ADHD

Question 1

ADHD sxs must be present before what age for diagnosis?

Answer 1

Before age 12

Question 2

Risk factors for ADHD (7)

Answer 2

Paternal antisocial behavior, maternal depression, prenatal exposure to tobacco, young maternal age at birth, low birth weight, premature birth, and > 2 hrs of screen time / day.

Question 3

Anatomic changes in ADHD

Answer 3

Reduction in overall brain volume, gray matter volume, and association cortices. Higher volume of white matter.

Question 4

Psychosocial factors that may predispose to ADHD.

Answer 4

Stressful events, emotional deprivation, and disruptions to the family.

Question 5

What percent of kids w/ ADHD present w/ aggression and defiance?

Answer 5

75%

Question 6

Does hyperactivity / impulsivity usually occur before or after inattention?
Which typically remits sooner?

Answer 6

Hyperactivity occurs sooner and remits sooner.

Question 7

DSM criteria for ADHD

Answer 7

Inattention OR hyperactivity that interferes w/ functioning or development. Need at least 6 months of either. Sxs must be present before age 12 and in 2+ settings.

Question 8

Diff diagnosis (4)

Answer 8

• Anxiety may cause distractibility, inattention, fidgetiness, and irritability. May be co-morbid.
• Depression may cause inattention and difficulties w/ concentration. May also be co-morbid.
• Mania causes hyperactivity, distractibility, and excessive talk, but sxs are often waxing / waning in kids and generally develop grandiosity, decreased need for sleep, etc.
• Learning disorders. Often co-morbid.

Question 9

What percentage of cases persist into adulthood?

What are risk factors for this?

Answer 9

15-20% of cases

Family history of ADHD, neg life event, or co-morbidity w/ conduct disorder / depression / anxiety.

Question 10

Common co-morbid disorders (5)

Answer 10

Anxiety, tics, depression, enuresis (involuntary peeing), and disruptive behavioral disorders. Kids who have co-morbid conduct disorder are at higher risk of substance abuse.

Question 11

Treating ADHD (4)

Answer 11

• Stimulant meds including methylphenidate (Ritalin) or extroamphetamine salts (adderall). Rare risks of heart problems w/ these meds. Screen. Check BP, pulse, weight, and height prior to and during meds.
• Atomoxetine – Nonstimulant drug
• Alpha-2 agonists – guanfacine and clonidine
• Psychosocial interventions – Structure classroom environment to minimize distraction, increased assistance w/ organizational skills, study skills training, social skills training