Neurodevelopmental Conditions Flashcards
What is ADHD?
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition characterised by an abnormally high activity level and an inability to concentrate.
ADHD affects a person’s development and ability to carry out everyday tasks. It primarily affects children but can be diagnosed at any age. Importantly, features must be present before the age of seven and be consistent across at least two settings.
ADHD is estimated to have a global prevalence of 5% (3-4% in the UK) and a male to female ratio of 3:1. However, it is thought to be under-recognised and diagnosed in girls.
Prior to what age must symptoms have been present to diagnose ADHD?
Age 7, and be consistent amongst at least 2 settings
Risk factors for ADHD
Prematurity
Low birth weight
Low paternal education
Prenatal smoking
Maternal depression
Typical features of ADHD?
Short attention span
Quickly losing interest in tasks
Constantly fidgeting or unable to sit still
Impulsive behaviour
Described as disruptive
Poor organisational skills
Acting without thinking
Differential diagnoses for ADHD
Anxiety (can present with inattention)
Depression (can present with poor concentration)
Autism (may have poor impulse control)
Childhood trauma (can cause children to perform less well in school, appear inattentive and disruptive. The history should sensitively enquire about any precipitating events to new behaviours)
Less common: Personality disorders (defiant disorder, conduct disorder), epilepsy, learning disability
Why is autism a potential differential for ?ADHD
Children with autism spectrum conditions often have poor impulse control and may be described as disruptive due their rigidity of thought. Parents should be asked about the child’s development in communication, social skills, and imaginative play.
How can anxiety present similarly to ADHD and how do the two differ in presentation?
Anxiety can often present with inattention due to excessive worry and rumination.7 Patients may report difficulty concentrating, forgetfulness and being easily distracted. Features more suggestive of anxiety include worry, palpitations and feeling like something awful might happen.
How many symptoms are required for a diagnosis of ADHD and under what conditions must they occur?
Children up to the age of 16: there must be six or more symptoms of inattention and six or more symptoms of hyperactivity and impulsivity.
For those aged 17 and over: only five or more symptoms are required from each category.
The symptoms must occur in multiple settings (e.g. at home and school), have been present for at least six months and are not better explained by another disorder.
For example, if a child only displays these behaviours at school but is calm at home it suggests that the cause may be environmental. If the behaviours only continue for two weeks, then they may be better explained by a situational caus
DSM-5 criteria doe ADHD: symptoms of inattention
Failing to pay close attention to detail or making careless mistakes
Difficulty concentrating on activity
Appearing not to listen without apparent distraction
Not finishing tasks (not due to lack of understanding)
Poor organisation skills
Disliking tasks requiring sustained concentration
Easily distracted
Repeatedly losing items for tasks
Forgetfulness
DSM-5 criteria doe ADHD: symptoms of hyperactivity and impulsivity
Fidgeting or struggling to remain still when seated
Leaving one’s seat when sitting is expected
Running around or climbing in inappropriate situations
Inability to play quietly
Talking excessively
Blurting put answers before questions are complete
Difficulty waiting their turn
Interrupting or intruding on others
Being ‘on the go’ - others may describe them as difficult to keep up with
How might impulsivity in adults with ADHD be reflected
Note that impulsivity in adults may be reflected in drug or alcohol use, forensic history and employment history
Primary care management of ADHD in children
Watchful waiting for up to 10 weeks and encouraged self help and simple behavioural management
Establishing healthy diet and regular exercise
For parents or carers offer referal to group based ADHD focussed support program
Simple behavioural management: reward charts, lsotifie redirections
If symptoms severe or issues persist after simple self help measures refer to CAMHS or specialist paediatrician
Secondary care management of ADHD in children
First line: ADHD focused group parent training program
Second line: medication (methylphenidate) and CBT
Issues with medicating ADHD in children and how this is managed
Methylphenidate is, counterintuitively, a central nervous system stimulant.
It can cause growth retardation, weight loss, tachycardia, and hypertension.
As such, children taking this medication need to have their height, weight, heart rate and blood pressure measured every six months.
Complications of ADHD symptoms persisting into adulthood
Lower educational and employment attainment
Poor self-esteem
Criminal behaviour
Relationship issues
Sleep disturbance
Substance abuse
Road traffic accidents
Self-harm
