ADHD

Question 1

Dx criteria for ADHD

Answer 1

3 subtypes, Sx for >6mo:

- Combined Type: 6 or more symptoms of inattention and 6 or more symptoms of hyperactivity-impulsivity 
- Predominantly Inattentive Type: 6 or more symptoms of inattention 
- Predominantly Hyperactive-Impulsive Type: 6 or more symptoms of hyperactivity- impulsivity 

• for older adolescents (>17 yr) or adults, 5 symptoms required
• onset no later than 7
• symptoms present in at least two settings (i.e. home, school, work)
• interferes with academic, family, and social functioning
does not occur exclusively during the course of another psychiatric disorder

Question 2

Epidemiology for ADHD: M/F? % of children?

Answer 2

• 5-7% school-aged children
• Boys 2-3x more than girls
  • Boys more impulsive/hyperactive Sx
  • Girls more inattentive/distractable Sx

Question 3

Clinical features of ADHD

Answer 3

• Inattention: careless mistakes, can’t concentrate/listen well/finish tasks, disorganised, lose things, distractable, forgetful
• Impulsivity: interrupts, can’t wait turn, losing control of emotions easily, being accident prone
Over(hyper)activity: ‘on the go’, fidgets/leaves seat, talks a lot

Question 4

Associated co-morbidities with ADHD

Answer 4

• Oppositional defiant behaviour
• Anxiety
• Learning difficulties
• Language disorder
• Tics
• Mood disorder e.g. anxiety, depression
• Substance abuse disorder

Question 5

Psychological/Behavioural Mx of ADHD

Answer 5

• Need psychologist referral, assessment and intervention
  
  • Requires interventional support for child, family and school over many years
• Positive parenting; boosting self-esteem, social skills
• Environmental manipulation: home and classroom strategies e.g. sit closer to teacher; optimal learning environment
• Time-management strategies
  
  • use of prompts and checklists (e.g. visual aides)
  • se of timers and signals
• Behavioural strategies
  
  • Clear instructions, rules and immediate consequences
  • setting academic targets and behavioural goals
  • reward pro-social behaviours immediately

• Working Memory Strategies
• Environmental Changes e.g. aides, quiet areas
• Skills to teach the young person
○ The ability to ask for help
○ Chunking, Rehearsal, Rote learning, Mental images
○ Taking frequent breaks during study
○ Setting realistic targets for periods of work

Question 6

1st line Rx for ADHD: what, what age to use, what must be monitored, AEs

Answer 6

○ Methylphenidate (Ritalin) and dexamphetamine
○ With rare exceptions, do not use stimulants in children aged younger than 4 years
○ help children to control antisocial verbal and physical impulses and sustain attention to tasks
○ Must monitor weight, height, BP
AEs: abdo discomfort, headache, tics, psychiatric e.g. psychosis, mania

Question 7

2nd and 3rd line Rx ADHD

Answer 7

• 2nd line - Atomoxetine (SNRI - MOA unknown)

* 3rd line - Clonidine/imipramine/risperidone