Attention-Deficit/ Hyperactivity Disorder (ADHD) based on Nelsons Flashcards
What is ADHD and how is it characterized?
ADHD is a common neurobehavioral disorder characterized by inattention, impulsivity, and hyperactivity.
What are the DSM-5 diagnostic criteria for ADHD?
A persistent pattern of inattention and/or hyperactivity-impulsivity interfering with functioning or development for ≥6 months, present in at least 2 settings, and causing significant impairment.
How does ICD-11 differ from DSM-5 in ADHD criteria?
ICD-11 describes ADHD features but does not specify age of onset, duration, or a minimum number of symptoms.
What is the prevalence of ADHD worldwide?
5–10% of school-age children are affected.
What is the male-to-female ratio for ADHD presentations?
4:1 for hyperactive-impulsive presentation and 2:1 for inattentive presentation.
What coexisting conditions are common in children with ADHD?
Learning disabilities, mood disorders, and language disorders.
What is the heritability of ADHD based on twin studies?
70–80%.
What structural brain abnormalities are associated with ADHD?
Dysregulation of frontal-subcortical circuits, smaller cortical volumes, and abnormalities in the cerebellum.
How do dopamine and norepinephrine play a role in ADHD?
Dopamine transporter density is increased, reducing dopamine availability; stimulant medications increase dopamine and norepinephrine at the synapse.
What environmental factors increase the risk for ADHD?
Prenatal tobacco or alcohol exposure, prematurity, and maternal mental illness.
What are the DSM-5 ADHD presentations?
Predominantly inattentive, predominantly hyperactive-impulsive, and combined presentations.
What are the minimum symptom criteria for ADHD according to DSM-5?
At least 6 inattentive symptoms and/or 6 hyperactive-impulsive symptoms.
At what age should ADHD symptoms begin to meet DSM-5 criteria?
Before age 12 years.
In how many settings must ADHD symptoms be present?
In at least two settings, such as home and school.
What types of symptoms are common in ADHD for preschool children?
Motor restlessness and aggressive or disruptive behaviors.
What ADHD symptoms tend to persist into adolescence and adulthood?
Impulsivity and inattention.
Which ADHD presentation is more common in females?
Predominantly inattentive presentation.
What symptoms are typically associated with ADHD in females?
Internalizing symptoms like anxiety and low mood.
What information is gathered during an ADHD clinical evaluation?
Developmental history, school performance, social skills, mood, sleep patterns, and family history.
What tools are used to collect information about ADHD symptoms?
Behavior rating scales from parents, teachers, and other caregivers.
What comorbidities should be screened during an ADHD evaluation?
Mental health symptoms, neurodevelopmental or learning problems, and medical history.
What physical assessments are important in ADHD evaluation?
Baseline height, weight, blood pressure, pulse, and motor coordination.
How does ADHD affect academic and social functioning?
ADHD may lead to academic underachievement, interpersonal problems, and low self-esteem.
What long-term risks are associated with untreated ADHD?
Underemployment, social dysfunction, substance abuse, and increased risk of accidents or suicide.
What role does maternal mental illness play in ADHD risk?
Underlying maternal mental illness, rather than treatment, increases the risk for ADHD in offspring.
What dietary factors might affect ADHD symptoms?
Diet is not generally a cause, but a small subset of children may be sensitive to certain foods or additives.
How is ADHD severity categorized?
Mild, moderate, or severe, based on symptom intensity and functional impairment.
What are the common ADHD presentations in older adolescents and adults?
Disorganized, distractible, and inattentive behaviors.
What are the common coexisting conditions in adults with ADHD?
Mood disorders, anxiety, and substance use disorders.
What is the recommended minimum age for initiating ADHD evaluation?
Age 4 years.
What are the goals of ADHD treatment?
Improve functioning, address coexisting conditions, and optimize the child’s strengths and resources.
What is the purpose of behavior rating scales in ADHD assessment?
Behavior rating scales help elicit information about ADHD symptoms across contexts (home and school) and assess functional impairment.
What are the two types of Vanderbilt ADHD Rating Scales?
Parent and teacher versions.
What specific ADHD symptoms does the Vanderbilt ADHD Rating Scale assess?
