ADHD

Question 1

triad of difficulties in the diagnosis of ADHD?

Answer 1

inattention
hyperactivity
impulsivity

Question 2

the traid of difficulties in ADHD occur alongside which symptoms?

Answer 2

symptoms related to self regulation which are

• developmentally inappropriate
• impairing functioning
• pervasive across setting (home, school, work etc)
• longstanding from age 5

Question 3

is ADHD a spectrum disorder?

Answer 3

yes
cut off for diagnosis is clinically determined aided by screening and assessment tools
can be subjective depending on how the difficulties of the child impact the family

Question 4

how does adult ADHD differ from child ADHD?

Answer 4

less obvious symptoms of hyperactivity or impulsivity and more inattentive symptoms

Question 5

impact of adult ADHD?

Answer 5

increased frequency of psychiatric comorbidity
higher level of criminality and antisocial behaviour
higher levels of substance misuse (commonly amphetamines - possibly self medication)
significant impairment in occupational function
increased frequency of early parenthood

Question 6

do people “grow out” of ADHD?

Answer 6

not really

brain and cortical thickness increases which can compensate for some of the behaviours

Question 7

what causes ADHD?

Answer 7

perinatal precipitants
genetic predisposition
psychosocial adversity
(cause neuroanatomical brain changes leading to cognitive and behavioural features of ADHD)

Question 8

what genetic factors are involved in ADHD?

Answer 8

ADHD tends to aggregate in families both within and across generations
around 60% increased risk of ADHD among offspring of adults with ADHD
15% increased risk if sibling affected

Question 9

what genes are involved in ADHD?

Answer 9

dopamine and serotonin transporter genes

Question 10

what perinatal factors are involved in ADHD?

Answer 10

tobacco and alcohol during pregnancy
ADHD like presentations in children with foetal alcohol syndrome and use of other illicit substances
prematurity and perinatal hypoxia
short/long labour, foetal distress, low forceps delivery and eclampsia
exposure to viral infection during first trimester

Question 11

how are psychosocial factors involved in ADHD?

Answer 11

some tentative links between parenting style and ADHD

• inconsistent parenting
• marital discord
• low social class
• large family
• paternal criminality
• maltreatment and emotional trauma

Question 12

describe the neurobiology seen in ADHD

Answer 12

brain map shows large area of underactive function within the frontal lobe

Question 13

what is the frontal lobes responsible for?

Answer 13

executive functioning

• reasoning
• planning
• impulse control
• judgement
• initiation of actions
• social/sexual behaviours
• long term memory (ability to learn from mistakes is impaired)
• forming long term goals

Question 14

how is neurochemistry different in ADHD?

Answer 14

ADHD brains have less dopamine
- there seems to be an excessively efficient dopamine-removal system (higher concentration of dopamine transporters - called reuptake inhibitors)
symptoms may also be caused by the reduction of norepinephrine which can affect attention when acting as a stress hormone and serotonin which influences mood, social behaviour, sleep and memory

Question 15

how can ADHD be assessed?

Answer 15

mainly driven by parents/school
ideally can do a school observation
screening/diagnostic questionnaires 
background information regarding risk factors (developmental history, family history, abuse etc)
explore attachment style

Question 16

how can ADHD in adults be assessed?

Answer 16

driven by patient
often present with historical difficulties and should be backed up by relatives
specific adult screening tools available
symptoms must be present currently, not just when they were a child
cognitive difficulties and ability to function need to be evaluated

Question 17

diagnostic criteria in children?

Answer 17

6 or more symptoms of inattention and/or

• 6 or more symptoms of hyperactivity and impulsiveness
• present before age 5
• reported by parents, school and seen in clinic
• symptoms get in the way of daily life

Question 18

diagnostic criteria for ADHD in adults?

Answer 18

in general, 5 or more of the symptoms of inattentiveness and/or 5 or more of hyperactivity and impulsiveness
historical concerns since early age

Question 19

what is essential for diagnosis in adults?

Answer 19

underachieving at work or in education
driving dangerously
difficulty making or keeping friends
difficulty in relationships with partners

Question 20

how can ADHD be managed?

Answer 20

parent training
social skills training
sleep and diet (controversial)
behavioural classroom management strategies (e.g traffic light system) 
specific educational interventions

Question 21

1st line pharmacological treatment for ADHD?

Answer 21

stimulants

• methylphenidate
• dexamfetamine
• lisdexamfetamine

Question 22

2nd line pharmacological treatment?

Answer 22

SNRI

- atomoxetine

Question 23

3rd line treatment?

Answer 23

alpha agonist

• clonidine
• guanfacine

Question 24

4th line treatment?

Answer 24

antidepressants (imipramine)

antipsychotics (risperidone)

Question 25

how do stimulants work?

Answer 25

methylphenidate increases dopamine by blocking its transporter
dexamphetamine same as above but also increases extracellular norepinepherine and possibly serotonin

Question 26

how do non-stimulants (SNRIs) work?

Answer 26

increase norepinephrine by blocking its transporter or (alpha agonists) by reducing sympathetic stimulation

Question 27

function of dopamine?

Answer 27

alertness
working memory
motivation
clarity

Question 28

function of norepinephrine?

Answer 28

attention
concentration
- execution, perserverance and recall memory
balanced mood
intuition