Externalising CAMH Disorders (ADHD, ODD, Conduct D/O) Flashcards
What are the classic symptoms of ADHD?
- Hyperactivity
- Impulsivity
- Inattention
What are the subtypes of ADHD?
- Hyperactive / impulsive
- Inattentive (may be harder to pick)
- Combined: both aspects simultaneously
MSE features of ADHD?
- Disinhibited
- Fidgeting
What is the role of medications in adolescent patients with MH disorders?
Aid and facilitate learning by increasing resilience factors
what are the principles of managing an adolescent with a MH disorder?
- Major focus on small wins
- Build competencies
- Don’t make sweeping changes quickly
- Emphasise decreasing stress in family unit
Drugs Mx ADHD?
- Stimulant medication
- Atomexetine
- Clonidine / Imipramine / Risperidone
What are the major principles which must be considered in ADHD pharmacotherapy?
- Clear goals for medication treatment
- AEx monitoring plan
- Crisis plan
- Clear review plan
- Plan for duration of Rx before trial withdrawal
Psychosocial strategies for management of ADHD?
- Time management strategies
- Behavioural strategies
- Environmental manipulation (sit close to teacher, away from distractions)
- Limit group work
What are the behavioural strategies in ADHD management?
- Clear rules and immediate consequences
- Academic targets and behavioural goals
- Reward pro social behaviours immediately
Strategies to improve working memory in ADHD?
Teach:
- ability to ask for help
- chunking
- rehearsal
- rote learning
- generate mental images of information
- frequent breaks
- realistic targets for work period
Environmental changes in ADHD Mx?
- Look for warning signs of memory overload
- Quiet working area / minimise distractions
- Gain attention before giving instructions
- Use short sentences / simple grammatical forms
- One task at a time
- Guide through tasks using prompts
- Visual aids where psosible
What are the child interventions for ODD?
- Cycle of change / motivational interviewing
- CBT
- Social skills
- Managing anger (recognising / self control)
- Changing self narrative
- Perspective taking / victim empathy
CBT strategies for ODD Mx?
- Self talk
- Relaxation techniques
- Problem solving
Social skills to develop for ODD Mx?
- making friends,
- assertiveness,
- communication skills
- accepting no
What characterises the hyperactive / impulsive subtype of ADHD?
Inability to sit still or inhibit behaviour
Symptoms of hyperactivity / impulsivity?
- Excessive fidgitiness
- Difficulty remaining seated
- Feelings of restlessness/ inappropriate running or climbing
Pattern of hyperactive symptoms throughout the lifespan?
Hyperactive:
- Observed by 4y
- peak 7-8y
- Decline by adolescence (may seem normal)
Pattern of impulsive symptoms throughout the lifespan?
Impulsive: persist throughout life
What determines the focus of impulsivity?
Environments e.g. ADHD teens in environment with EtOH/drugs available more likely to engage
What characterises the inattentive subtype of ADHD?
Reduced ability to focus attention and reduced speed of cognitive processing and responding: sluggish / day dreaming / off task
When do symptoms of inattention typically become apparent?
8-9yo. Usually lifelong
What must occur for core symptoms to meet ADHD criteria?
Must impair academic, social or occupational function
What should be discussed in ADHD consultations?
Safety: greater risk of intentional and unintentional injury
What are the clinical features of conduct disorder?
- Aggression to people and animals
- Destruction of property
- Deceitfulness or theft
- Serious violations of rules
What is conduct disorder?
Repetitive and persistent violation of age-appropriate social norms, rules, or basic rights of other
What are the CFx of anxiety disorder?
Persistent, excessive, difficult to control worry about events or activities; associated with:
- Restlessness
- Easy fatigability
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance
What is learning disability inc CFx?
Intrinsic cognitive difficulty that results in lower academic achievement than expected for intellectual potential; examples include:
- Reading disorder
- Disorder of written language
- Mathematics disorder
- Learning disorder, not otherwise specified
What is ODD?
Recurrent, negative, defiant, disobedient and hostile behaviour toward authority figures
What are the CFx of ODD?
- Losing temper
- Arguing with adults
- Actively defying or refusing to comply with adult’s requests or rules
- Deliberately annoying people
- Blaming others for mistakes or misbehaviour
- Touchy or easily annoyed
- Angry or resentful
- Spiteful or vindictive
ADHD evaluation should screen for which comorbid conditions?
- Anxiety / depression
- ODD
- Conduct disorder
- learning disabilities
- substance use
DSM V criteria ADHD?
Under 17 = 6+
Over 17 = 5+
Symptoms of hyperactivity or inattention.
Must:
- occur often
- present in more than one setting
- persist for at least six months
- present before 12y
- impair function
- excessive for develop,mental level of child
- not explained by other physical / situtaional / MH explanation
Neuro / developmental Ddx for ADHD?
- Learning disability
- Language / communication disorders
- ASD
- Neurodev syndromes (FRAX, FAS, Klinefelter)
- Seizure do
- CNS infxn/trauma sequelae
Stimulant medication MoA?
Increases post synaptic concentrations of catecholamines (esp DA, NA, 5HT3). Stimulates post synaptic release, inhibits repute weak MAO inhibitor
Stimulants used for ADHD Mx?
- Dexamphetamine
- Methylphenidate (Ritalin)
Common AEx stimulant medication?
- LoA, LoW
- Insomnia
- HA
- Abdo pain
What should be documented pre commencement of stimulant medication?
- Growth parameters
- BP
- PR
Consider behaviour rating scale pre and during treatment
CIx to stimulants?
- Psychosis
- Previous sensitivity
- Symptomatic CVD
- Hyperthyroidism
- HTN
- Glaucoma
