ADHD Flashcards
How common is ADHD?
1-5% prevalence
What are the core features of ADHD?
Inattention
Excessive activity
Impulsivity
Before which age must the symptoms of ADHD be present?
Before seven years old
What does it mean that the symptoms of ADHD are pervasive?
They must be present in more than one environment
ADHD is more common in females. T/F?
False
How do the symptoms of impulsivity present in a child with ADHD?
Poor awareness of danger Social disinhibition Excessively talkative Poor peer relationships Emotional dysregulation
Describe how attention develops over the first five years of life.
0-12 months fleeting attention 1-2 years rigid attention 2-3 years single Chanelled attention 3-4 years single focused attention 4-5 years dual challenged attention More than 5years integrated attention
What genetic syndromes are associated with ADHD?
Fragile x syndrome
Klinefelters syndrome
Williams syndrome
Children affected with ADHD are often exposed to years of negative feedback. T/F?
True
How is brain structure affected by ADHD?
Smaller brain volume mainly affected frontal and parietal cortex
Smaller basal ganglia
Right dorsolateral prefrontal lobe reduced
Smaller cerebellum vermis
What are the comorbid disorders associated with ADHD?
Sleep disorders Behavioural difficulties Specific learning disabilities Social communication difficulties Anxiety symptoms Tic disorders Mood difficulties Increase psychosocial factors
There is no specific diagnostic test for ADHD. What is involved in assessment?
Direct observations Psycho educational assessment Structured questionnaires Identifying comorbid health problems Developmental history
What factors need to be asked about in previous history with suspected ADHD?
Pregnancy Patterns of feeding, sleeping and play Activity levels Impulsivity Emotional reactivity Ability to sustain interest
Once a thorough history of ADHD is established what additional checks are required?
Hearing and vision screening tests
Examination of neurological signs and physical anomalies
Baseline height and weight
Baseline blood pressure, pulse and heart sounds
What measures can be put in place to manage the environment of children with ADHD?
Provide a calm environment without background noise
Avoid too many distracting stimuli
Initially avoid situations that require quiet, still behaviour for long periods
Maintain structure and supervision
What behavioural management strategies can be used for children for ADHD?
Waiting to get the child’s attention before giving instructions
Give clear, short direct instructions
Providing support when needed
Ask the child to repeat the instructions back to ensure they have heard and understood them
Improve concentration skills with activities the child already enjoys
Plan ahead for problem situations
Model good listening skills
Which two psychostimulants are used in the treatment of ADHD?
Methylphenidate and dexamphetamine
What second line anti ADHD drug acts on noradrenaline transporters?
Atomoxetine
What is the mechanism of action of guanfacine?
Acts as an alpha 2a adrenergic receptor agonist
What is the mechanism of action of methylphenidate?
Blocks dopamine and noradrenaline reuptake
What is the mechanism of action of dexamphetamine?
Releases dopamine stored in presynaptic vacuoles
What is the prodrug form of dexamphetamine which can be used inADHD?
Elvanse
What is the disadvantage of use of prolonged release tablet formations in ADHD?
Tablet cannot be crushed, chewed or broken before swallowing
What factors are associated with persistence of ADHD to adulthood?
Progressive reduction in cerebellum and hippocampal volumes Maternal depression Marital discord Negative parent child interaction Family socioeconomic disadvantage Familial ADHD
Describe the pathophysiology of ADHD?
There is a defective inhibitory response due to a compromised prefrontal cortex which leads to insufficient information processing
Neutrons in the prefrontal cortex are unable to distinguish between important signals and background noise
Other than guanfacine, which unlicensed third line drug for ADHD can be used?
Clonidine
Which psychostimulant used in the treatment of ADHD can be dissolved in water to ease administration?
Dexamphetamine
What are the side effects of dexamphetamine?
Potential for growth retention Anorexia Blood pressure Heart rate irregularities Insomnia Irritability Abdominal pain Headaches
What factors must be monitored for patients administered atomoxetine for ADHD?
Pulse Blood pressure Heigh Wright LFTs Mood
What is the onset of atomoxetine?
6week
What are the side effects of atomoxetine?
Nausea and vomiting Excessive tiredness Insomnia Abdominal pain Appetite suppression Weight loss Constipation Headaches Mood swings Hepatic impairment Increased heart rate and blood pressure Sundial ideation
What are the side effects of clonidine and guanfacine?
Sedation
Dizziness
Hypotension
Why is it relevant that guanfacine is a CYP 3A4 substrate?
Guanfacine is is metabolised by cytochrome p450 system so its metabolism is affected by other drugs which affect metabolism
It may be possible to use antidepressants in the treatment of ADHD.T/F?
True
What are the side effects of mofafinil?
Appetite
Abdominal pain
Dry mouth
Tachycardia
What type of drug is modafinil?
It is a weak psychostimulant
What is epidemiology of ADHD?
1-2% prevalence associated with poverty, lower social class and lower family income
There is a genetic component to ADHD. T/F?
True
What environmental factors have been implemented in the development in ADHD?
Low birth weight maternal smoking and alcohol use in pregnancy lead exposure poverty iron deficiency antenatal antidepressant use
What are the hyperactive-impulsive symptoms of ADHD?
fidgeting or squirming in seat
leaves seat in classroom / other situations where expected to be seated
often runs about or climbs excessively in inappropriate situations
difficulty playing quietly
often on the go
often talks excessively
blurts out answers before question completed
difficulty waiting their turn
often interrupts or intrudes on others
What are the inattentive symptoms of ADHD?
fails to give close attention to details / makes careless mistakes
difficulty sustaining attention in tasks
does not seem to listen when spoken to directly
does not follow through on instructions and fails to complete schoolwork/chores
difficulty organising tasks and activities
avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort
easily distracted by extrenaous stimuli
forgetful in daily activities
What is involved in the mental status examination in ADHD?
Appearance, alertness and orientation
ability to relate with interviewer
speech, mood, affect on thought process, estimation of cognitive ability
over signs of ADHD - motor restless, inattention, working memory impairment
What is involved in psychoeducation in ADHD?
Educated about symptoms, typical source, potential treatments
referral to support and advocacy organisations
outline resources and toolkits
important for parents, children, and teachers
Doses of psychostimulants in ADHD should be titrated upwards until optimal dose found. T/F?
True
