CAMHS Flashcards
What are the core features of ADHD?
Inattention
Impulsivity
Hyperactivity
Examples of hyperactivity symptoms in ADHD
Fidgeting Climbing on furniture Always on the go Talking excessively Interrupting
Examples of inattention in ADHD
Easily distracted Unable to complete tasks Unable to organise Forgetful Losing things Appearing not to listen
Age of onset for hyperkinetic disorder (ICD-10)
Before 5
Age of onset for ADHD in DSM-IV and V
IV: Before 7
V: Before 12
Gender ratio of ADHD in children
3:1 boys:girls
Risk of ADHD in siblings
2-3x increase
Prevalence of ADHD in the UK
ICD-10 criteria: 1-2%
DSM IV criteria: 3-4%
Neuro-imaging aetiology of ADHD
Reduced cerebral blood flow in frontal lobe.
Neutrotransmitter aetiology of ADHD
Dopamine and noradrenaline dysregulation in pre-frontal cortex
Which neurotransmitters do psychostimulants impact for ADHD symptoms?
Release Noradrenaline, Dopamine and Seretonin (which modulates dopamine transmission)
Environmental aetiological factors
Obstetric complications Low birth weight and prematurity Prenatal exposure to alcohol, nicotine and benzos Poor attachment and early deprivation Growing up in institutions
Co-morbid disorders in ADHD
Oppositional defiant disorder (40%) Anxiety disorder (34%) Conduct disorder (14%) Tics (11%) Mood disorder (6%)
How many children with ADHD have a comorbid disorder?
50-80%
How many children with ADHD go on to develop problems with substance misuse?
15-20%
How many children will continue to suffer residual symptoms into adulthood?
50%
What happens to ADHD symptoms as one gets older?
Fewer impulsive-hyperactivity symptoms
Factors that result in poor prognosis for ADHD
Poverty and overcrowding High EE Parental psychopathology Severe symptoms Symptoms predominantly hyperactive-impulsive Conduct disorder Language disorders
Non-pharmacological treatment options for ADHD
Educational/remedial interventions
o Parent training programme for child management skills– based on social learning theory and
behavioural interventions
o Individual/family/group therapies
o CBT methods, especially behavioural, are often effective
o Social skills training
Which medication for ADHD has the most rapid onset?
Methylphenidate - 1-3 hours
What type of medication is Atomoxetine?
NARI
How does Atomoxetine work?
Increases NA in synaptic cleft
Monitoring for methylphenidate
Height & weight, HR and BP at initially 3 then 6 montys
Monitoring for atomoxetine
Height and weight at 3 then 6 months
Signs of depression or suicidality