ADHD

Question 1

What is ADHD?

Answer 1

Attention deficit hyperactivity disorder
Hyperactivity, inattention and impulsivity
Inability to focus, stay still or concentrate

Question 2

Risk factors for ADHD?

Answer 2

Male
Family history
Social deprivation
Age of onset 3-7y

Question 3

What are clinical features of ADHD?

Answer 3

Inattention:
Not listening when spoken to
Easily distracted
Forgetful in daily activities

Hyperactivity:
Restlessness and fidgeting
Talks excessively
Often on the go in appropriately

Impulsivity:
Difficulty waiting their turn
Interrups others
Disobedient

Question 4

What are criteria for diagnosis of ADHD?

Answer 4

Abnormality of inattention, hyperactivity and impulsivity at home
Demonstrable abnormality of inattention and hyperactivity at school or nursers
Directly observed abnormality of attention or activity
Does not meet criteria for developmental disorder, mania, depressive or anxiety disorder
Onset before age of 7y
Duration of at least 6 months
IQ above 50

Question 5

What investigations in ADHD?

Answer 5

Conner’s questionnaire
School observation
School report

TFT
Hearing test - pure tone audiometry

ECG if prescribing - medication can cause arrhythmias

Question 6

What is management for pre-school children?

Answer 6

Parent training/education programme (psychoeducation and teachers informed of child’s diagnosis, care plan, and SEN
Support groups add+up, ADDISS

Question 7

What is management for mild-moderate ADHD in school age children?

Answer 7

Behavioural strategies in parent education sessions
CBT and social skills training for the child
Teachers training on behavioural strategies in class room
CAMHS follow up

Question 8

What is management for severe ADHD in school age children?

Answer 8

5 years +
Medication as first line
IF medication is declined , advise on benefits and offer a group parent training/education programme

Question 9

First line pharmacological management for ADHD? MOA? S/E? Second line?

Answer 9

Methylphenidate (ritalin)
Six week trial basis
CNS stimulant which acts as dopamine/norepinehprine reuptake inhibitor

SE: abdominal pain, nausea, dyspepsia
Weight and height monitored every 6m

Lisdexamfetamine
Dexamfeatmine

Question 10

What are side effects of CNS stimulants?

Answer 10

Cardiotoxic
Perform baseline ECF
Raised blood pressure
Disturbed sleep
Impaired growth and appetite suppression
Problems with aggression

Question 11

What should be monitored when pt is on methylphenidate?

Answer 11

Weight and height - can impair growth