ADHD and conduct/overactivity problems

Question 1

What are some of the terms used for a syndrome characterized by persistent over-activity, impulsivity and difficulties in sustaining attention?

Answer 1

Attention deficit hyperactivity disorder (ADHD), attention deficit disorder (ADD), hyperkinetic disorder (HKD), hyperkinesis, and disorder of attention, motor control and perception (DAMP)

Question 2

What is currently the most widely used term for a syndrome characterized by persistent over-activity, impulsivity and difficulties in sustaining attention?

Answer 2

Attention deficit hyperactivity disorder (ADHD)

Question 3

What are the primary problems of ADHD cases

Answer 3

Inattention, impulsivity and hyperactivity

Question 4

In DSM-5 and ICD-10 different terms are used for the syndrome of inattention, overactivity and impulsivity. What term is used in the DSM-5?

Answer 4

ADHD

Question 5

In DSM-5 and ICD-10 different terms are used for the syndrome of inattention, overactivity and impulsivity. What term is used in the ICD-10?

Answer 5

Hyperkinetic disorder

Question 6

Diagnosis of attention deficit hyperactivity disorder (ADHD) in the DSM-5

Criteria A:

Answer 6

A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development

Question 7

Diagnosis of attention deficit hyperactivity disorder (ADHD) in the DSM-5

Criteria A: A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2). What is (1)?

Answer 7

1) Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/ occupational activities:

a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).

b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).

c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).

d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).

e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).

f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).

g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

h. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).

i. Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).

Question 8

Diagnosis of attention deficit hyperactivity disorder (ADHD) in the DSM-5

Criteria A: A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2). What is (2)?

Answer 8

2. Hyperactivity-Impulsivity. Six (or more) of
   the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:

a. Often fidgets with or taps hands or feet or squirms in seat.

b. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).

c. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.)

d. Often unable to play or engage in leisure activities quietly.

e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended
time, as in restaurants, meetings; may be experienced by
others as being restless or difficult to keep up with).

f. Often talks excessively.

g. Often blurts out an answer before a question has been
completed (e.g., completes people’s sentences; cannot
wait for turn in conversation).

h. Often has difficulty waiting his or her turn (e.g., while
waiting in line).

i. Often interrupts or intrudes on others (e.g., butts into
conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).

Question 9

Diagnosis of attention deficit hyperactivity disorder (ADHD) in the DSM-5

Criteria A: A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2).

A note is attached to criteria A. What does it say?

Answer 9

Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required.

Question 10

Diagnosis of attention deficit hyperactivity disorder (ADHD) in the DSM-5

Criteria A: A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2).

How many symptoms from (1) and/or (2) respectively is needed in order for a youngster to meet the criteria?

Answer 10

6 or more

Question 11

Diagnosis of attention deficit hyperactivity disorder (ADHD) in the DSM-5

Criteria A: A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2).

For hos long must the symptoms from (1) and/or (2) have persisted in order for a person to meet the criteria?

Answer 11

At least 6 months to a degree that
is inconsistent with developmental level and that negatively impacts directly on social and academic/ occupational activities

Question 12

Diagnosis of attention deficit hyperactivity disorder (ADHD) in the DSM-5

Criteria A: A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2).

How many symptoms from (1) and/or (2) respectively is needed in order for older adolescents and adults (17 and older) to meet the criteria?

Answer 12

At least five symptoms

Question 13

Diagnosis of attention deficit hyperactivity disorder (ADHD) in the DSM-5

Criteria B:

Answer 13

Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.

Question 14

Diagnosis of attention deficit hyperactivity disorder (ADHD) in the DSM-5

Criteria C:

Answer 14

Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).

Question 15

Diagnosis of attention deficit hyperactivity disorder (ADHD) in the DSM-5

Criteria D:

Answer 15

There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.

Question 16

Diagnosis of attention deficit hyperactivity disorder (ADHD) in the DSM-5

Criteria E:

Answer 16

The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).

Question 17

What are the cardinal features which are both necessary and should be evident in more than one situation (e.g. home or school) for the diagnosis of Hyperkinetic disorders according to the ICD-10?