Inattention and hyperactivity/impulsivity, corresponding to DSM-5 criteria.
What coexisting conditions does the Vanderbilt ADHD Rating Scale screen for?
Anxiety/depression and oppositional behaviors/conduct disorder.
Name two additional ADHD-specific rating scales.
Conners 3 ADHD Index and ADHD Rating Scale 5.
What are broadband rating scales useful for in ADHD assessment?
Assessing coexisting conditions.
Give two examples of broadband rating scales.
Achenbach Child Behavior Checklist (CBCL) and Behavioral Assessment Scale for Children (BASC).
What is the significance of electronic capture of rating scale information?
It facilitates completion and scoring.
How should clinicians interpret discrepancies between parent and teacher rating scale results?
By assessing the context and level of support in each setting.
What percentage decrease in ADHD symptom scores is considered significant improvement?
25% or more.
Why might functional outcomes be more important than changes in symptom scores?
They better reflect the real-world impact of treatment.
What is critical to consider when assessing children on medication for ADHD?
Whether the medication was active during observation.
What features should a physical exam for ADHD include?
Cardiac and neurologic evaluations, thyroid, hearing and vision assessments, and checking for dysmorphic features.
When might laboratory tests or brain imaging be indicated in ADHD assessment?
When there is hypertension, ataxia, asymmetric neurologic findings, or symptoms of sleep, seizure, or thyroid disorders.
What role does educational testing play in ADHD assessment?
It helps identify specific learning disabilities that often coexist with ADHD.
When should intelligence or developmental testing be conducted in ADHD cases?
When there are concerns about slow developmental milestones.
What are two symptoms that might indicate a need for autism spectrum disorder assessment?
Concerns about social communication skills and restricted, repetitive behaviors or interests.
What are two psychiatric conditions that can mimic ADHD?
Depression and anxiety disorders.
What psychiatric condition involves proactive aggression and authority challenges?
Oppositional defiant disorder (ODD) or conduct disorder.
What medical condition might mimic ADHD due to disrupted sleep?
Obstructive sleep apnea or restless legs syndrome.
What developmental conditions should be included in the differential diagnosis for ADHD?
Low/high cognitive abilities, learning disabilities, communication disorders, and autism spectrum disorder.
What medical conditions can overlap with ADHD symptoms?
Sleep disorders, hearing or vision impairment, thyroid disorders, genetic syndromes like fragile X, and others.
Why is a private interview with adolescents important during ADHD assessment?
To screen for mood symptoms, psychosocial stressors, and substance use.
What are common triggers for symptoms resembling ADHD?
Major life stresses like divorce, family violence, or child abuse/neglect.
What are the four general categories of ADHD differential diagnosis?
Developmental, psychiatric, medical, and psychosocial.
What psychosocial conditions can lead to ADHD-like symptoms?
Response to abuse, distress at home, inappropriate expectations or parenting practices, or inappropriate classroom settings.
What is the overall treatment approach for ADHD?
ADHD is managed as a chronic condition with education, regular follow-up visits, behavioral therapy, school-based supports, and medications. The treatment plan should be developed collaboratively with the child and family.
What is the recommended first-line treatment for preschool-age children with ADHD?
For children under 6, the first-line treatment is evidence-based parent- and/or teacher-administered behavior therapy. Medication should be considered if there is moderate to severe impairment and behavior interventions are not effective.
What is the first-line treatment for school-age children and adolescents with ADHD?
For children aged 6 years and older, ADHD medications should be considered first-line, along with behavior and educational interventions.
What are behaviorally oriented treatments for ADHD?
Behavioral interventions focus on modifying the environment and empowering caregivers with strategies to promote positive behaviors, using reinforcement, clear rules, and consistent enforcement.
What is the purpose of behavioral parent training in ADHD?
It involves teaching parents behavior modification strategies to address specific behaviors, emphasizing positive reinforcement and appropriate consequences for maladaptive behaviors.
What is the role of exercise in ADHD treatment?
At least 60 minutes of moderate to vigorous exercise is recommended for children ≥6 years old. Exercise may help reduce ADHD symptoms, in addition to supporting general health.
What is the role of cognitive-behavioral therapy (CBT) in ADHD treatment?
