Diagnosis and Treatment of ADHD

Question 1

WIth the new DNS 5, what age to symptoms need to appear before to get the ADHD diagnosis?

Answer 1

12 years (used to be 7)

Question 2

FOr the ADHD diagnosis, the symptoms have to NOT be from what three other conditions?

Answer 2

psychosis, depression, and anxiety

Question 3

What are the three general subtypes of ADHD?

Answer 3

1. inattentive
2. hyper/impulsive
3. mixed

Question 4

Which subtype is most common in boys? Which is most common in grisl?

Answer 4

mixed - boys
inattentive - girls

(hyper/impulsive is least common)

Question 5

What early medical history possibilities are contributors to ADHD

Answer 5

in utero exposures to substances
birth traumas
other frfontal lobe trauma (TBI, lead, mercury, etc)

Question 6

What should be in the differential diagnosis for ADHD

Answer 6

learning disorders
behavioral disorders (ODD< conduct, etc)
anxiety disorders
mood disorders (depression, bipolar)
psychotic (rare

Question 7

What is formal testing for ADHD?

Answer 7

cognitive psychological testing with tests like the TOVA, trails, working memory, wisconsin card sort, etc.

Question 8

What are the cloninger dimensions of ADHD personality?

Answer 8

increased risk taking
decresaed harm avoidance
potentially increased reward dependence

Question 9

What is the gold standard for pharmacotherapy in ADHD?

Answer 9

psychostimulants - methylphenidate and amphetamines

Question 10

What are the risks associated with stimulants?

Answer 10

cardiovastular (so be careful if FAS)
tics, tourettes (maybe)
anxiety/dep
psychosis/mania

Question 11

What is the best adminstration system for stimulants in ADHD?

Answer 11

the daytrana patch - it’s continuous for a long period of time

Question 12

If ADHD is comorbid with depression, how do you treat it?

Answer 12

treat whatever is most severe and then add a 2nd treatment is the first doesn’t fix it

Question 13

What drug should you give th comorbid ADHD and anxiety?

Answer 13

atomoxetine to treat both

Question 14

What are some of the signs of ADHD in infancy?

Answer 14

unduly sensitive to noise, light, temp or change in general
very active
sleep little
cry often
explosively irritable
emotionally labile
difficulty delaying gratifications

Question 15

Can you diagnose a kid with ADHD in preschool?

Answer 15

you maybe could, but it’s controversial because they wont look overly abnormal. just watch closely for a couple more years

Question 16

What are th eneurological “soft signs” of ADHD?

Answer 16

clumsiness, L/R confusion, perceptual-motor dyscoordination

Question 17

do kids with ADHD tend to have low or hihg self esteem? How well are they socialized?

Answer 17

low self esteem

poor socialization

Question 18

What is the prevalence of ADHD?

Answer 18

probably 5% in school age children and 3-4% in adults

Question 19

What are females with ADHD often diagnosed with first?

Answer 19

depression because females tend to exhibit less hyperactivity and internalize more

Question 20

ADHD wins the prize for what in terms of childhood disorders?

Answer 20

it’s the most commonly treated childhood disorder

Question 21

what percentage of kids on stimulants get get them a primary care doc?

Answer 21

60%

Question 22

What are the three major parts of the brain involved in ADHD?

Answer 22

prefrontal cortex (development delayed), basal ganglia (volume reduced), cerebellum (volume reduced)

Question 23

What two main NTs are involved with ADHD?

Answer 23

NE and DA (lower concentration or, lower firing rate, possibly fewer receptors)

Question 24

What role does the basal ganglia play in ADHD?

Answer 24

it’s normally inolved with th eselection of appropriate behaviors and voluntary motor control. aslo emotional function. Without it, you get dysfuntion as in ADHD

Question 25

What does the dorsal anterior cingulate cortex fail to mediate in ADHD?

Answer 25

it normally regulates selective attention, so they have little attention to detail and make careless mistakes/lose things

Question 26

What does the dorsolateral preforntal cortex fail to mediate in ADHD?

Answer 26

it normally regulates SUSTAINED attention, problem solving and executive functioning

so they lack follow torugh and organization

Question 27

What part of the brain regulates the motor hyperactivity seen in ADHD?

Answer 27

premotor cortex

fidgeting, leaving seat, est

Question 28

What part of the brain mediates the impulsivity and social/emotional responses of ADHD?

Answer 28

orbital frontal cortex

Question 29

Cerebellar volume is decreased with ADHD< so what motor symptoms might they have?

Answer 29

bad handwriting, clumsiness, delays in achieving motor milestones

Question 30

Why does a lack of dopamine result in ADHD

Answer 30

DA usually enhances signal to improve attention - keeps you focused on task behavior and cognition

Question 31

Why does a lack of NE result in ADHD?

Answer 31

NE usually dampens noise, increases inhibition and helps executive operations

Question 32

For the ADHD criteria, it is 6 signs before 12 years old, but once you’re older than 17, how many are needed?

Answer 32

only 5

Question 33

Does the gender difference in ADHD persist into adulthood?

Answer 33

nope - 1:1

Question 34

Comorbidites are the absolute norm with adulte ADHD. WHat are some?

Answer 34

mood disorders (dep anx, bipolar), dementia, sleep apnea, insomnia, hyperthymid personality

Question 35

Which tends to persist more into adulthood - inattentiveness or hyperactivity?

Answer 35

inattentiveness