ADHD Flashcards
Why do girls tend to be underdiagnosed with ADHD when compared to boys?
- Girls tend to have inattentive/distractible symptoms which are less disruptive and boys tend to display impulsive/hyperactive symptoms which are noticed.
How heritable is ADHD?
- Very (75%)
What else would be on your DDX for a child being investigated for ADHD?
- Learning disorder
- Hearing/Vision disorder
- Hyperthyroidism
- Congenital problems (FASD, Fragile X)
- Lead poisoning (only if history dictates)
- Previous head injury
- Normal response to traumatic events
What are the symptoms of inattention? (9)
- Careless mistake
- Can’t sustain attention in tasks or play
- Not listening when directly spoken to
- Fails to complete tasks
- Disorganized
- Avoids, dislikes tasks needing sustained mental effort
- Loses things needed for tasks or activities
- Distractable
- Forgetful
- I like to categorize based on
1) Things hard to do because of inattention
2) Things they avoid because inattention makes harder and they are bad at
What are the symptoms of hyperactivity? (6)
- Fidgits or squirms in seat
- Leaves seat when shouldn’t
- Runs or climbs ++
- Can’t play quietly
- “Driven by motor” on the go
- Talks excessively
What are the symptoms of impulsivity? (4)
- Blurts out answers before question finished
- Difficulty waiting turn
- Interrupts others
Why is ADHD very difficult to diagnose in children under 4 years?
- In this young age group normal behaviour is highly variable
- Often identified upon school entry
When children are not treated for ADHD, what problems do they have more commonly as adults?
1) Academic
- increased drop out
- lower grades
2) Social fx and self esteem
- Child too distracted observe social norms
3) Health and Injury
- Increase risk of mental illness and substance abuse
- Impulsivity increases risk of traumatic injury
4) Criminality
- Impulsivity increases risk
5) Sexual behaviour
- more likely to partake in risky behaviour
What are some non-pharmacological treatment options for ADHD?
Behaviour Modification
- Positive reinforcement (reward/privilege)
- Negative consequences
- Small class size
- Structure
- Appropriate seating arrangement at school
- Exercise / Extracurricular
What are the first line Pharmacological treatment options for ADHD?
First Line: Stimulants
- Methylphenidate
- Amphetamine salts
What is second line pharma treatment for ADHD? Third line?
2nd: Atomoxetine
- NE reuptake inhibitor
3rd: Alpha agonists (clonidine, guanfacine) & NDRI (buproprion)
What are common side effects of stimulant medications?
- Decreased appetite
- Sleep problems
- Delayed growth
- Tachy/Palpitations
- Headache
- Irritability/Anxiety
What percentage of children with ADHD will have symptoms continue into adolescence? Adulthood?
- Adolescence (70-80%) but hyperactivity tends to settle
- 65% continue
What is ADHD in a general sense?
- Attention deficit hyperactivity disorder
- Developmentally inappropriate inattentiveness, hyperactivity, and impulsivity
What percentage of school age children are affected by ADHD?
3-10%
Why is psychological and developmental testing part of the ADHD evaluation?
- Psychological and learning disorders are common in the ADHD population
What are the most common coexisting psychiatric disorders in children with ADHD?
- Oppositional defiant disorder (35%)
- Conduct disorder (25%)
- Anxiety disorder (25%)
- Depressive disorder (18%)
What is required for a diagnosis of Combined type ADHD?
- 6+ symptoms of hyperactivity/impulsivity
- AND 6+ symptoms of inattention
- 6+ months
- symptoms interfering with function
- Occur in 2+ settings
- Occur before age 12
- Not due to other medical issue
What is required for Inattentive type ADHD diagnosis?
- 6+ symptoms of inattention
- 6+ months
- symptoms interfering with function
- Occur in 2+ settings
- occur before age 12
- Not due to other medical issue
What is required for a diagnosis of hyperactive/impulsive type ADHD?
6+ symptoms of hyperactivity/impulsive
- 6+ months
- symptoms interfering with function
- Occur in 2+ settings
- Occur before age 12
- Not due to other medical issue
The criteria for diagnosis of ADHD changes slightly after a certain age. What age is this and what is the change?
- Age 17
- After which 5+ features will result in a diagnosis along with meeting remaining criteria
- Symptoms should have been present before the age of 12
