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People and Illness > ADHD > Flashcards

ADHD Flashcards

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1
Q

How common is ADHD?

A

1-5% prevalence

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2
Q

What are the core features of ADHD?

A

Inattention
Excessive activity
Impulsivity

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3
Q

Before which age must the symptoms of ADHD be present?

A

Before seven years old

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4
Q

What does it mean that the symptoms of ADHD are pervasive?

A

They must be present in more than one environment

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5
Q

ADHD is more common in females. T/F?

A

False

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6
Q

How do the symptoms of impulsivity present in a child with ADHD?

A 
Poor awareness of danger
Social disinhibition
Excessively talkative
Poor peer relationships
Emotional dysregulation
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7
Q

Describe how attention develops over the first five years of life.

A 
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
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8
Q

What genetic syndromes are associated with ADHD?

A

Fragile x syndrome
Klinefelters syndrome
Williams syndrome

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9
Q

Children affected with ADHD are often exposed to years of negative feedback. T/F?

A

True

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10
Q

How is brain structure affected by ADHD?

A

Smaller brain volume mainly affected frontal and parietal cortex
Smaller basal ganglia
Right dorsolateral prefrontal lobe reduced
Smaller cerebellum vermis

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11
Q

What are the comorbid disorders associated with ADHD?

A 
Sleep disorders
Behavioural difficulties
Specific learning disabilities
Social communication difficulties
Anxiety symptoms
Tic disorders
Mood difficulties
Increase psychosocial factors
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12
Q

There is no specific diagnostic test for ADHD. What is involved in assessment?

A 
Direct observations
Psycho educational assessment
Structured questionnaires
Identifying comorbid health problems
Developmental history
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13
Q

What factors need to be asked about in previous history with suspected ADHD?

A 
Pregnancy
Patterns of feeding, sleeping and play
Activity levels
Impulsivity
Emotional reactivity
Ability to sustain interest
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14
Q

Once a thorough history of ADHD is established what additional checks are required?

A

Hearing and vision screening tests
Examination of neurological signs and physical anomalies
Baseline height and weight
Baseline blood pressure, pulse and heart sounds

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15
Q

What measures can be put in place to manage the environment of children with ADHD?

A

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

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16
Q

What behavioural management strategies can be used for children for ADHD?

A

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

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17
Q

Which two psychostimulants are used in the treatment of ADHD?

A

Methylphenidate and dexamphetamine

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18
Q

What second line anti ADHD drug acts on noradrenaline transporters?

A

Atomoxetine

19
Q

What is the mechanism of action of guanfacine?

A

Acts as an alpha 2a adrenergic receptor agonist

20
Q

What is the mechanism of action of methylphenidate?

A

Blocks dopamine and noradrenaline reuptake

21
Q

What is the mechanism of action of dexamphetamine?

A

Releases dopamine stored in presynaptic vacuoles

22
Q

What is the prodrug form of dexamphetamine which can be used inADHD?

A

Elvanse

23
Q

What is the disadvantage of use of prolonged release tablet formations in ADHD?

A

Tablet cannot be crushed, chewed or broken before swallowing

24
Q

What factors are associated with persistence of ADHD to adulthood?

A 
Progressive reduction in cerebellum and hippocampal volumes
Maternal depression
Marital discord
Negative parent child interaction
Family socioeconomic disadvantage
Familial ADHD
25
Q

Describe the pathophysiology of ADHD?

A

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

26
Q

Other than guanfacine, which unlicensed third line drug for ADHD can be used?

A

Clonidine

27
Q

Which psychostimulant used in the treatment of ADHD can be dissolved in water to ease administration?

A

Dexamphetamine

28
Q

What are the side effects of dexamphetamine?

A 
Potential for growth retention
Anorexia
Blood pressure
Heart rate irregularities
Insomnia
Irritability
Abdominal pain
Headaches
29
Q

What factors must be monitored for patients administered atomoxetine for ADHD?

A 
Pulse
Blood pressure
Heigh
Wright
LFTs
Mood
30
Q

What is the onset of atomoxetine?

A

6week

31
Q

What are the side effects of atomoxetine?

A 
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
32
Q

What are the side effects of clonidine and guanfacine?

A

Sedation
Dizziness
Hypotension

33
Q

Why is it relevant that guanfacine is a CYP 3A4 substrate?

A

Guanfacine is is metabolised by cytochrome p450 system so its metabolism is affected by other drugs which affect metabolism

34
Q

It may be possible to use antidepressants in the treatment of ADHD.T/F?

A

True

35
Q

What are the side effects of mofafinil?

A

Appetite
Abdominal pain
Dry mouth
Tachycardia

36
Q

What type of drug is modafinil?

A

It is a weak psychostimulant

37
Q

What is epidemiology of ADHD?

A 
1-2% prevalence 
associated with poverty, lower social class and lower family income
38
Q

There is a genetic component to ADHD. T/F?

A

True

39
Q

What environmental factors have been implemented in the development in ADHD?

A 
Low birth weight
maternal smoking and alcohol use in pregnancy
lead exposure
poverty
iron deficiency
antenatal antidepressant use
40
Q

What are the hyperactive-impulsive symptoms of ADHD?

A

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

41
Q

What are the inattentive symptoms of ADHD?

A

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

42
Q

What is involved in the mental status examination in ADHD?

A

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

43
Q

What is involved in psychoeducation in ADHD?

A

Educated about symptoms, typical source, potential treatments
referral to support and advocacy organisations
outline resources and toolkits
important for parents, children, and teachers

44
Q

Doses of psychostimulants in ADHD should be titrated upwards until optimal dose found. T/F?

A

True

People and Illness (18 decks)

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