ADHD

Question 1

what is ADHD?

Answer 1

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterised by persistent patterns of inattention, impulsivity, and hyperactivity that are inappropriate for the individual’s developmental level. The symptoms significantly affect daily functioning in more than one setting, such as at home, school or work.

Question 2

what are the subtypes of ADHD?

Answer 2

Inattentive subtype (20-30% of cases)
Hyperactive-impulsive subtype (15% of cases)
Combined subtype (50-75% of cases)

Question 3

what are RF for ADHD?

Answer 3

Family history
Low birth weight
Maternal smoking during pregnancy
Less associated risk factors include: preterm delivery, epilepsy, acquired brain injury, lead exposure, iron deficiency, alcohol exposure during pregnancy

Question 4

what are inattentive symptoms of ADHD?

Answer 4

Difficulty focusing on and completing tasks
Disorganisation
Forgetfulness and losing possessions
Careless mistakes

Question 5

what ar hyperactivity and impulsivity symptoms of ADHD?

Answer 5

Excessive movement and activity(ie fidgeting, tapping, chattiness)
Decisions or actions which are not thought through and have potential risk associated with them (ie interrupting others, temper outbursts)

Question 6

what are additional criteria needed to diagnose ADHD?

Answer 6

Question 7

how do you diagnose ADHD?

Answer 7

Question 8

what is the conservative management of ADHD?

Answer 8

Question 9

what is the medical management of ADHD?

Answer 9

1st = methylphenidate
then Lisdexamfetamine and Dexamfetamine; Atomoxetine

Question 10

who is methylphenidate used in?

Answer 10

Used in children over the age of 5 years
Initiated by a psychiatrist, but is under shared care or continued by the G

Question 11

s/e methylphenidate?

Answer 11

Abdominal pain, nausea, GI upset
Palpitations and arrhythmia
Insomnia
Impaired cognitive function

Question 12

when should methylphenidate not be used?

Answer 12

Should not be used in children with a history of arrhythmias, cardiomyopathy or severe mental health disorders.

Question 13

who are Lisdexamfetamine and Dexamfetamine used in?

Answer 13

Used in children over the age of 5 years for who a 6-week trial of methylphenidate has not worked

Question 14

s/e of Lisdexamfetamine and Dexamfetamine

Answer 14

Reduced appetite, poor weight gain and reduced growth
Insomnia
Arrhythmia and hypertension

Question 15

what is atomoxetine?

Answer 15

A selective noradrenaline reuptake inhibitor (SNRI)

Question 16

s/e atomoxetine?

Answer 16

GI effects: dry mouth, nausea, vomiting
Suicidal ideation
Palpitations, tachycardiw

Question 17

what motoring is needed for ADHD meds?

Answer 17

For all of these drugs, patients require weight, height, blood pressure, heart rate and physiatric monitoring on initiation, dose changes and every 6 months whilst on these medications. This is because they can impact appetite and so it is vital to ensure children are still growing in a healthy manner.

Question 18

what is the prognosis of ADHD?

Answer 18

Many children with ADHD are said to be in “partial remission” by the age of 25, such that some symptoms still remain and continue to cause an impairment in function. It is estimated that 15% of children with ADHD will still meet diagnostic criteria at age 25.

Question 19

what is 1st line in adults?

Answer 19

Question 20

what do you need to remember about ADHD drugs?

Answer 20

Methylphenidate and lisdexamfetamine are cardiotoxic.

Perform a baseline ECG before starting treatment, and refer to a cardiologist if there is any significant past medical history or family history, or any doubt or ambiguity.