Answer 17

Impaired attention and over-activity

Question 18

How is the cardinal feature “impaired attention” described in the ICD-10?

Answer 18

Impaired attention is manifested by prematurely breaking off from tasks and leaving activities unfinished. The children change frequently from one activity to another, seemingly losing interest in one task because they become diverted to another. These deficits in persistence and attention should be diagnosed only if they are excessive for the child’s age and IQ.

Question 19

How is the cardinal feature “Over-activity” described in the ICD-10?

Answer 19

Over-activity implies excessive restlessness, especially in situations requiring relative calm. It may, depending upon the situation, involve the child running and jumping around, getting up from a seat when he or she was supposed to remain seated, excessive talkativeness
and noisiness, or fidgeting and wriggling. The standard for judgement should be that the activity is excessive in the context of what is expected in the situation and by comparison with other children of the same age and IQ. This behavioural feature is most evident in structured, organized situations that require a high degree of behavioural self-control.

Question 20

When should the characteristic behavior problems of hyperkinetic disorders have onset according to ICD-10?

Answer 20

The characteristic behaviour problems should be of early onset (before the age of 6 years) and long duration.

Question 21

What are the associated features of hyperkinetic disorder in ICD-10?

Answer 21

Associated features include disinhibition in social relationships, recklessness in situations involving some danger, impulsive flouting of social rules, learning disorders, and motor clumsiness.

Question 22

What are the two subtypes of hyperkinetic disorder ind ICD-10?

Answer 22

1) Hyperkinetic disorder with disturbance of activity and attention: When antisocial features of conduct disorder are absent.

2) Hyperkinetic conduct disorder: When criteria for both conduct disorder and hyperkinetic disorder are met.

Question 23

What are the main distinctions between subtypes in the DSM-5?

Answer 23

In DSM the main distinctions are between cases where inattention and over-activity are present or absent.

DSM also distinguishes between mild, moderate and severe sub-types.

Question 24

What are the main distinctions between subtypes in the ICD-10?

Answer 24

Co-morbid conduct problems is the basis for sub-typing in ICD.

Question 25

How can children with predominantly inattentive presentation (subtype of ADHD in the DSM-5) be described?

Answer 25

Children with the inattentive sub-type of ADHD are described clinically as sluggish, apathetic daydreamers who are easily distracted and have difficulty completing assigned tasks within school because of learning difficul- ties. Within their family history there is a preponderance of learning disorders and emo- tional disorders such as anxiety and depression.

Question 26

How can children with predominantly hyperactive/impulsive representation or combined presentation (subtypes of ADHD in the DSM-5) be described?

Answer 26

Those with the hyperactive-impulsive or combined sub-type of ADHD are characterized by extreme over-activity, oppositional and aggressive behaviours. Conduct problems are their most notable school-based difficulties and they have a high rate of school suspension and special educational placement. Within their family history they have a preponderance of anti-social problems such as drug abuse and criminality, and children with the hyperactive-impulsive profile are at risk for long-term anti-social behaviour problems and poor social adjustment.

Question 27

In a meta-analysis of 97 studies, Willcutt (2012) found that ___–___% of children and adolescents have ADHD

Answer 27

5.9–7.1%

Question 28

In a meta-analysis of 97 studies, Willcutt (2012) found that ___% of young adults have ADHD.

Answer 28

5%

Question 29

Using stringent ICD-10 hyperkinetic disorder criteria demanding cross-situational stability of symptoms, a prevalence rate of ___% was obtained in a UK national epidemiological study

Answer 29

1%

Question 30

ADHD is more prevalent in which gender?

Answer 30

ADHD is more prevalent in boys than girls

Question 31

ADHD is more prevalent in which age group?

Answer 31

ADHD is more prevalent in pre-adolescents than in late adolescents

Question 32

Which sub-type is most prevalent in community surveys

Answer 32

The predominantly inattentive sub-type is most prevalent

Question 33

A significant minority of young people with ADHD have the following co-morbid neurodevelopmental disorders:

Answer 33

Intellectual disability, developmental language disorder, specific learning disorder, motor co-ordination disorder, Tourette’s disorder, autism spectrum disorders, elimination problems and sleep disorders.

