ADHD_Flashcards
Who are part of the MDT for ADHD?
Paediatrician, psychiatrist, ADHD nurses, mental health and learning disability trusts, CAMHS, parent groups, social care, school/college
Who should make the diagnosis of ADHD?
Specialist psychiatrist, paediatrician or other qualified professional with training and expertise in ADHD diagnosis
What criteria should be met for an ADHD diagnosis?
Meet criteria for DSM5 or ICD10 (hyperkinetic disorder), cause at least moderate psychological, social or educational impairment, be pervasive in 2 or more settings
What should be considered in children with behavioural/attention problems impacting their development or family life?
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
What is the first line of management for children under 5 years with ADHD?
Offer an ADHD-focused group parent-training programme to parents and carers
When should medication be offered to children under 5 years with ADHD?
Do not offer medication unless under the instruction of a specialist ADHD service
What is recommended for children over 5 years with ADHD?
ADHD-focused group parent-training programme, individualised parent-training programmes if needed, offer medication if symptoms persist and cause significant impairment
What medications are offered for children over 5 years with ADHD?
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
What should be established before starting ADHD medication?
Baseline physical state (height and weight) and baseline ECG
What therapy is considered for significant impairment in social skills, problem solving, self-control, active listening and dealing with expressing feelings?
Consider Cognitive Behavioral Therapy (CBT)
What are other medications used in ADHD management and for what symptoms?
Clonidine for sleep disturbance, rages or tics, antipsychotics for aggression and irritability
How should ADHD medication be monitored?
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
What dietary advice should be given for ADHD?
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
What is the summary management for ADHD?
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
What is the 1st line pharmacotherapy for ADHD in children > 5 years?
Methylphenidate
What is the 2nd line pharmacotherapy for ADHD in children > 5 years?
Lisdexamphetamine, consider dexamphetamine if side-effects are intolerable
What is the warning for ADHD medications?
All drugs are cardiotoxic, so baseline ECG should be conducted
What is the MDT approach for Autism Spectrum Disorders (ASD)?
Paediatrician/adolescent psychiatrist, psychologist, occupational therapist
What are the psychosocial interventions for ASD?
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
When should CBT be considered for ASD?
If patient has anxiety and has the verbal and cognitive ability to engage in therapy
What speech and language therapy is recommended for ASD?
Social skills training
What pharmacological treatments are not recommended for core features of autism?
Antipsychotics, antidepressants, anticonvulsants, or exclusion diets
When should antipsychotic medication be considered for ASD?
If behavioral issues make psychosocial interventions ineffective, review at 3-4 weeks, stop at 6 weeks if no clinical indication
How should comorbidities in ASD be treated?
Treat according to the specific condition, refer to the ADHD management section if comorbid with ADHD
What support should be offered to families and carers of children with ASD?
Personal, social and emotional support, practical support in caring role (respite breaks and emergency plans), plan for future care, offer carer’s needs assessment
What educational support should be considered for children with ASD?
Assess for learning disability, discuss EHC plan if needing extra support
What should be explained to parents about ADHD?
Explain the diagnosis, management, and that manifestation will change as the child gets older, some may grow out of it
What should be explained about ADHD medication?
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
