Attention deficit/Hyperactivity disorder

Question 1

Etiological risk factors

Answer 1

Genetic predisposition
Low birth weight
Maternal smoking

Question 2

Pathophysiology

Answer 2

Etiology
• genetic: dopamine candidate genes, catecholamine/neuroanatomical hypothesis
• cognitive: developmental disability, inhibitory control and other errors of executive function
• arousal: alterations in the sensory system filters

Question 3

Differential

Answer 3

learning disorders, hearing/visual defects, thyroid, atopic conditions, congenital
problems (fetal alcohol syndrome, Fragile X), lead poisoning, history of head injury, traumatic
life events (abuse)

Question 4

Diagnosis criteria

Answer 4

diagnosis (3 subtypes):
1. ƒƒCombined Type: 6 or more symptoms of inattention and 6 or more symptoms of
hyperactivity-impulsivity
2. ƒƒPredominantly Inattentive Type: 6 or more symptoms of inattention
3. ƒƒPredominantly Hyperactive-Impulsive Type: 6 or more symptoms of hyperactivityimpulsivity

symptoms persist for >6 mo
ƒƒonset before age 7
ƒƒsymptoms present in at least two settings (i.e. home, school, work)
ƒ interferes with academic, family, and social functioning
ƒƒdoes not occur exclusively during the course of another psychiatric disorder

Question 5

Features of inattention (9)

Answer 5

Careless mistakes
Cannot sustain attention in tasks or play
Does not listen when spoken to directly
Fails to complete tasks
Disorganized
Avoids, dislikes tasks that require
sustained mental effort
Loses things necessary for tasks or
activities
Distractible
Forgetful

Question 6

Features of hyperactivity (6)

Answer 6

Fidgets, squirms in seat
Leaves seat when expected to remain
seated
Runs and climbs excessively
Cannot play quietly
On the “go”, driven by a motor
Talks excessively

Question 7

Features of impulsivity (3)

Answer 7

Blurts out answers before questions
completed
Difficulty awaiting turn
Interrupts/intrudes on others

Question 8

Potential future/current risks for child with ADHD

Answer 8

risk of substance abuse, particularly cannabis and cocaine, depression, anxiety, academic failure,
poor social skills, risk of comorbid CD and/or ODD, risk of adult ASPD

Question 9

Management

Answer 9

1. non-pharmacological:
   ->parent management,
   ->anger control strategies, behavioural management,
   ->positive reinforcement,
   ->social skills training,
   ->individual/family therapy,
   ->resource room, tutors, classroom intervention,
   ->exercise routines, extracurricular activities
2. pharmacological
   ŠŠa. stimulants: methylphenidates [Ritalin®, Concerta® (long-acting)], Biphentin®
   b. ŠŠamphetamines: dextroamphetamine, mixed amphetamine salts (Adderall®), lisdexamfetamine (Vyvanse®)
   c. ŠŠSNRI: atomoxetine (Strattera®)->for those with + risk of substance misuse, for comorbid symptoms: antidepressants, antipsychotics

Question 10

When advising parents about helping their child with ADHA what components need to be address

Answer 10

1. Verbal instructions
2. Written work
3. Avoiding over-activity and fatigue
4. Other learning
5. Structure
6. Self esteem
7. Social skills
8. Communication between school and home
9. Homework completion

Question 11

Verbal instruction and written and other learning strategies

Answer 11

Brief and conscise
Tap and say name->make eye contract
Monitor, encourage and support
Ask child to repeat instruction to be sure they understood

Highlight important points
Limit copying from blackboard

One to one
Classroom buddy
Hands on
Scheduling at best concentration
Checklist of tasks
Front of class, limit distractions
Avoid clutter

Question 12

Avoiding over-actvitiy, structuring

Answer 12

Regular rest breaks
Physical actvity dispersed with academic

Routine
Advise in advance of changes to routine
Prepare them for what is expected next
Organised and scheduling

Question 13

Self esteem and social skills

Answer 13

Congratulate on work
Highlight the positives in achievements for the day
Involve in smaller groups
Reward appropriate sharing/cooperation
Tech responses when feel provoked->walk away, talk with teacher
Encourage supervised socialising->sporting groups
Talk with them about the consequences of their actions
Use visual prompts to remind then to think before acting->Stop, think, do

Question 14

Is there a link with diet

Answer 14

1. No specific scientific evidence

2. If parents believe there is a link, they have observed a correlation can avoid

Question 15

Counselling use of psychostimulants->methylphenidate

Answer 15

1. Thought to increase DA/NE, improves frontal lobe
2. Precautions in: hepatic, cardiac, psychiatric, pregnancy
3. Adverse
   Tremor
   ND, dry mouth
   Loss of appetite, weight loss
   Insomnia
   Aggression
   TachyC, palpitation
4. Overall growth->generally normal, mostly insignificant but continue to monitor weight and growth
5. Avoid in early afternoon if difficulty with sleep
6. Can make feel dizzy
7. Assess CV function before
8. Measure and monitor height and weight
9. Do not continue if no benefit
10. When used for ADHD does not increase risk