Question 34

The principal externalizing disorders that occur in conjunction with ADHD are …

Answer 34

Oppositional defiant disorder, conduct disorder and substance use disorders.

Question 35

The co-morbidity rate for ADHD and conduct disorder is ___%

Answer 35

23.3%

Question 36

The main internalizing or emotional disorders that occur co-morbidly with ADHD are

Answer 36

Anxiety disorders and depression

Question 37

The co- morbidity rate for ADHD and major depression is ___%

Answer 37

10.5%

Question 38

The co- morbidity rate for ADHD and anxiety disorders is ___%

Answer 38

11,8%

Question 39

How many children with ADHD have a good prognosis?

Answer 39

About a third of children with ADHD have a good prognosis

Question 40

How many children with ADHD have a moderate prognosis?

Answer 40

About a third of children with ADHD have a moderate prognosis

Question 41

How many children with ADHD have a poor prognosis?

Answer 41

About a third of children with ADHD have a poor prognosis

Question 42

For how many cases does the primary problems of inattention, impulsivity and hyperactivity persist into late adolescence?

Answer 42

For two-thirds of cases

(and for some of these the primary symptoms persist into adulthood)

Question 43

How many of people with ADHD develop significant anti-social behaviour problems in adolescence including conduct disorder and substance abuse?

Answer 43

Roughly a third

(for most of this sub-group, these problems persist into adulthood leading to criminality)

Question 44

In how many cases does occupational adjustment problems and suicide attempts occur?

Answer 44

In a small but significant minority of cases

Question 45

A thorough psychometric assessment of intelligence, attainments and language is also essential in the assessment of children with ADHD because …

Answer 45

Most children with ADHD have learning problems and many have co-morbid neurodevelopmental disorders.

Question 46

___ - ___% of children diagnosed with ADHD continue to meet diagnostic criteria in adulthood

Answer 46

50-66%. That is more than half of children diagnosed with ADHD continue to meet diagnostic criteria in adulthood

Question 47

What is the difference between diagnosis of ADHD in children and adults according to the DSM-5 criteria?

Answer 47

The DSM-5 criteria are the same for both age groups. Diagnosis of adults with ADHD involves applying childhood criteria to adulthood presentations, albeit requiring five rather than six symptoms to be present.

Question 48

What are common changes in ADHD symptoms with increasing age?

Answer 48

In particular, overt hyperactive-impulsive behavioural symptoms appear to decline significantly with increasing age and become increasingly internalised, whereas inattentive symptoms show less recovery

Question 49

Which DSM-5 subtype of ADHD will most adults be diagnosed with and why?

Answer 49

The vast majority of individuals with ADHD in adulthood present either with the combined or inattentive subtype. Some in this latter category will previously have met criteria for combined type but no longer reach five out of nine hyperactive-impulsive criteria, and therefore fall into the inattentive sub- type category as adults

This is because overt hyperactive-impulsive behavioural symptoms appear to decline significantly with increasing age and become increasingly internalised.

Question 50

What are the diagnostic criteria for combined presentation in the DSM-5?

Answer 50

If both Criterion A1 (inattention) and Criterion A2 (hyperactivity-impulsivity) are met for the past 6 months.

Question 51

What are the diagnostic criteria for predominantly inattentive presentation in the DSM-5?

Answer 51

If Criterion A1 (inattention) is met but Criterion A2 (hyperactivity-impulsivity) is not met for the past 6 months.

Question 52

What are the diagnostic criteria for predominantly hyperactive/impulsive presentation: presentation in the DSM-5?

Answer 52

If Criterion A2 (hyperactivity-impulsivity) is met and Criterion A1 (inattention) is not met for the past 6 months.

Question 53

What is “ADHD in partial remission” in the DSM-5?

Answer 53

A further subtype of ADHD used in clinical practice, where more than six diagnostic criteria were met previously but currently there are fewer than five symptoms in both categories, and yet there is persistent functional impairment.

