Cooley - ADHD

Question 1

What percentage of kids met any criteria for any type of ADHD?
What percentage of kids had some medication treatment?
What percentage had consistent medication treatment?
What gender were less likely to have their disorder recognized?
What patient population were least likely to receive ADHD medication treatment?

Answer 1

8.7
39
32
Girls
Poor

Question 2

What type of ADHD do female kids usually have?

Why are they more commonly under identified?

Answer 2

Inattentive subtype

Less disruptive behavior

Question 3

What is the estimated prevalence of clinically assessed adult ADHD?
What percentage of adult ADHD received treatment?

Answer 3

4.4

11

Question 4

What is the point be was trying to make behind the question, has prevalence of ADHD increased?

Answer 4

True prevalence of ADHD has not increased, just the number of ADHD diagnoses has gone up because of increasing awareness and access to services

Question 5

4 most common comorbidities for adult ADHD?

Answer 5

Mood disorders
Anxiety disorders
Substance disorders
Intermittent explosive disorders

Question 6

3 comorbidities to childhood ADHD

Answer 6

Tourette’s syndrome
Chronic tic disorder
Childhood suicide

Question 7

How do we classify Tourette’s syndrome?
What is the triad?
What symptoms do boys and girls most commonly have?

Answer 7

Neuropsychiatric spectrum disorder
Tics, OCD and ADHD
Boys are more likely to have TICS and ADHD
Girls more likely to have OCD

Question 8

Explain the primary function of executive functioning?

Answer 8

Ability to assess a situation
Figure out what is relevant or not
Filter our irrelevant
Make a plan to act
Execute the plan
Assess the effect of action

Question 9

What is a dysfunction of the executive functioning?

Primary cause?

Answer 9

Information processing dysfunction within the prefrontal cortex
Dopamine and NE deficiency

Question 10

What is the region of the brain identified as dysfunctional in ADHD?

Answer 10

daMCC

Question 11

How many symptoms do kids need for a diagnosis of ADHD?

How many symptoms do people 17 and older need?

Answer 11

6

5

Question 12

What other mental disorders can cause deficits of attention and concentration? 5.

Answer 12

Anxiety, depression, bipolar, borderline personality, and autism

Question 13

What are the two tests for ADHD?

What are the strengths and weaknesses of each?

Answer 13

TOVA: custom, lots of languages, normalize to age, immediately available report, easy to train people to administer it, has a shorter test for kids.
Conners: more specific for attention disorders, computer, easily executed by patient, short. 8 and older

Question 14

Best parent approach for ADHD kids?
First line treatment for preschool aged kids with ADHD?
What if behavior doesn’t improve, what is second line?

Answer 14

Less harsh
Evidence based behavior therapy
Ritalin

Question 15

What is preferred treatment of elementary school aged children with ADHD?

Answer 15

Behavior therapy and Ritalin

Question 16

Treatment of teens with ADHD?

Answer 16

Meds and therapy

Question 17

Besides the physical exam and HPI of the patient, what other history components do we want from the patient?

Answer 17

How is it effecting your life?
Development history?
Medical history?
Family history?

Question 18

As far as medications, what does the evidence point to that is most effective?

Answer 18

Stimulants

Question 19

MOA of Guanfacine and Clonidine and their effect?

Answer 19

Alpha 2 agonists, that can modulate adrenergic tone in the PFC

Question 20

MOA of Bupropion?
3 advantages?
1 risk?

Answer 20

Antidepressant
Lack of abuse, single day dosing, and helps with anxiety and depression
Risk of seizure

Question 21

MOA of atomoxetine?

Risk and patient population to use caution in?

Answer 21

SSRI
QTc prolongation
Cv patients

Question 22

MOA of modafinil?
2 adverse effects?
Use this med in what patient population only?

Answer 22

Blocks dopamine uptake
Serious Dermatologic and psychiatric reactions
Adults only

Question 23

2 stimulates to use and their MOA?

Answer 23

Methylphenidate: reuptake inhibitor of catecholamines, especially dopamine
Amphetamine: reuptake inhibitor and release of catechoamines

Question 24

Big time adverse effect of stimulants for ADHD?

Answer 24

Neurochemical imprinting, which is increased CBF and increased dopamine levels