ADHD Flashcards
Describe some causative factors associated with ADHD
- CNS Injury
- Genetics
- Environment
- Smoking, lead, low birth weight
Describe the characteristics of a child diagnosed with ADHD?
o Academic limitations
o Poor Peer Relationships
o Increased injuries
Identify symptoms of Inattention
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
- Often has trouble holding attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
- Often has trouble organizing tasks and activities.
- Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
- Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
- Is often easily distracted
Identify symptoms of Hyperactivity and Impulsivity
- Often fidgets with or taps hands or feet, or squirms in seat.
- Often leaves seat in situations when remaining seated is expected.
- Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
- Often unable to play or take part in leisure activities quietly.
- Is often “on the go” acting as if “driven by a motor”.
- Often talks excessively.
- Often blurts out an answer before a question has been completed.
- Often has trouble waiting his/her turn.
- Often interrupts or intrudes on others
Name and define the 3 presentations of ADHD
- Combined Type
- Predominantly Inattentive Type
- Predominately Hyperactive-Impulsive Type
What is the combined type of ADHD?
If enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
What is the predominantly inattentive type like in ADHD?
If enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
What is the predominately hyperactive-impulsive type like in ADHD?
If enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months
Identify factors that can help with evaluation of ADHD
- Family – parents (individually), siblings, extended family
- School
- Teachers
- Report Cards
- Past Medical Records
- Rating Scales – Vanderbilt, BASC
- Psychological Evaluations
- Family History
- Home Environment
- Social Events
- Babysitters
- School Functioning
- Peer Relationships
- Police Records, problems with authority
- Associated Complaints
Describe treatment goals for ADHD?
o Improved Cognition
o Decreased motor activity
o Improved social skills
o Improved efficiency
Describe all treatments for ADHD
1. Behavioral Counseling A. CONSISTENCY B. Positive Reinforcement C. Time Management D. Parents / Child / School 2. Parenting Classes 3. Medication 4. School Involvement 5. Activities 6. Other Problems
DSM V Diagnosis guidelines
Inattention
Hyperactivity – impulsivity
Duration at least 6 months
Onset before age 12 (was 7)
Impairment in 2 or more settings (home, work, school, social situations)
Clinically significant impairment must be evident in social, academic, or occupational functioning
Symptoms of inattention: How many do children up to 16 need for a diagnosis?
6 or more!
Symptoms of inattention: How many do adolescents 17 and older need for a diagnosis?
5 or more!
Symptoms of hyperactivity & Impulsivity: How many do children up to 16 need?
6 or more!
Symptoms of hyperactivity & Impulsivity: How many do adolescents 17 and older need?
5 or more!
Which 2 neurotransmitters are out of balance in ADHD?
- Dopamine
2. Serotonin
Differential Diagnoses for ADHD
Mood Disorders Anxiety Disorders Psychosis Pervasive Developmental Disorder Learning Disabilities Poor environmental controls Family Dysfunction PTSD Oppositional Defiant Disorder Conduct Disorder Tourette’s Syndrome Age – appropriate over-activity
Factors that will delay a diagnosis of ADHD?
Primary Inattentive Subtype Female Sex Highly Supportive Family High IQ Well Developed Social Skills
Name some neurodevelopment disorders associated with ADHD?
Fetal alcohol syndrome Alcohol related neurodevelopment disorder Down syndrome Prader-Willi syndrome Williams syndrome Tourette syndrome Turner syndrome
FDA approved Medications for ADHD?
- Stimulants
A. Methylphenidate (eg: Ritalin, Concerta, Focalin)
B. Amphetamine (eg: Dexedrine, Adderall, Vyvanse) - Non-stimulants
A. Atomoxetine (Strattera)
B. Guanfacine XR (Intuniv)
Clonidine XR (Kapvay)
MOA: Stimulant (Methylphenidate)
Blocks dopamine uptake by inhibition of dopamine transporter (DAT) of central adrenergic neurons
MOA: Stimulant (Amphetamines)
Not only block Dopamine Transporter (DAT) but also increase catecholamine release as a primary mechanism
Which non-stimulant medication is approved for the treatment of children, adolescents, & adults with ADHD?
Atomoxetine (Strattera)
Which non-stimulants are approved for treatment of solely children & adolescents 6-17? No adults
- Guanfacine XR (Intuniv)
2. Clonidine XR (Kapvay)
What is the MOA for non-stimulant Atomoxetine (Strattera)?
Blocks reuptake at the noradrenergic neurons
MOA for non-stimulants: Guanfacine XR (Intuniv) & Clonidine XR (Kapvay)?
An alpha-2A adrenergic receptor agonist
What is the initial medical work up for stimulants?
- Physical Exam
- Height and Weight
- Blood Pressure and Pulse
- Lab tests as baseline data (cbc and dif, LFT) Screening for tics, involuntary movements
- Pregnancy Tests
Most Common (less severe) SE of Stimulants
Decreased appetite Insomnia Gastrointestinal pain Rebound phenomena Mood swings and irritability Increased heart rate (clinically insignificant)
Less common (more severe) SE of Stimulants
Growth retardation Tic disorders Psychosis Mood swings / depression Increased heart rate and BP (significant)
Children < 5 yrs should not be given what as a treatment of first choice?
Stimulants
A. Higher incidence of SE
What drug is not approved for children <6 years old?
Methylphenidate
Short acting and long acting Methylphenidate’s include?
1. Short Acting A. Ritalin B. Focalin 2. Long Acting A. Ritalin SR B. Metadate CD C. Concerta D. Ritalin LA E. Patches F. Quillivant Elixir
Short and long acting Amphetamine’s?
1. Short Acting A. Dexedrine B. Adderall 2. Long Acting A. Dexedrine Spansule B. Adderall XR C. Vyvanse
With ADHD there is increased risk for what?
- Conduct Disorder
- Antisocial Personality Disorder
- Psychiatric problems
