ADHD- Patho, Diagnosis, Symptoms

Question 1

Environmental factors of ADHD

Answer 1

FAS, lead poisoning, meningitis, obstetric adversity, maternal smoking, adverse parent-child relationship, ADHD

Question 2

In ADHD, what areas of the brain have a decreased total volume?

Answer 2

Prefrontal cortex, caudate nucleus, anterior cingulate gyrus, cerebellum

Question 3

As ADHD symptoms remit with treatment, what happens to the brain volume?

Answer 3

There is increased cortical thickening and greater brain volume in regions controlling attention and behavior

Question 4

Where is activity reduced in the brain with ADHD, and what reverses this?

Answer 4

There is reduced activity in the prefrontal and anterior cingulate cortex, but this is reversed with stimulants

Question 5

What causes lapses in attention and impulse control?

Answer 5

Lack of connectivity between the prefrontal cortex and precuneus

Question 6

When anticipating reward, there is decreased activation where in the brain?

Answer 6

Ventral striatum

Question 7

What does MPH suppress?

Answer 7

Default mode network overactivity

Question 8

Symptoms of ADHD: inattention

Answer 8

wandering off task, lacking persistence, having difficulty sustaining focus, being disorganized

Question 9

Symptoms of ADHD: hyperactivity

Answer 9

excessive motor activity, fidgeting, tapping, talkativeness, extreme restlessness, wearing others out

Question 10

Symptoms of ADHD: impulsivity

Answer 10

desire for immediate rewards or inability to delay gratification, social intrusiveness, making important decisions without consideration of long-term consequences

Question 11

Presentation of ADHD in infancy

Answer 11

irritability, fidgeting, crying, difficulty feeding, short periods of sleep/frequently interrupted sleep

Question 12

Presentation of ADHD: preschool

Answer 12

excessive motor activity, intense temper tantrums

Question 13

Presentation of ADHD: school age

Answer 13

difficulty academically, combined inattentive and hyperactive/impulsivity, comorbid oppositional defiant disorder, conduct disorder, aggression –> puts the child at greater risk for delinquency and SUD in adolesence

Question 14

Presentation of ADHD: adolescents 12-18

Answer 14

inattention and impulsivity more than hyperactive, significant functional impairment, higher rates of delinquency, drug and alcohol abuse, speeding and MVA risk increases

Question 15

Presentation of ADHD: adults

Answer 15

inattention –> hyperactive/impulsive symptoms are associated with higher rates of comorbid BPD and psychosis; cognitive deficits, impatience, greater risk for unemployment, unstable relationships, psychiatric hospitalizations, incarceration

Question 16

General diagnosis of ADHD: the onset of symptoms must be when?

Answer 16

Before 12 years of age!

Question 17

Other general aspects of ADHD diagnosis

Answer 17

Significant impairment must be seen in ≥2 settings and symptoms must be documented

Evidence that symptoms interfere with or reduce the quality of social, academic, or occupation functioning

Not due to another psychiatric disorder, aren’t better explained by another mental disorder, and aren’t due to substance use/intoxication

Question 18

In children and young adolescents, how many symptoms of inattention/hyperactivity must be present?

Answer 18

≥6 and must be present for at least 6 months

Question 19

In older adolescents and adults, how many symptoms of inattention/hyperactivity must be present?

Answer 19

≥5

Question 20

Functional consequences of ADHD

Answer 20

Delays in language, motor, or social development common

Low frustration tolerance; irritability and mood lability

Impaired work/school performance (performance, attendance, attainment)

Social rejection in childhood and adolescence

Elevated incidence of interpersonal conflicts with family, peers, spouses, etc.

By early adulthood: increased risk of suicide attempts

Further increased with comorbid mood, conduct, or SUDs

Increased prevalence of SUDs and incarceration rates