ADHD & Disruptive, Impulse-control & conduct disorders

Question 1

Attention Deficit Hyperactivity Disorder Incidence

Answer 1

● Male to female ratio 4:1 for the predominantly hyperactive
presentation and 2:1 for the predominantly inattentive presentation
● Prevalence estimated to be around 7%, increases with increasing
age (7.7% age 4-11, 13.5% age 12-17)1

Question 2

Risk factors for ADHD

Answer 2

● Genetics: Heritability is Estimated at 80%
● Neuroanatomy
● Poor Sleep
● Perinatal (Premature, Maternal alcohol and tobacco)

Question 3

ADHD - Symptoms

Answer 3

● Unable to “Forward Plan”
● Developmental Impairment of
Executive Functions
● Activation

Question 4

Inattention

Answer 4

● Forgetfulness
● Easily Distracted
● Misplacing Things
● Disorganization
● Academic Underachievement
● Poor Follow Through with Assignments or Tasks
● Poor Concentration
● Poor Attention to Detail

Question 5

Hyperactivity

Answer 5

● Excessive Fidgeting
● Excessive Talking
● Difficulty Remaining Seated
● Difficulty Playing Quietly
● “Always on the Go”

Question 6

Impulsivity

Answer 6

● Difficulty Waiting for Turns
● Disruptive Classroom Behavior (Blurting Out Answers)
● Difficulties with Response Inhibition: Intrusive or Interruptive
● Peer Rejection
● Unintentional Injury and Accidental Death
● Untreated Impulsive Adolescents are at Greater Risk for Drug and/or
Alcohol Abuse

Question 7

Managing & Modulating Emotions in ADHD

Answer 7

○ Frustration
○ Anger
○ Worry (anxiety)
○ Disappointment
○ Desire (delayed gratification)

Question 8

Diagnosis (DSM 5 Criteria) ADHD rule

Answer 8

6:6:2 rule
○ 6 symptoms for 6 months in 2 areas of life before age 12
● Symptoms clearly interfere with function and are inappropriate for
developmental level

Question 9

ADHD - Subtypes

Answer 9

● Predominantly Inattentive
○ Reduced Ability to Focus
● Predominantly Hyperactive-Impulsive
○ Cannot Sit Still or Inhibit behaviors
● Combined Typ

Question 10

Evaluation of Children - ADHD

Answer 10

● Comprehensive medical, developmental, educational, and
psychosocial evaluation
● Medical: Family history, sleep disturbances, cardiac risk
● Vanderbilt Assessment Scales

Question 11

Adult Specific ADHD Symptoms

Answer 11

○ Hyperactivity: Restlessness, Verbosity, Constant activity, A
tendency to choose very active jobs
○ Impulsivity (may have more serious consequences in adults
than during childhood): Ending relationships, Quitting jobs,
Overreacting to frustrations, driving violations
○ Inattention: Procrastination, Difficulty making decisions, Poor
time management, Difficulty in organizing activities

Question 12

Evaluation of Adults - ADHD

Answer 12

● Conners’ adult ADHD rating scale
● The Adult ADHD Self-Report Scale (ASRS) is a brief and practical
choice
● TOVA testing

Question 13

ADHD - Treatment in preschool children (age 4 through 5 years)

Answer 13

parent (caregiver) training in behavior management (PTBM, known as behavior therapy) rather than medication as the initial therapy

Question 14

ADHD - Treatment in School-aged children and adolescents (≥6 years of age)

Answer 14

stimulant medication combined with PTBM

Question 15

ADHD - Treatment in Adults

Answer 15

Combination medication and CBT
● For most adults with ADHD, initial pharmacologic management with
an amphetamine
● History of SUD - atomoxetine