ADHD

Question 1

core diagnostic criteria

Answer 1

inattention
impulsivity
hyperactivity

Question 2

Inattention

Answer 2

unable to: listen to detail, sustain attention in play activities, follow instructions, finish homework, organise tasks
loses/forgets things

Question 3

Hyperactivity

Answer 3

squirming/figiting, on the go all the time, talks incessantly, climbs over everything, no quiet hobbied

Question 4

Impulsivity

Answer 4

blurts out answers, interupts, can’t take turns, poor road safety

Question 5

Diagnosis

Answer 5

no diagnostic test- most parents first notice hyperactivity at the toddler stage
Diagnosis made through careful history taking from young person and parents and teachers, observation at school and clinic, rating scales (eg Conners) and screen for organic causes

Question 6

differentials and associations

Answer 6

low or high IQ, hearing impairment and behavioural disorders
associated with conduct disorder or other disruptive behaviour. Young people with ADHD are at risk of being victims of assault, suicide and self harm

Question 7

course of disease

Answer 7

signs often attenuate in adolescence but can persist into adulthood
18 yrs- 1/3 have symptoms which don’t need need medication, 1/3 need medication, 1/3 have no symptoms

Question 8

Treatement

Answer 8

positive patenting and behavioural techniques, social skills training

Question 9

Drug treatment

Answer 9

Methylphenidate- immediate release (ritalin) lasting 4hrs or modified release lasting 12hrs - recommended that treatment is no given at weekends as it surpasses appetite and can suppress growth
Atomexitine- second line - takes up to 6 weeks to reach full efficacy

Question 10

What must you check for with methylphenidate use

Answer 10

misuse- similar to speed - it is a stimulant

Question 11

how does medication work

Answer 11

stimulant- improve dopaminergic neurotransmission