ADHD

Question 1

What is and is not ADHD?

Answer 1

IS:
Excessive Inattention
Hyperactivity
Impulsivity
Any combination of the above

IS NOT:
Oppositional Behaviors
Intellectual Disability (can have at any IQ)
Specific Learning Disorder
Only reason for poor focus or hyperactivity

Question 2

Neuropsychological Deficits in ADHD

Answer 2

Response Inhibition

Delay Aversion (Focus on just what’s right in front of you)

Executive Functioning

Question 3

Types of ADHD

Answer 3

Inattentive Type
Hyperactive/Impulsive Type
Combined Type

Question 4

Inattentive Type ADHD

Answer 4

Careless mistakes
Difficulty sustaining attention
Often does not seem to listen when spoken to directly
Poor follow through
Often avoids, dislikes, or is reluctant to do tasks that require sustained mental effort (e.g. homework, notes, taxes, etc)
Is often forgetful in daily activities

Question 5

Hyperactive/Impulsive Type

Answer 5

Fidgeting; Difficulty sitting still 
Often unable to play or take part in leisure activities quietly.
“Driven by a motor” (high energy level)
Often talks excessively.
Often has trouble waiting for turn

Question 6

How to make the diagnosis of ADHD?

Answer 6

Good diagnostic interview and exam:

6 or more symptoms (of the 9) in either (or both) category; 5 symptoms for >17 y.o.

Several symptoms present before age 12

Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities).

There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.

Question 7

What correlates with earlier and later diagnosis of ADHD?

Answer 7

Earlier: more hyperactive
Later: Higher IQ

Question 8

Comorbidities of ADHD

Answer 8

Developmental risks (less education completed)
Antisocial personality disorder
Non-alcohol drug abuse
Tobacco use
Major depression 
Enuresis
Oppositional disorder
Conduct disorder
Overanxious 
Separation Anxiety
Social phobia
Simple phobia
Multiple anxiety
Learning disabilities

Question 9

Stimulants

Answer 9

2 classes:

1. Amphetamines: Adderall
2. Methylphenidates: Ritalin

Effective and typically well-tolerated

Rule of thumb: About 80-90% reduction in symptom burden with right dose

Improve quality of life generally

Question 10

ADHD and ODD

Answer 10

NOT the same

but are comorbidities

Question 11

Meds for ADHD

Answer 11

Very effective

Stimulants
Atomoxetine
Bupropion

Question 12

ADHD and substance abuse

Answer 12

Adults with ADHD have higher rates of substance abuse

Treatments early-on help protect against this.

Question 13

Differential for attention problems

Answer 13

Broad

Don’t forget about physical problems like obstructive sleep apnea