CAMHS Flashcards
How long does ADHD need to last?
Symptoms need to last at least 6 months (with evidence of impairment before age 12)
What areas of functioning may you check for ADHD?
Academic
Social
Occupational
Name some differential diagnoses for ADHD?
Intellectual disability - concerns about performance for age? difficulty understanding?
ASD - restricted interests? difficulties with communication?
sensory sensitivities?
ODD/Conduct disorder
Ilicit substances
Mania
What are the domains of ADHD
Inattention
- Losing things when go to school/forgetting things at school
- Daydreaming
- Difficulty following instructions
- Reading/films
Hyperactivity
- Always on the go
- Driven by a motor
- Fidgets
- Climbing/jumping
Impulsivity
- Not able to wait turn
- Interrupts when talking
- Quick decisions
What risk areas would you check for ADHD
Road safety!
Climbing/jumping
Fights - to others or from others
Substances
Finances
Sexual risk - if appropriate for age
How is ADHD diagnosed? (for explaining)
- No blood test or brain scan
- Diagnosis if clinical history/observations/tests
Standardised forms
Cognitive test to exclude intellectual disability
History
School observation
School reports
What risk factors for ADHD?
Sex:
- Men (3:1)
Perinatal:
- Low birth weight, prematurity, smoking/alcohol in pregnancy/ maternal mental health problems
- Epilepsy/brain in jury
Genetics:
- ADHD/ASD
What is the ADHD prognosis like?
15% retain diagnosis
65% partial remission
Inattention persists
Impulsivity/hyperactivity reduces
What is management for ADHD?
Psychoeducation
- Parents - group strategies (incredible years) or individual
- Young person
School interventions:
- SEN/EHCP
- Environmental adjustments
Peer support groups:
- For young person
Hobbies/things to do at weekends
If environmental and conservative measures don’t work - medication/CBT
note - under 5 medication is off-label
What contraindications need to be checked for ADHD medication?
- Cardiac history to check
- Seizures/tics - lower threshold for seizures and worsen tics
What are the side effects for stimulant methylphenidate?
Stomach upset
Dizzy
Appetite suppression (weight loss)
Sleep disturbance
Headaches
How can the mechanism methylphenidate be explained?
“Stimulates part of the brain that helps with focus”
What are the symptom domains for ASD?
Deficits in:
Reciprocal social interaction and social communication
Restrictive, repetitive and inflexible patterns of behaviour, interests or activities (incudes sensory atypicalities)
- Need to be atypical OR excessive for age and socio-cultural context
- Causing functional problems
- Onset during early childhood
What questions could be asked to investigate ASD?
How old did symptoms begin?
Social interaction/communication:
- Difficulty talking to children & adults?
- Difficulty reading/explaining emotions?
RRBI:
- Whats there play like?
- Do they have a difficulty making friends?
- Difficulty picking up cues?
Pregnancy
Birth and developmental history
Explore differentials (-ve schizophrenia symptoms, intellectual disability)
How is autism diagnosed?
Clinical history and direct observation
- MDT –> SALT, OT, educational psychologist involvement, medics
- No blood tests or scans
- Screening questionnaire - SCQ
- Interview - ADI-R (parents)
- Assessment with young person - ADOS (child observation)
How can ASD causes/risk factors be explained?
1-2% of children
3:1 or 5:1 male to female ratio - NICE say females are better
FHx (ASD in sibling, maternal mental health)
Perinatal risk factors (prematurity, birth defects, neonatal or infant encephalopathy)
No evidence of vaccine link
Asperger is a term no longer used - referred to people with milder symptoms/more high functioning - spectrum now
How if ASD managed?
“Depends on the difficulties the child has”
Psychoeducation for the child AND parent
Sleep difficulties (pharmacological and non-pharmacological)
Challenging behaviour
Communication - SALT
Occupational therapy
Managing co-morbidities (mood/anxiety)
School support (EHCP)
How long does ADHD need to last?
6 months w/ evidence of symptoms prior to 12 years
What differentials do you want to screen for ADHD?
DDx:
- Intellectual disability
- Autism spectrum disorder
- ODD and conduct disorder
- Ilicit substance misuse
- Mania
Should screen for anxiety and depression
NEED TO EXPLORE IMPACT ON ACADEMIC, SOCIAL AND OCCUPATIONAL FUNCTIONING
What are the symptom domains for ADHD?
Inattention
- Losing things/forgetting things at school
- Daydreaming
- Difficulty following instructions
- Struggle reading/watching films
Hyperactivity
- Are they always on the go?
- Driven by a motor?
- Climbing on the window?
Impulsivity
- Ask about road safety
- Struggling waiting turns
- Making quick decisions without thinking of consequences
- Blurting out answers
How is a dx of ADHD made?
- Clinical history
- Observation (can be w/ school)
- Standardised forms
- May perform a cognitive test - to assess academic ability (reaching full potential/exclude learning disability)
NO BLOOD TEST OR BRAIN SCAN - D’UH?!
How many kids have ADHD?
3-4% currently
In adulthood 15% retain diagnosis and 65% enter partial remission
RF:
- Boys > Girls (3:1 - may be under-diagnosed in girls)
- Associated with low birth weight, prematurity, maternal smoking/alcohol, maternal mental health problems
- Big heritability!
What physical health conditions may you want to check for an ADHD hx?
- Seizures
- Tics
- Cardiac history
How is ADHD mx
< 5 years - parent focussed group training, environmental modifications (medication off label)
> 5 years
- Environmental modification
- Medication
- CBT
- Diet and exercise
- Liaison w/ school ADHD (EHCP - name the adjustments)
INCREDIBLE YEARS - PARENTING PROGRAMME FOR ADHD