Question 54

How does the ICD-10 define hyperkinetic disorder?

Answer 54

As a persistent and severe impairment of psychological development characterised by ‘early onset; a combination of overactive, poorly modulated behaviour with marked inattention and lack of persistent task involvement; and pervasiveness, over situations and persistence over time of these behavioural characteristics’

Question 55

Why is it that few adults with ADHD would actually meet criteria for diagnosis with ICD-10 of hyperkinetic disorder?

Answer 55

ICD-10 acknowledges that hyperkinetic disorder can persist into adult life, but the diagnostic criteria stipulate there must be evidence of both impaired attention and overactivity. This latter aspect of the disorder seems to show particular improvement with age, and therefore it is rare that an individual is displaying marked overactivity that is developmentally inappropriate.

Question 56

Prevalence estimates indicate that ___% (range 1.2–7.3%) of adults have ADHD

Answer 56

3.4%

Question 57

In childhood, which gender is more likely to have inattentive subtype ADHD?

Answer 57

Girls

Question 58

In childhood, which gender are more likely to have hyperactive-impulsive or combined subtype ADHD?

Answer 58

Boys

Question 59

___% of adults with ADHD have the hyperactive-impulsive subtype

Answer 59

2%

Question 60

___% of adults with ADHD have the inattentive subtype

Answer 60

37%

Question 61

___% of adults havde the combined ADHD subtype

Answer 61

56%

Question 62

The ratio of males to females is approximately __:__ in childhood

Answer 62

4:1

Question 63

The ratio of males to females is approximately __:__ in young adults

Answer 63

2:1

Question 64

How is the ratio of males to females in middle age?

Answer 64

Approaching even numbers

Question 65

What is one reason why the ratio of males to females are approaching even numbers in middle age?

Answer 65

One explanation for this change in gender ratio is that the hyperactive-impulsivity symptoms more prevalent in boys are more likely to improve with age, and therefore they no longer meet diagnostic criteria. In contrast, if attentional difficulties persist with age, this may explain why a relatively greater proportion of females continues to maintain an inattentive subtype diagnostic status

Question 66

Comorbidity: Adults with ADHD are more likely to present with additional psychological disorders or psychosocial problems, with only ___% having just a single diagnosis of ADHD

Answer 66

14%

Question 67

What are the most common comorbidities of ADHD?

Answer 67

Anxiety, depression or dysthymia, bipolar disorder, personality disorders and substance use disorders

Question 68

About ___% of children with conduct prob- lems have a poor prognosis.

Answer 68

60%

Question 69

In a review of 12 international epidemiological studies Costello et al. (2004) found that the prevalence of conduct disorder ranged from 1.1–10.6% with a median prevalence rate of ___%

Answer 69

3.7%

Question 70

The range for oppositional defiant disorder was 1.3–7.4% and the median prevalence rate was ____%

(conduct disorder)

Answer 70

3.7%

Question 71

Conduct disorder is more prevalent in which gender?

Answer 71

Conduct disorder is more prevalent in boys than in girls

Question 72

Male–female ratios for conduct disorder varies from ___:1 to ___:1

Answer 72

2:1 to 4:1

Question 73

Conduct disorder is more prevalent in which age group?

Answer 73

Conduct disorder is more prevalent in adolescents than children

Question 74

Conduct disorder is more prevalent in which socio-economic group?

Answer 74

Conduct disorder is more prevalent in low than in high socio-economic groups.

Question 75

The co-morbidity rate for conduct disorder and ADHD in community populations is ___%

Answer 75

23.3%

Question 76

Certain distinctions are made in DSM-5 and ICD-10 in the classification of conduct problems. The first distinction:

Answer 76

A distinction is made between transient adjustment disorders following an identifiable stressor involving circumscribed conduct problems on the one hand and more pervasive long-standing conduct problems that have been present for more than six months on the other.

Question 77

Certain distinctions are made in DSM-5 and ICD-10 in the classification of conduct problems. The second distinction:

Answer 77

A second distinction is that made between oppositional defiant disorder and conduct disorder with the former reflecting a less pervasive disturbance than the latter

Question 78

In the DSM system a distinction is made between (subtypes of conduct disorder in DSM-5):

Answer 78

Childhood-onset and adolescent-onset sub-types of conduct disorder.

