SCD/ADHD- 5B

Question 1

Name 4 components of social communication disorder diagnosis

Answer 1

• deficits in using communication for social purposes
• impairment in ability to change communication to match content or needs of the listener
• difficulties following rules for conversation/story telling
• difficulties understanding what is not explicitly stated and nonliteral or ambiguous meanings of language

And, deficits result in functional limitations

Terrible at the social rules of communication and very literal, therefore functionally socially very awkward

Question 2

Three symptoms components of ADHD diagnosis:

Answer 2

• inattention
• hyperactivity
• impulsivity

Question 3

Four important components of ADHD diagnosis:

Answer 3

• symptoms: inattention, hyperactivity, impulsivity
• onset before age 12y
• symptoms present in 2 or more settings
• symptoms interfere with quality of social, academic, or occupational functioning

Question 4

Epidemiology of childhood ADHD

Answer 4

• 5-8% of school age children
• M:F 5:1
• girls more commonly with inattentive presentation

Question 5

Epidemiology of adult ADHD

Answer 5

• estimated 60% of children with ADHD continue to have ADHD symptoms into adulthood
• prevalence estimated 1-5%
• M:F 1:1
• high comorbities with anxiety disorders, mood disorders, impulse control disorders, substance use disorders

Question 6

Risk factors for ADHD

Answer 6

• perinatal stress
• low birth weight
• pre-term child
• traumatic brain injury
• maternal smoking during pregnancy
• severe early deprivation
• familial risk (parent with ADHD, child has 50% chance of ADHD)

Question 7

Neuroimaging findings in ADHD

Answer 7

• smaller total cerebral volumes

- smaller frontal lobe volumes

Question 8

Medication algorithm for ADHD

Answer 8

• 0: diagnosis and family consultation
• 1: methylphenidate OR amphetamind
• 2: stimulant not used in stage 1
• 3: atomoxetine
• 4: bupropion or TCA (not FDA approved)
• 5: agent not used in Stage 4
• 6: alpha2 agonist clonidine/quanfacine

Question 9

Efficacy of stimulants for ADHD

Answer 9

• ~70% of children with ADHD have robust response

- longer term studies do not support differences between children who are and are not receiving meds

Question 10

What is the association between stimulants and cardiac risk?

Answer 10

• increased risk of sudden death in children and teens
• FDA recommendation: obtain cardiac history and perform physical exam
• for pts with history, obtain EKG or echocardiogram

Question 11

What is atomoxetine?

Answer 11

• its an SNRI
• avoid in use with 2D6 inhibitors, MAOI’s, pressors
• avoid in pts with narrow angle glaucoma