ADHD Flashcards
define ADHD
A persistent pattern of INATTENTION and/or HYPERACTIVITY/IMPULSIVITY that interferes with functioning or development as characterized by specific symptoms of each
how many symptoms of inattention and/or hyperactivity do you need to meet criteria for ADHD
6+ (need at least 6 in one of the two categories, not 6 between the two)
(5+ if older than 17)
what is criterion A for ADHD
a persistent pattern of inattention and/or hyperactivity/impulsivity that interferes wtih functioning or development, as characterized by 1) inattention and/or 2) hyperactivity and impulsivity
6+ symptoms required of inattention and/or hyperactivity which have persisted for at least SIX MONTHS to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities
symptoms are NOT solely a manifestation of oppositional behaviour, defiance, hostility or failure to understand tasks or instructions
how many symptoms are listed under criterion A for inattention? impulsivity?
9 for both
list the symptoms of inattention listed in criterion A of the dsm 5
- often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (i.e overlooks or misses details, work is inaccurate)
- often has difficulty sustaining attention in tasks or play activities
- often does not seem to listen when spoken to directly (i.e mind seems elsewhere, even in absence of any obvious distraction)
- often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (i.e starts tasks but quickly loses focus and is easily sidetracked)
- often has difficulty organizing tasks and activities (i.e difficulty managing sequential tasks, keeping materials and belongings in order, messy, poor time management)
- often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort
- often loses things necessary for tasks or activities (i.e school materials, pencils)
- is often easily distracted by extraneous stimuli (for older kids, may include unrelated thoughts)
- is often forgetful in daily activities
list the symptoms of hyperactivity/impulsivity listed in criterion A of the dsm 5
- often fidgets with or taps hands or feet or squirms in seat
- often leaves seat in situations when remaining seated is expected
- often runs about or climbs in situations where it is inappropriate (in older kids, may be limited to feeling restless)
- often unable to play or engage in leisure activities quietly
- often “on the go” acting as if “driven by a motor” (i.e unable to be or is uncomfortable being still for extended periods as in restaurants, meetings)
- often talks excessively
- often blurts out an answer before a question has been completed (i.e completes peoples sentences, cannot wait for turn in coversation)
- often has difficulty waiting their turn
- often interrupts or intrudes on others (i.e butts into conversations or games, may start using other peoples things without permission)
what is criterion B for ADHD
several inattentive or hyperactive/impulsive symptoms were present prior to age 12 years
what is criterion C for ADHD
several inattentive or hyperactive/impulsive symptoms are present in two or more settings (i.e at home, school, work, with friends, other activities)
what is criterion D for ADHD
there is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning
what is criterion E for ADHD
the symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder
what are the 3 diagnostic DSM specifiers for ADHD
- combined presentation–>
if both criterion A1 (inattention) and criterion A2 (hyperactivity) are met for the last 6 months - predominantly inattentive presentation–> if criterion A1 is met but not A2 for the last 6 months
- predominantly hyperactive/impulsive presentation –> if criterion A2 is met but not A1 for the last 6 months
*when full criteria were previously met, but fewer than the full criteria have been met for the last 6 months and the symptoms still results in impairment, can specify IN PARTIAL REMISSION
how do you grade severity for ADHD
mild–> moderate–> severe
define mild ADHD
few, if any, symptoms in excess of those required to make the diagnosis are present, and symptoms result in no more than minor impairments in social or occupational functioning
define moderate ADHD
symptoms or functional impairment between mild and severe are present
define severe ADHD
many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe are present, or the symptoms result in marked impairment in functioning
what is the essential feature of ADHD
persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development
how does inattention manifest behaviourally in ADHD
wandering off task, lacking persistence, having difficulty sustaining focus, being disorganized
not due to defiance or lack of comprehension
what does hyperactivity refer to in ADHD
excessive motor activity (such as a child running about) when it is not appropriate, or excessive fidgeting, tapping or talkativeness
how might hyperactivity manifest in adults with ADHD
extreme restlessness or wearing others our with their activity
what does impulsivity refer to in ADHD
hasty actions that occur in the moment without forethought and that have high potential for harm to the individual (ie darting into the street without looking)
impulsivity may reflect a desire for IMMEDIATE REWARDS or an inability to DELAY GRATIFICATION
how might impulsive behaviours manifest in ADHD
social intrusiveness and/or making important decisions without consideration of long term consequences
how do you make sure symptoms of ADHD occur across settings
consult informants who have seen the individual in those settings
how do symptoms vary within a setting
vary depending on context within a given setting–> ie signs of the disorder may be minimal or absent when the individual is receiving frequent rewards for appropriate behaviour, is under close supervision, is in a novel setting, is engaged in especially interesting activities, has consistent external stimulation or is interacting in one on one situations
list some associated features that may support diagnosis of ADHD
- though not specific to ADHD, mild delays in language, motor or social development often co occur with adhd
- low frustration tolerance
- irritability
- mood lability
- academic or work performance often impaired even in absence of specific learning disorder
how does ADHD impact risk of suicide
by early adulthood, ADHD is associated with an INCREASED RISK of suicide attempt
*primarily when comorbid with mood, conduct or substance use disorders
is there any biological marker that is diagnostic for adhd?
no
what findings might there be on EEG that would be consistent with ADHD
increased slow wave EEGs
what findings might there be on MRI that would be consistent with ADHD
reduced total brain volume
+
delay in posterior to anterior cortical maturation
what is the prevalence of ADHD
5% of children and 2.5% of adults across most cultures
after what age do symptoms of hyperactivity become more clearly distinguishable from normative behaviours
after age 4
when is ADHD most often identified
elementary school years
what is the natural course of ADHD
most often IDed in elementary school–> most people have relatively STABLE course through early adolescence, though some have worsening course with development of ANTISOCIAL behaviours –> in most people, symptoms of hyperactivity become less obvious in adolescence and adulthood but difficulties with RESTLESSNESS, INATTENTION, poor PLANNING and IMPULSIVITY persist
a substantial proportion of kids with ADHD remain relatively impaired into adulthood
what is the main manifestation of ADHD in preschool
hyperactivity
when does inattention become more prominent in ADHD
elementary school
ADHD is associated with which temperamental factors
ADHD is associated with: 1. reduced behavioural inhibition, effortful control, or constraint
2. negative emotionality
3. elevated novelty seeking
*may predispose to ADHD but not specific to the disorder
list environmental risks for ADHD
- very LOW BIRTH WEIGHT (less than 1500 grams)–> 2-3x risk for ADHD
(but most kids with low birth weight do not develop adhd) - correlated with SMOKING during pregnancy
- minority of cases may be related to reactions to aspect of diet
- may be history of childhood abuse, neglect, multiple foster placements
- neurotoxin exposure (i.e lead)
- infections (i.e encephalitis)
- alcohol exposure in utero
