ADHD_Flashcards

Question 1

Who are part of the MDT for ADHD?

Answer 1

Paediatrician, psychiatrist, ADHD nurses, mental health and learning disability trusts, CAMHS, parent groups, social care, school/college

Question 2

Who should make the diagnosis of ADHD?

Answer 2

Specialist psychiatrist, paediatrician or other qualified professional with training and expertise in ADHD diagnosis

Question 3

What criteria should be met for an ADHD diagnosis?

Answer 3

Meet criteria for DSM5 or ICD10 (hyperkinetic disorder), cause at least moderate psychological, social or educational impairment, be pervasive in 2 or more settings

Question 4

What should be considered in children with behavioural/attention problems impacting their development or family life?

Answer 4

Consider a period of watchful waiting for up to 10 weeks, offer referral to group-based ADHD-focused support for parents, refer to specialist if problems are severe

Question 5

What is the first line of management for children under 5 years with ADHD?

Answer 5

Offer an ADHD-focused group parent-training programme to parents and carers

Question 6

When should medication be offered to children under 5 years with ADHD?

Answer 6

Do not offer medication unless under the instruction of a specialist ADHD service

Question 7

What is recommended for children over 5 years with ADHD?

Answer 7

ADHD-focused group parent-training programme, individualised parent-training programmes if needed, offer medication if symptoms persist and cause significant impairment

Question 8

What medications are offered for children over 5 years with ADHD?

Answer 8

1st line: Methylphenidate for 6 week trial, switch to lisdexamphetamine if unsuccessful, consider dexamphetamine if side-effects are intolerable, offer atomoxetine or guanfacine if other medications cannot be tolerated

Question 9

What should be established before starting ADHD medication?

Answer 9

Baseline physical state (height and weight) and baseline ECG

Question 10

What therapy is considered for significant impairment in social skills, problem solving, self-control, active listening and dealing with expressing feelings?

Answer 10

Consider Cognitive Behavioral Therapy (CBT)

Question 11

What are other medications used in ADHD management and for what symptoms?

Answer 11

Clonidine for sleep disturbance, rages or tics, antipsychotics for aggression and irritability

Question 12

How should ADHD medication be monitored?

Answer 12

Use symptom rating scales (e.g. Conner’s), measure height every 6 months, weight every 3 months, HR and BP every 6 months, monitor for development of tics, sexual dysfunction, seizures, sleep disturbance and worsening behavior

Question 13

What dietary advice should be given for ADHD?

Answer 13

Stress importance of balanced diet and regular exercise, explore foods influencing behavior, recommend keeping a food diary, consider referral to dietician if certain foods affect behavior, no dietary interventions are particularly evidence-based

Question 14

What is the summary management for ADHD?

Answer 14

10-week watch and wait period, refer to secondary care if symptoms persist, 1st line: parent education and training programmes, if this fails, consider pharmacotherapy for children > 5 years

Question 15

What is the 1st line pharmacotherapy for ADHD in children > 5 years?

Answer 15

Methylphenidate

Question 16

What is the 2nd line pharmacotherapy for ADHD in children > 5 years?

Answer 16

Lisdexamphetamine, consider dexamphetamine if side-effects are intolerable

Question 17

What is the warning for ADHD medications?

Answer 17

All drugs are cardiotoxic, so baseline ECG should be conducted

Question 18

What is the MDT approach for Autism Spectrum Disorders (ASD)?

Answer 18

Paediatrician/adolescent psychiatrist, psychologist, occupational therapist

Question 19

What are the psychosocial interventions for ASD?

Answer 19

Increase attention, engagement and reciprocal communication, adjust to the child’s developmental level, increase understanding of patient’s communication patterns, expand communication, interactive play and social routines, therapist modeling and video-interaction feedback

Question 20

When should CBT be considered for ASD?

Answer 20

If patient has anxiety and has the verbal and cognitive ability to engage in therapy

Question 21

What speech and language therapy is recommended for ASD?

Answer 21

Social skills training

Question 22

What pharmacological treatments are not recommended for core features of autism?

Answer 22

Antipsychotics, antidepressants, anticonvulsants, or exclusion diets

Question 23

When should antipsychotic medication be considered for ASD?

Answer 23

If behavioral issues make psychosocial interventions ineffective, review at 3-4 weeks, stop at 6 weeks if no clinical indication

Question 24

How should comorbidities in ASD be treated?

Answer 24

Treat according to the specific condition, refer to the ADHD management section if comorbid with ADHD

Question 25

What support should be offered to families and carers of children with ASD?

Answer 25

Personal, social and emotional support, practical support in caring role (respite breaks and emergency plans), plan for future care, offer carer’s needs assessment

Question 26

What educational support should be considered for children with ASD?

Answer 26

Assess for learning disability, discuss EHC plan if needing extra support

Question 27

What should be explained to parents about ADHD?

Answer 27

Explain the diagnosis, management, and that manifestation will change as the child gets older, some may grow out of it

Question 28

What should be explained about ADHD medication?

Answer 28

Explain it is a 6-week trial, side-effects (loss of appetite, mood changes, palpitations, tics), requires 6 monthly height and 3 monthly weight monitoring if continued