ADHD and ID

Question 1

Three subtypes of ADHD

Answer 1

Predominately inattentive type (ADHD-I)
6 inattentive symptoms and <6 HI symptoms

Predominately hyperactive-impulsive type (ADHD-HI)
6 HI symptoms and <6 I symptoms

Combined type (ADHD-C)
6 or more HI AND 6 or more I

Question 2

ADHD: Diagnostic Criteria inattention

Answer 2

Inattention for 6+ months that negatively impacts social, academic, vocational activities:

Question 3

ADHD: Diagnostic Criteria hyperactivity and impulsivity

Answer 3

Hyperactivity and impulsivity for 6+ months that negatively impacts social, academic, vocational activities:

Question 4

ADHD: Diagnostic Criteria age of onset, area where symptoms happen, comorbid

Answer 4

Age of onset prior to 12

Symptoms present in more than one setting

Not exclusively part of another more serious mental health condition:
Schizophrenia
Psychosis
Personality Disorder
Substance Abuse
Dissociative Disorder

Question 5

ADHD: Associated Features

memory, language, motor, social

Answer 5

Mild delays in language, motor, social development

Difficulties with memory and executive functions

Question 6

ADHD: Associated Features

increased risk with?

Answer 6

Increased risk of TBI, suicide attempt by early adulthood

Question 7

adhd in preschool

adhd as adult

Answer 7

Course: more common to see hyperactivity in preschool ages; inattention and impulsivity still problematic by adulthood

Question 8

ADHD: Risk Factors?

Answer 8

Gender: 2-1 ratio males to females

Environmental factors:
very low birth weight
Lead exposure
Teratogenic substances in utero

Genetic and physiological:
Highly heritable
Common in TBI, epilepsy, sleep disorders, etc.

Question 9

examples of genetic syndromes known to be associated with intellectual disability:

Answer 9

Down syndrome (Trisomy 21)
Fragile X syndrome
Prader-Willi syndrome
Angelman syndrome
Williams syndrome
Tuberous sclerosis complex

Question 10

Most common genetic disorder associated with intellectual disability, usually in the mild to moderate range (1 in 800 newborns diagnosed); not typically inherited

Answer 10

Down Syndrome

Question 11

A.k.a. Trisomy 21 due to genetic etiology
Associated physical features and medical complications
Behavioral challenges common
High rates of co-occurring disorders

Answer 11

Down Syndrome

Question 12

downs Associated physical features include:

Answer 12

flattened face and nose bridge, prominent upper eyelid fold, upward slanting eyes, small ears, short neck, large tongue, Brushfield spots on irises, small hands and feet, single palmar crease, small pinky fingers curving towards thumb, hypotonia (i.e., low muscle tone), short stature

Question 13

downs Associated medical problems are possible:

Answer 13

congenital cardiac abnormalities (in about 50%), digestive abnormalities, gastroesophageal reflux, orthopedic abnormalities, hearing loss, airway obstruction (obstructive sleep apnea), vision problems, endocrine problems, higher risk of autoimmune diseases, higher risk of acute leukemia, anemia, skin-related problems

Question 14

downs Behavioral features may include:

Answer 14

limitations in language and communication skills, limitations in cognition and nonverbal problem-solving skills, impulsive and disruptive behaviors, inattention, stubborn or oppositional behavior, increased anxiety/ruminative thinking, social deficits, chronic sleep problems, regression of skills with increased age

Question 15

downs Higher rates of co-occurring disorders including

Answer 15

autism spectrum disorder, anxiety disorder, obsessive-compulsive disorder, depression, early onset dementia (usually starting around 50 years of age)

Question 16

Most common inherited genetic disorder associated with intellectual disability (1 in 4,000 males and 1 in 8,000 females), with males being more severely affected than females with this disorder

Answer 16

Fragile X

Question 17

FMR1 gene mutation, inherited X-linked dominant pattern

Higher rates of co-occurring disorders including:
autism spectrum disorder, ADHD, anxiety, mood disorders

Answer 17

Fragile X

Question 18

fragile x Associated physical features include

Answer 18

long and narrow face, prominent jaw and forehead, large ears, very flexible fingers, flat feet, high-arched palate, and enlarged testes in males after puberty

Question 19

Prader-Willi Syndrome Associated physical/medical features include

Answer 19

early feeding difficulties and failure to thrive, developmental delays, delayed puberty, infertility, short stature, small hands and feet, obesity due to hyperphagia, and distinctive facial features such as narrow forehead, almond-shaped eyes, and triangular mouth

Question 20

Loss of gene function in region of chromosome 15 (not typically inherited)

Answer 20

Prader-Willi Syndrome

Question 21

Prader-Willi Syndrome Associated clinical features usually include:

Answer 21

most are in mild to moderate range of ID or have learning disability, insatiable appetite, sleep disturbance, irritability, repetitive skin picking, compulsive behaviors

Question 22

Genetic cause: Loss of UBE3A gene function (most cases involve a segment deletion on chromosome 15, with other mutations occurring as well); most cases are not inherited

Answer 22

Angelman Syndrome

Question 23

Angelman Syndrome Associated physical/medical features include:

Answer 23

microcephaly, ataxic movements, “coarse” facial features, epilepsy

Question 24

Angelman Syndrome

Associated clinical features usually include:

Answer 24

most present with severe to profound ID, absent or limited expressive language, significant developmental delays by 6-12 months of age, frequent smiling or bouts of laughter (happy, excitable demeanor), stereotyped/repetitive mannerisms, sleep difficulties, inattention

Question 25

Medication Management for ADHD Psychostimulants

Answer 25

Psychostimulants
Methylphenidate
Adderall XR
Concerta
Vyvanse
Focalin

Question 26

Medication Management for ADHD Non-stimulants

Answer 26

Non-stimulants
Intuniv (guanfacine)
Strattera (atomoxetine)
Less common:
Wellbutrin for adults