ADHD

Question 1

Why do girls tend to be underdiagnosed with ADHD when compared to boys?

Answer 1

• Girls tend to have inattentive/distractible symptoms which are less disruptive and boys tend to display impulsive/hyperactive symptoms which are noticed.

Question 2

How heritable is ADHD?

Answer 2

• Very (75%)

Question 3

What else would be on your DDX for a child being investigated for ADHD?

Answer 3

• Learning disorder
• Hearing/Vision disorder
• Hyperthyroidism
• Congenital problems (FASD, Fragile X)
• Lead poisoning (only if history dictates)
• Previous head injury
• Normal response to traumatic events

Question 4

What are the symptoms of inattention? (9)

Answer 4

• Careless mistake
• Can’t sustain attention in tasks or play
• Not listening when directly spoken to
• Fails to complete tasks
• Disorganized
• Avoids, dislikes tasks needing sustained mental effort
• Loses things needed for tasks or activities
• Distractable
• Forgetful
• I like to categorize based on
  1) Things hard to do because of inattention
  2) Things they avoid because inattention makes harder and they are bad at

Question 5

What are the symptoms of hyperactivity? (6)

Answer 5

• Fidgits or squirms in seat
• Leaves seat when shouldn’t
• Runs or climbs ++
• Can’t play quietly
• “Driven by motor” on the go
• Talks excessively

Question 6

What are the symptoms of impulsivity? (4)

Answer 6

• Blurts out answers before question finished
• Difficulty waiting turn
• Interrupts others

Question 7

Why is ADHD very difficult to diagnose in children under 4 years?

Answer 7

• In this young age group normal behaviour is highly variable
• Often identified upon school entry

Question 8

When children are not treated for ADHD, what problems do they have more commonly as adults?

Answer 8

1) Academic
- increased drop out
- lower grades
2) Social fx and self esteem
- Child too distracted observe social norms
3) Health and Injury
- Increase risk of mental illness and substance abuse
- Impulsivity increases risk of traumatic injury
4) Criminality
- Impulsivity increases risk
5) Sexual behaviour
- more likely to partake in risky behaviour

Question 9

What are some non-pharmacological treatment options for ADHD?

Answer 9

Behaviour Modification

• Positive reinforcement (reward/privilege)
• Negative consequences
• Small class size
• Structure
• Appropriate seating arrangement at school
• Exercise / Extracurricular

Question 10

What are the first line Pharmacological treatment options for ADHD?

Answer 10

First Line: Stimulants

• Methylphenidate
• Amphetamine salts

Question 11

What is second line pharma treatment for ADHD? Third line?

Answer 11

2nd: Atomoxetine
- NE reuptake inhibitor
3rd: Alpha agonists (clonidine, guanfacine) & NDRI (buproprion)

Question 12

What are common side effects of stimulant medications?

Answer 12

• Decreased appetite
• Sleep problems
• Delayed growth
• Tachy/Palpitations
• Headache
• Irritability/Anxiety

Question 13

What percentage of children with ADHD will have symptoms continue into adolescence? Adulthood?

Answer 13

• Adolescence (70-80%) but hyperactivity tends to settle

- 65% continue

Question 14

What is ADHD in a general sense?

Answer 14

• Attention deficit hyperactivity disorder

- Developmentally inappropriate inattentiveness, hyperactivity, and impulsivity

Question 15

What percentage of school age children are affected by ADHD?

Answer 15

3-10%

Question 16

Why is psychological and developmental testing part of the ADHD evaluation?

Answer 16

• Psychological and learning disorders are common in the ADHD population

Question 17

What are the most common coexisting psychiatric disorders in children with ADHD?

Answer 17

• Oppositional defiant disorder (35%)
• Conduct disorder (25%)
• Anxiety disorder (25%)
• Depressive disorder (18%)

Question 18

What is required for a diagnosis of Combined type ADHD?

Answer 18

• 6+ symptoms of hyperactivity/impulsivity
• AND 6+ symptoms of inattention
• 6+ months
• symptoms interfering with function
• Occur in 2+ settings
• Occur before age 12
• Not due to other medical issue

Question 19

What is required for Inattentive type ADHD diagnosis?

Answer 19

• 6+ symptoms of inattention
• 6+ months
• symptoms interfering with function
• Occur in 2+ settings
• occur before age 12
• Not due to other medical issue

Question 20

What is required for a diagnosis of hyperactive/impulsive type ADHD?

Answer 20

6+ symptoms of hyperactivity/impulsive

• 6+ months
• symptoms interfering with function
• Occur in 2+ settings
• Occur before age 12
• Not due to other medical issue

Question 21

The criteria for diagnosis of ADHD changes slightly after a certain age. What age is this and what is the change?

Answer 21

• Age 17
• After which 5+ features will result in a diagnosis along with meeting remaining criteria
• Symptoms should have been present before the age of 12