Attention Deficit Hyperactivity Disorder (ADHD)

Question 1

ADHD definition:

Answer 1

A behavioral syndrome characterized by a persistent pattern of inattention, poor concentration, impulsivity, and overactivity that exceeds normal developmental variation.

Question 2

ADHD subtypes:

Answer 2

Inattention type
Hyperactive-impulsive type
Combined type

Question 3

ADHD diagnosis:

Answer 3

Six or more symptoms of inattention (or)
Six or more symptoms of hyperactivity/impulsivity (and)
Symptom onset prior to 7 years of age; symptoms problem-causing in at least two settings; negative impact of symptoms on social, academic, and/or work performance; and symptoms not attributed to more significant underlying medical disorder

Question 4

Symptoms of inattention:

Answer 4

Poor attention to detail/ careless mistakes
Difficulty maintaining attention during activities
Failure to listen even when directly spoken to
Problems following directions or with completion of assignments or tasks
Disorganized in activities and tasks
Avoids activities that require focused mental attention
Frequently loses items necessary for successful completion of task
Easily distracted by external stimuli
Forgetful

Question 5

Symptoms of hyperactivity/ impulsivity:

Answer 5

Fidgets and squirms
Difficulty staying seated when expected or appropriate
Excessive running and climbing
Difficulty with quiet play activities
Very high energy and activity level
Excessively verbal and talkative
Answers questions abruptly before question is completed
Difficulty waiting for a turn
Frequently interrupts others and acts intrusively

Question 6

ADHD differentials:

Answer 6

Age appropriate for highly active child
Inadequate environment (understimulating or chaotic)
Learning disabilities/ sensory impairment
Seizures or mental retardation
Situational anxiety and/or depressive reaction
Oppositional behavior and/ or conduct disorder

Question 7

ADHD management–Structured environment:

Answer 7

Establish regular routine
Clear and simple rules
Firm limits
Minimize distraction, overstimulation, and fatigue

Question 8

ADHD management–Behavioral management:

Answer 8

Reward/reinforce good behavior
Time-out or systematic ignoring to decrease unacceptable behaviors
Child-based therapy for depression, anxiety, low self-esteem
CBT to increase self control
Parenting classes or family therapy for relationship difficulties

Question 9

ADHD Pharmacotherapy–Methylphenidate:

Answer 9

Ritalin, Concerta
Effective in 75-80% of children
Trial at least 2-3 weeks
Give 20 minutes before meals to maximize effectiveness
Avoid p.m. doses to avoid insomnia

Question 10

ADHD Pharmacotherapy–Dextroamphetamine

Answer 10

Adderall, Adderall XR
Effective in 70-75% of children
Rapid response

Question 11

ADHD Pharmacotherapy–Atomoxetine

Answer 11

Strattera
Non-stimulant
Causes less insomnia