Attention Difficulties and Disruptive Behaviour

Question 1

Pathogenesis of ADHD

Answer 1

Genetic factors (especially involving DA)
Neuroanatomy: smaller prefrontal cortex and anterior cingulate cortex, reduced global activation and local activation of the basal ganglia
Food additives, refined sugar, and essential fatty acid deficiencies have possible relationships
Iron and zinc deficiency have likely relationships

Question 2

Diagnostic criteria for ADHD

Answer 2

For children under 18
6+ symptoms
Present before the age of 12
Persist for > 6 months
More than one setting
Impairs function
Excessive for developmental level
Behavioural ratings from 2 settings

Question 3

FIRST B.PAW

Answer 3

For hyperactivity and impulsivity subtype
F: fidgetiness
I: interruption or intrusion
R: restlessness
S: troubles remaining seated
T: excessive talking
B: blurting out answers
P: difficulties playing quietly
A: always on the go
W: difficulties waiting turn

Question 4

FATED DOLL

Answer 4

Inattention subtype
F: forgetful
A: difficulty sustaining attention
T: fails to follow through
E: avoids tasks requiring sustained effort
D: distractibility
D: not providing close attention to detail
O: difficulties with organization
L: loses objects
L: seems not to listen

Question 5

Management of ADHD

1. Preschool (4-5)
2. School-age (6+)

Answer 5

1. Behavioural 1st line, behaviour + meds second line

2. 1st line is stimulant and behavioural

Question 6

When would you use meds in a preschool age kid?

Answer 6

At risk for expulsion
Significant injury to others
Strong family history of ADHD
Suspected CNS cause
ADHD interferes with other needed therapies

Question 7

Behavioural management examples

Answer 7

Positive reinforcement
Response cost
Token economy
Parent-child interaction
Time-outs
Programs (incredible years, triple p, etc)

Question 8

ABCs of behaviour

Answer 8

A: antecedent
B: behaviour of interest
C: consequence

Question 9

Side effects of stimulants

Answer 9

Appetite suppression
Poor growth
CV: dizziness, HTN
Mood lability
Insomnia
Rebound behavioural effects
Tics
Less common: priapism, psychosis

Question 10

DSM Diagnosis of Learning Disability

Answer 10

Difficulties in learning and using academic skill
Substantially affected and quantifiably below expected performance (by standardized tests)
Must persist for 6 months despite intervention
Begin during school age years

Question 11

Dyslexia

Answer 11

A reading disability

Issues with decoding and phonics

Question 12

Intellectual Disability

Answer 12

Neurodevelopmental disorder characterized by deficits in intellectual and daily living skills
Presents before 18 years old
Multiple definitions and severity

Question 13

3 adaptive domains

Answer 13

Conceptual: literacy and math concepts
Social: friendships, social problem solving
Practical: personal care, daily routines, occupation

Question 14

Global Developmental Delay

Answer 14

Intellectual and adaptive impairment in children Under 5
Significant delay (2 SDs below mean) in at least 2 developmental domains