an active form of dextroamphetamine.

102
Q

How long can the effects of Lisdexamphetamine last?

A

Up to 13 hours, thus not needing repeated doses during the day.

103
Q

Why is the effect of Lisdexamphetamine prolonged ?

A

Due to its gradual conversion

104
Q

Which medications are recommended within their licensed indications for ADHD?

A

Methylphenidate, dexamphetamine, and atomoxetine.

105
Q

What factors influence the choice of medication for ADHD?

A

– Co-morbid conditions (eg tics/epilepsy)
– Tolerability, adverse effects
– Convenience of dosing ( compliance/schools)
– Potential for diversion
– Patient/ parent preference

106
Q

What should be considered if more than one medication is suitable?

A

Prescribe the medication with the lowest cost.

107
Q

What should be monitored for loss of appetite in patients on ADHD medication and how often?

A

Measure weight before starting medication and then every 3-4 months

108
Q

What is a potential side effect related to growth in children taking ADHD medication?

A

Growth delay

109
Q

How should the growth be monitored in kids with ADHD and how often ?

A

measure height before starting medication and then every 3-4 months.

110
Q

What should be gathered before prescribing medication regarding sleep?

A

Information on insomnia.

111
Q

How often should cardiovascular side effects be monitored in patients on ADHD medication?

A

Monitor blood pressure and pulse every 3-6 months.

112
Q

What specific hepatotoxicity concerns are associated with Atomoxetine?

A

Increase in hepatic enzymes, bilirubin, and jaundice.

113
Q

What is a serious potential side effect of ADHD medications that requires monitoring?

A

Emergent suicidal behaviors.

114
Q

What tools can be used to assess sleep disturbances in patients?

A

Sleep diary and polysomnography if a sleep breathing disorder is suspected

115
Q

What actions should be taken if sleep disturbances are noted?

A

Monitor, stop medication, add a small dose if rebound occurs, add melatonin, or change the stimulant.

116
Q

When should a patient be referred to psychiatry?

A

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.

117
Q

What is the maximum dose of methylphenidate recommended by a GP?

A

Maximum 1 mg/kg/day.

Psychiatry3 (7 decks)

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