CBT can be beneficial for children and adolescents with ADHD and coexisting anxiety or depression, addressing symptoms of anxiety or low mood.
What types of educational supports may benefit children with ADHD?
Children may benefit from preferential seating, motor breaks, frequent teacher check-ins, individualized behavior plans, and a daily report card for regular communication between parents and teachers.
What is the purpose of a daily report card in ADHD management?
A daily report card includes target problem behaviors, and the teacher provides ratings for each behavior. This report is sent home to be used for home-based rewards for goal achievement.
What accommodations might children with ADHD need to support executive functioning?
Children with ADHD often need explicit instruction in organization, using tools like an agenda book, color coding, and regular teacher check-ins for organizing tasks.
What is an individualized educational plan (IEP) and who qualifies for it?
An IEP is designed for children with ADHD and coexisting learning disorders, communication delays, mental health challenges, or autism spectrum disorder, providing specialized educational support.
What should be done before initiating medication for ADHD?
A history and physical examination should be conducted, including an assessment of baseline sleep, eating, and mood, as these need to be monitored throughout medication treatment.
What types of medications are commonly used to treat ADHD?
ADHD medications fall into three categories: stimulants, norepinephrine reuptake inhibitors, and α2-adrenergic agonists.
What is the first-line medication treatment for ADHD?
Stimulants are the first-line medication treatment, with a larger treatment effect size compared to nonstimulants.
What is the role of norepinephrine reuptake inhibitors in ADHD treatment?
Norepinephrine reuptake inhibitors like atomoxetine and viloxazine may be used when there is a concern for substance use disorder or if a family prefers nonstimulant medication.
What is the role of α2-adrenergic agonists in ADHD treatment?
α2-adrenergic agonists (guanfacine, clonidine) may be used as monotherapy or adjunctive therapy, especially for children with coexisting tic disorders or sleep problems.
What are common side effects of stimulant medications for ADHD?
Common side effects include decreased appetite, headaches, stomachaches, difficulty falling asleep, and mood lability.
What should be monitored when a child is on stimulant medication for ADHD?
Height, weight, pulse, and blood pressure should be periodically monitored. Growth should also be assessed, as stimulants can slightly reduce linear growth.
What should be done if a child experiences significant reductions in growth while on stimulant medication?
If a child experiences significant reductions in height or weight, the medication should be reconsidered, potentially switching to a different ADHD medication.
What should be done before starting stimulant medications for ADHD?
Children should be screened for symptoms of cardiomyopathy, coronary artery disease, arrhythmias, or family history of sudden death to ensure safety.
What is rebound with stimulant medication?
Rebound refers to symptoms like mood lability occurring as the medication wears off. This may be managed by switching to a longer-acting stimulant or adding a low-dose short-acting medication.
What is the risk of substance abuse with stimulant medications?
Stimulant medications have the potential for misuse, diversion, and abuse, so adolescents should be counseled about safe medication storage and taking medications only as prescribed.
How long does it take for norepinephrine reuptake inhibitors to show effectiveness?
Atomoxetine and viloxazine may take up to 4 weeks to show effectiveness.
What are the common side effects of norepinephrine reuptake inhibitors?
Side effects of norepinephrine reuptake inhibitors include fatigue, decreased appetite, nausea, vomiting, irritability, and a rare risk of suicidal thinking.
What are the side effects of α2-adrenergic agonists for ADHD?
Common side effects of α2-adrenergic agonists include sedation, headaches, hypotension, and they should be stopped gradually to avoid a rapid increase in blood pressure.
What is the prognosis for individuals diagnosed with ADHD in childhood?
More than half of individuals with ADHD will develop a mental health condition in adulthood. One-third to two-thirds will continue to have significant symptoms of ADHD in adulthood.
What long-term risks are associated with ADHD in adolescence and young adulthood?
Adolescents with ADHD are at increased risk for risk-taking behaviors, educational underachievement, substance use, psychosis, and relationship difficulties.
What are the benefits of consistent treatment for ADHD?
Consistent treatment with medication and other therapies can reduce the risks associated with ADHD, including injuries and substance use.
What role does parent training play in secondary prevention for ADHD?
Parent training can significantly improve ADHD symptoms and oppositional behaviors, leading to better long-term outcomes when ADHD is detected and treated early.
