ADHD

Question 1

what are the triad of difficulties in ADHD

Answer 1

inattention
hyperactivity
impulsivity

Question 2

what is needed for a diagnosis of ADHD

Answer 2

triad of difficulties:

• inattention
• hyperactivity
• impulsivity

frequently occur with a cluster of impairing symptoms relating to self regulation (executive functioning, emotional regulation)

these must be:

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

Question 3

what if school is a problem but child is fine at home

Answer 3

could be learning difficulty/ bullying etc

Question 4

what is a child with ADHD typically like

Answer 4

daydreamy
cant keep focus
lots of energy
impuslive

Question 5

how does adult ADHD differ from child ADHD

Answer 5

less obvious symptoms of hyperactivity/ impulsivity

more symptoms of inattention

Question 6

what is the impact of childhood ADHD

Answer 6

parenting difficulties
increase home stress, high expressed emotions
emotional dysregulation - difficulties in peer relationships and reckless and dangerous behaviour
poor problem solving ability - inappropriate decision making
barrier to learning and exclusion from education

Question 7

what is the impact of adult ADHD

Answer 7

increase psychiatric comorbidities
higher levels of criminality, antisocial behaviour
higher substance abuse
occupational impairments

Question 8

why do most adults with childhood ADHD present with residual symptoms that no longer meet diagnostic criteria

Answer 8

possible improvement in cortical thickness (maturation) that allows for the brain to compensate for cognitive deficits

Question 9

what causes ADHD

Answer 9

genetic predisposition
\+ 
perinatal precipitants 
\+
psychosocial adversity 

cause neuroanatomical brain changes which lead to the cognitive and behavioural features of ADHD

Question 10

what genes in ADHD

Answer 10

dopamine and serotonin transporter genes

60% increased in offspring if parents have ADHD

Question 11

what are the perinatal factors in ADHD aetiology

Answer 11

tobacco and alcohol
foetal alcohol syndrome, illicit substances
significant prematurity ad perinatal hypoxia
unsually short/ long labour, foetal distress, low forceps delivery, eclampsia

Question 12

what are the psychosocial adversities linked to causing ADHD

Answer 12

inconsistent parenting styles 
severe martial discord
low social class 
large family 
paternal criminality 
maternal mental disorder 
maltreatment
emotional disorder

Question 13

what is the neurobiology of ADHD

Answer 13

under active function within the frontal lobe

excessive (higher concentration of dopamine transporters) dopamine removal system

reduced noreopinephrine and serotonin

Question 14

what is the frontal lobe responsible for

Answer 14

reasoning 
planning 
impulse control 
judgement 
initiation of actions 
social/ sexual behaviour long term memory

Question 15

how do you asses child ADHD

Answer 15

usually school observation
screening questionnaires
background info- risk factors, developmental Hx, family Hx

Question 16

how do you assess adult ADHD

Answer 16

historical concerns from close ones
screening tools
current symptoms consistent with ADHD
cognitive difficulties and ability to function evaluated

Question 17

what is the diagnostic criteria for childhood ADHD

Answer 17

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

Question 18

what is the diagnostic criteria for adult ADHD

Answer 18

5 or more symptoms of inattentiveness and/ or
5 or more of hyperactivity and impulsiveness
historical concerns since early age

Question 19

what is essential for a diagnosis of adult ADHD

Answer 19

that symptoms have a moderate effect of different areas of their life:

• underachieving in work/ education
• driving dangerously
• difficulty making/ keeping friends
• difficulty in relationships with partners

Question 20

what are the psychosocial interventions for ADHD

Answer 20

for mild-severe in children 
parent training 
social skills training 
sleep and diet (controversial)
behavioural classroom management strategies 
specific educational interventions

Question 21

what are the pharmacological treatment for ADHD

Answer 21

only for mod- severe 
1st Line (stimulants) 
Methylphenidate 
Dexamfetamine
Lisdexamfetamine

2nd Line (SNRI)
Atomoxetine

3rd Line (alpha agonist)
Clonidine
Guanfacine

4th Line
Antidepressants (imipramine)
Antipsychotics (Risperidone)

Question 22

how does methylphenidate (stimulant work)

Answer 22

increases dopamine by blocking its transporter:

improves alertness, working memory, motivation and clarity

Question 23

how does dexamphetamine (stimulant) work

Answer 23

increases dopamine by blocking its transporter

also increases norepinephrine and serotonin

Question 24

what does increasing norepinephrine and serotonin do for ADHD

Answer 24

norepinephrine- concentration
serotonin- satisfaction

together- intuition, balanced mood

Question 25

how do SNRIs work in ADHD

Answer 25

increase norepinephrine