A distinction is also made between in the DSM system between conduct disorder with and without callous unemotional traits.

Question 79

Callous unemotional traits in conduct disorder includes:

Answer 79

Lack of remorse and empathy, a lack of concern about school performance and the manipulative use of emotional display for personal again.

Question 80

What subtypes are defined for conduct disorders in the ICD-10?

Answer 80

Conduct disorder with either co-morbid ADHD or depression is defined as distinct sub-types of the condition in the ICD system (i.e. hyperkinetic con- duct disorder and depressive conduct disorder)

Question 81

Diagnosis of oppositional defiant disorder in the DSM-5

Criteria A:

Answer 81

A pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness lasting at least 6 months, and exhibited during interaction with at least one individual who is not a sibling.

Question 82

Diagnosis of oppositional defiant disorder in the DSM-5

Criteria B:

Answer 82

The disturbance in behaviour is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning.

Question 83

Diagnosis of oppositional defiant disorder in the DSM-5

Criteria C:

Answer 83

The behaviours do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder.Also, the criteria are not met for disruptive mood dysregulation disorder.

Question 84

Diagnosis of conduct disorder in the DSM-5

Criteria A:

Answer 84

A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated

Question 85

Diagnosis of conduct disorder in the DSM-5

Criteria A: A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:

What are the categories?

Answer 85

Aggression to people and animals

Destruction of property

Deceitfulness or theft

Serious violation of rules

Question 86

Diagnosis of conduct disorder in the DSM-5

Criteria B:

Answer 86

The disturbance in behaviour causes clinically significant impairment in social, academic, or occupational functioning.

Question 87

Diagnosis of conduct disorder in the DSM-5

Criteria C:

Answer 87

If the individual is age
18 years or older, criteria are not met for antisocial personality disorder.

Question 88

Diagnosis of oppositional defiant disorder in the ICD-10:

The essential feature of this disorder according to the ICD-10 is:

Answer 88

a pattern of persistently negativistic, hostile, defiant, provocative and disruptive behaviour which is clearly outside the normal range of behaviour for a child of the same age in the same sociocultural context and which does not include the more serious violations of the rights of others associated with conduct disorder.

Question 89

Diagnosis of oppositional defiant disorder in the ICD-10:

Where is the behavior frequently most evident according to the ICD-10?

Answer 89

Frequently this behaviour is most evident in interactions with adults or peers whom the child knows well, and signs of the disorder may not be present during clinical interview.

Question 90

Diagnosis of oppositional defiant disorder in the ICD-10:

What are the key distinction from other types of conduct disorder?

Answer 90

The key distinction from other types of conduct disorder is the absence of behaviour that violates the law and the basic rights
of others such as theft, cruelty, bullying, assault and destructiveness.

Question 91

Diagnosis of conduct disorder in the ICD-10:

Conduct disorders (CD) are characterized by

Answer 91

a repetitive and persistent pattern of dissocial, aggressive, or defiant conduct. Such behaviour, when at its most extreme for the individual should amount to major violations of age-appropriate social expectations, and is therefore more severe than ordinary childish mischief or adolescent rebelliousness.

Question 92

Diagnosis of conduct disorder in the ICD-10:

Exclusion criteria include:

Answer 92

Serious underlying conditions such as schizophrenia, hyperkinetic disorder or depression.

Question 93

Diagnosis of conduct disorder in the ICD-10:

Duration:

Answer 93

The diagnosis is not made unless the duration of the behaviour is 6 months or longer.

Question 94

Diagnosis of conduct disorder in the ICD-10:

Specify subtypes:

Answer 94

CD confined to family context where the symptoms are confined to the home.

Unsocialized CD where there is a pervasive abnormality in peer relationships.

Socialized CD where the individual is well integrated into a peer group.

Depressive conduct disorder where there are marked depressive symptoms.

Hyperkinetic conduct disorder where there is comorbid hyperkinetic disorder.