peds: ADHD

Question 1

Gold standard ADHD txt

Answer 1

stimulant meds (ampthetamines + methylphendiate)

Question 2

define ADHD

Answer 2

development disorder of inattention + hyperactivity/impulsivity

Question 3

Worldwide Prevalence of 
ADHD Is ___

Answer 3

5% (in ALL countries)

Question 4

are boys or girls more likely to have ADHD?

Answer 4

boys, but Higher number of males may be due to referral bias (rowdy boys)

Question 5

median age of Dx? what does a younger Dx often mean?

Answer 5

7 yo

- younger Dx is usually a more severe case

Question 6

Symptoms of ADHD _____ and ______ from childhood to adulthood. Clinicians should consider impact on _____ ?

Answer 6

decline and change 
consider QOL  (i.e. as an adult- difficulty holding a job)

Question 7

biological cause of ADHD?

Answer 7

overall: biological substrate (not just enviornmental cause)
(extra info: Compromise of “executive center” in frontal lobe Impairment of dopamine and norepinephrine function)

Question 8

ADHD- affects in adolescence (4)

Answer 8

Poor participation in group activities
Few friends
Vulnerable to antisocial groups (Gangs)
Vulnerable to drug abuse

Question 9

ADHD affect on parents

Answer 9

stress + lower self-esteem. Increased alcohol/drug use, marital and employment disruption

Question 10

Increased Lifetime Substance Abuse 
in what group?

Answer 10

Untreated Adults with ADHD (roughly 2x risk)

Question 11

smoking and traffic violations- increase with ADHD?

Answer 11

yes!

Question 12

Dx of ADHD

Answer 12

• Use of parent and teacher behavior rating scales
• Medical and neurological examination and interview of child
• psych eval.

Question 13

activity in _____ is NOT predictive of ADHD

Answer 13

doctor’s office

Question 14

DSM V for hyperactive/impulsivity symptoms of hyperactivity and impulsivity must occur _____. What is the time period?

Answer 14

hyperactivity and impulsivity
OFTEN
*Must have 6 or more symptoms for at least 6 months to a degree that is maladaptive and inconsistent with developmental level.

Question 15

DSM V for inattention symptoms, symptoms of inattention must occur ____ ? time period?

Answer 15

OFTEN
(Careless, Difficulty sustaining attention in activity, Doesn’t listen, loses items etc. )
*Must have 6 + symptoms for at least 6 months that are maladaptive + inconsistent w/ development level

Question 16

DSM V ADHD (4 criteria to meet)

Answer 16

A: symptoms for 6 months
B: 2 + settings (eg, school and home)
C: Significant impairment: social, academic, or occupational
D: Exclude other mental disorders

Question 17

what are two particular medical disorders may mimic ADHD?

Answer 17

seizures, sleep apnea

Question 18

3 part non-pharm mgmt of ADHD

Answer 18

• educational intervention
• counseling
• Behavior management: positive reinforcement strategies

Question 19

meds for ADHD

Answer 19

Medications: **stimulants, nonstimulants (straterra) , antidepressants, anti-HTNs, alpha adrenergics (guanfacine) , neuroleptics

Question 20

4 ADRs of stimulants

Answer 20

Appetite suppression;
Insomnia if given in evening
Headache, stomach ache, dysphoria, tics–10% - 20%
Rebound phenomenon

Question 21

Concern: use of stimulants may increase _____ or _____

Answer 21

motor or vocal tics

but not a problem for most

Question 22

if on a stimulant, what must be monitored twice a year?

Answer 22

Height and weight

Question 23

4 signs you should refer ?

Answer 23

1. academic difficulties persist- psychological testing
2. Parental and family strain - family therapy
3. sustained low self-esteem -individual child psychotherapy or CBT
4. not responding to meds- child psychiatrist

Question 24

severe ADR with stratterra (atomoxetine) ?

Answer 24

liver impairment - but studies show the risk if actually low

Question 25

severe ADR with adderall?

Answer 25

cardiovascular issues

Question 26

do Current guidelines of AAP recommend cardiac screening or routine EKG before putting someone on stimulant drugs?

Answer 26

no

Question 27

what can you use for diet mgmt in ADHD?

Answer 27

vayarin