Attention Deficit Hyperactivity Disorder (ADHD) Flashcards
ADHD epidemiology and facts
Affects 5-9% of school-aged children
- more common in males
Is a neuro-developmental disorder
Often presents with the following coexistent issues
- sleep disorders
- anxiety
- conduction disorders
- autism
- learning disabilities
- tic disorders
Comorbidities associated are
- mood disorders
- depression
- Anxiety
Risk factors for ADHD
Age must be lower than 12
Being younger
- decreases in prevalence as you get older
Male
- 3:1 male vs female ratio
Being white
- least common is in Asian children
Genetic relation ship of ADHD
2-8x more likely in children if at least one parent or sibling has ADHD
Monozygotic twins = 92% concordance rate
Dizygotic twins = 33% concordance rate
- non-Mendelian multifactorial inheritance pattern for most with some autosomal dominant features*
- multiple loci have been associated with ADHD
***ADHD phenotype = OMIM #143465
Theory surrounding ADHD
Aberrant dysregulation of catecholamine metabolism
- reduced dopamine activity in the prefrontal-striatal-thalamocortical and cerebellar circuits
also some evidence for abnormally low serotonin activity, since serotonin is a modulator for dopamine
often when they become older, this dysregulation goes away
How to make a diagnosis of ADHD
It’s all clinical based
- physical history
- documented reports/behavior rating scales from parents/caregivers/teachers
- physical examination
Requires at least 6 core symptoms that is maladaptive and inconsistent with developmental level and impairs functioning in social/academic or occupational settings
- if greater than 17 = 5 core symptoms in 2 more settings
must last at least 6 months and in 2 different settings and must be present before age 12 yrs
MUST RULE OUT OTHER DISORDERS
Is ADHD often a singular diagnosis?
NO
- almost always coexists with other issues/comorbidities
How long should a caregiver/teach have had regular contact with a child you suspect ADHD in before allowing them to fill out a behavioral form?
Minimum of 4 months
Other diagnosis that resemble ADHD in some form
1) Central nervous system diseases
- will also present with subtle neurologic “soft signs” (HTN/papilledema/ataxia/Visual and or hearing defects)
2) hyperthyroidism
- will also present with hyperthyroid signs (weight loss, HTN, resting tachycardia, goiter, weakness, diaphoresis at rest, etc)
- get T4 and TSH assay
3) high lead levels (toxicity)
- family history is important here and can get lead tests if suspect
4) congenital genetic syndromes
- usually present with dysmorphic features as well
5) primary sleep disorders
6) evaluate for substance use disorder when clinical concern exists
What is the number one sign that suggests potential ADHD diagnosis should be dismissed entirely?
If the manifestation of ADHD symptoms are sudden with no previous history
in this case it is usually head trauma, Mood disorders or neurodegenerative issues
Classifications of ADHD
1) Predominantly inattentive type
- more common in females
- cognitive impairment is present
- ONLY shows inattention criteria
- average onset = 8-9 yrs
2) Predominantly hyperactivity type
- more common in males
- ONLY shows hyperactivity/impulsivity
- may or may not show cognitive impairment
- average onset = 4-5 years. Peaks at 7-8
3) Combined type
- more common in males
- criteria for both inattention and hyperactivity/impulsivity
Clinical presentation of ADHD in children
Hyperactivity/impulsivity starts to appear at age 4 and peaks at age 7-8
- cant start giving meds until at the age of at least 6 yrs
Most Prominent symptoms are
- motor restlessness
- disruptive behavior
Inattention symptoms develop around age 8-9
Clinical presentation of ADHD in older adolescents/adults
Almost exclusively exhibit inattention
- hyperactivity is less pronounced And if present is inner/inability to settle down
Most prominent symptoms are
- distractability
- disorganization
- impulsivity
- relationship/occupational problems
disorder continues into adulthood up to 40% of affected children
DSM-5 criteria for inattention
Must include at least 6 of the following symptoms:
1) lack of attention to detail
- careless mistakes or misses small details
2) difficulty sustaining attention
- cant stay on track with tasks or play activities
- especially if they are boring
3) difficulty with listening skills
- doesn’t respond to verbal cues often
4) difficulty with task completion
5) difficulty with organizational skills
6) difficulty with tasks requiring sustained attention
7) frequently loses belongings
8) Easily distracted
9) forgetful
Hyperactivity vs impulsivity
Hyperactivity = restlessness/excess motor activity
Impulsivity = tendency to act without thinking of consequences and social interference
DSM-5 criteria for hyperactivity/impulsivity
Needs at least 6 of the following
1) fidgeting and squirming
2) stands when sitting is expected
3) runs around inappropriately
4) difficulty with quiet play
5) inability to relax and remain still
6) excessive talking
7) blurts out answers
8) difficulty waiting for turns
9) interrupts
