ADHD

Question 1

What is ADHD?

Answer 1

A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning and development.

Question 2

What core abilities are impaired in ADHD?

Answer 2

Attention, impulse control, and executive functioning

Question 3

By what age must symptoms be present for an ADHD diagnosis?

Answer 3

Before age 12

Question 4

List key symptoms of inattention in ADHD.

Answer 4

Fails to give attention to details
Difficulty sustaining attention
Does not listen when spoken to
Does not follow through on instructions
Disorganized
Avoids tasks requiring sustained effort
Loses things
Easily distracted
Forgetful

Question 5

List key hyperactive-impulsive symptoms of ADHD.

Answer 5

Fidgets
Leaves seat
Runs or climbs
Unable to engage in quiet activities
“On the go”
Talks excessively
Blurts out answers
Difficulty waiting turn
Interrupts others

Question 6

What are the three ADHD subtypes?

Answer 6

ADHD, inattentive type
ADHD, hyperactive-impulsive type
ADHD, combined type

Question 7

ADHD, inattentive type is characterized by what?

Answer 7

Inattention symptoms dominate; no significant hyperactivity/impulsivity

Question 8

ADHD, hyperactive-impulsive type is characterized by what?

Answer 8

Hyperactivity/impulsivity dominates; no significant inattention

Question 9

ADHD, combined type requires what?

Answer 9

Criteria met for both inattention and hyperactivity-impulsivity

Question 10

Which brain areas are involved in ADHD?

Answer 10

Frontal cortex (executive function, behavior)
Basal ganglia (motor control, learning, emotions)
Reticular activating system (focus, arousal, sleep-wake regulation)

Question 11

Which neurotransmitters are implicated in ADHD?

Answer 11

Dopamine dysfunction
Norepinephrine dysfunction
Serotonin (secondary role)

Question 12

ADHD is considered what type of disorder biologically?

Answer 12

A polygenic neurobiological disorder affecting executive functioning

Question 13

Common mental status exam findings in ADHD?

Answer 13

Restlessness
Inattention
Distractible speech
Overproductive speech
Affective lability
Poor memory and concentration

Question 14

Common rating scales used to assess ADHD?

Answer 14

Conners’ Parent & Teacher Rating Scales (copyrighted)
Vanderbilt ADHD Diagnostic Scales (public domain)

Question 15

Why are rating scales important in ADHD?

Answer 15

To establish diagnosis, monitor progress, and track symptom change over time

Question 16

First-line pharmacologic treatment for ADHD?

Answer 16

Stimulants

Question 17

Two major stimulant classes used in ADHD?

Answer 17

Amphetamines
Methylphenidate

Question 18

FDA-approved minimum ages for stimulants?

Answer 18

Amphetamines: age 3+
Methylphenidate: age 6+

Question 19

What must be assessed before starting stimulants?

Answer 19

Cardiac history (risk of ↑ HR, ↑ BP, MI, stroke)

Question 20

Common stimulant side effects?

Answer 20

GI upset
Appetite suppression / weight loss
Increased BP and pulse
Headache, dizziness
Irritability

Question 21

Rare but serious stimulant adverse effects?

Answer 21

Psychosis and growth suppression

Question 22

When should non-stimulants be considered?

Answer 22

If stimulants are ineffective or cause intolerable side effects (e.g., tics)

Question 23

FDA-approved non-stimulants for ADHD?

Answer 23

Atomoxetine (Strattera) – age 6+
Guanfacine (Intuniv) – ages 6–17
Clonidine (Kapvay) – ages 6–17
Qulbree ~ ages 6-17

Question 24

Which antidepressants may be used off-label for ADHD?

Answer 24

Desipramine, venlafaxine, bupropion

Question 25

Core nonpharmacologic treatments for ADHD?

Answer 25

Behavioral therapy Parent & patient CBT training Psychoeducation (at diagnosis) Treat learning disorders Family therapy & education

Question 26

Why is psychoeducation essential at diagnosis?

Answer 26

Helps families understand ADHD, reduce stigma, and improve adherence

Question 27

Helps families understand ADHD, reduce stigma, and improve adherence

Answer 27

Stress Self-blame Social isolation Embarrassment Depression Marital discord

Question 28

What must be monitored long-term in ADHD?

Answer 28

Symptom control Growth and development Academic and social functioning

Question 29

Can ADHD persist into adulthood?

Answer 29

Yes — symptoms may persist and require long-term planning

Question 30

Minimum symptom count required for ADHD diagnosis?

Answer 30

Six or more symptoms in the relevant domain

Question 31

ADHD + executive dysfunction + dopamine/norepinephrine = ?

Answer 31

Classic ANCC ADHD pattern

Question 32

What are common signs of stimulant abuse?

Answer 32

Insomnia Tremors Increased blood pressure Increased heart rate Heart palpitations Agitation Anxiety Irritability Mood changes

Question 33

Which sleep-related symptom is a red flag for stimulant abuse?

Answer 33

Insomnia

Question 34

Which cardiovascular signs may indicate stimulant misuse?

Answer 34

Hypertension, tachycardia, palpitations

Question 35

Which behavioral changes raise concern for stimulant abuse?

Answer 35

Agitation, anxiety, irritability, mood instability

Question 36

What is a first-line intervention if stimulant abuse or misuse is suspected?

Answer 36

Change stimulant dosing to morning administration

Question 37

Why should stimulant medications be given in the morning?

Answer 37

To reduce insomnia and nighttime stimulation, lowering misuse risk

Question 38

What should be considered if insomnia persists despite morning dosing?

Answer 38

Provide a non-abusable sleep medication

Question 39

Why must caution be used when prescribing stimulants?

Answer 39

They have high abuse potential

Question 40

Insomnia + tachycardia + agitation in a patient on stimulants suggests what?

Answer 40

Stimulant misuse or abuse

Question 41

What phrase in an exam question signals stimulant abuse?

Answer 41

Difficulty sleeping,” “palpitations,” or “increased anxiety” after stimulant use

Question 42

What is the safest initial response to suspected stimulant abuse on ANCC?

Answer 42

Adjust timing of dose and address sleep—do NOT abruptly discontinue unless indicated