ADHD

Question 1

What are the three subtypes of ADHD?

Answer 1

1. Inattentive type
2. Hyperactive-impulsive type
3. Combined type

Question 2

What are the criteria for diagnosis of ADHD

Answer 2

• 6 symptoms (from the following categories) must be present that cause a fxn’l impairment that occur in at least 2 settings
  1. Inattention
  2. Hyperactivity
  3. Impulsivity

Question 3

Diagnostic criteria:
Often makes careless mistakes in schoolwork or other activities; Often cannot focus attention on tasks; Often does not seem to listen when addressed directly; Often has difficulty with organization; Often avoids activities that take mental effort for a sustained period; Often loses things
Is easily distracted
Is forgetful

Answer 3

Inattention

Question 4

Diagnostic criteria:
Often fidgets with hands, cannot sit still; Often leaves the seat in a classroom; Often has difficulty playing or engaging in leisure activities quietly; Often talks constantly

Answer 4

Hyperactivity

Question 5

Diagnostic Criteria:
Often blurts out answers before the questions have been completed; Often has difficulty awaiting their turn; Often interupts

Answer 5

Impulsivity

Question 6

What are treatments available for ADHD?

Answer 6

1. Support groups
2. Specialized educational planning
3. Diet
4. Focused therapies (behavioral therapies) -First line for mild symptoms or preschool age
5. Medication

Question 7

What medications are used for treatment of ADHD?

Answer 7

1. Stimulants
2. Antidepressants
3. Atomoxetine
4. Alpha-2 agonists

Question 8

What are the types of stimulants?

Answer 8

1. Methylphenidate (Ritalin, Concerta, Focalin, Methylin, Metadate, Daytrana))
2. D-Amphetamine (Adderall, Dexedrine, Destrostat, Desoxyn, Vyvanse
   - Forms of administration: Tablets, chewable tablets, liquid, capsule, skin patch
   - Short (2-3x), intermediate (1-2x), and long (1x) acting

Question 9

ADRs:
- Short term: Reduced appetite, Insomnia, Nervousness, GI disturbances
- Increased aggression
- May precipitate tics or psychotic symptoms
- Some cardiac fatalities
Contraindication: people with borderline or above normal blood pressure

Answer 9

Stimulant drugs

Question 10

Second line ADHD treatment; Selective norepinephrine reuptake inhibitor; Age 6 and up to adult; Equal to methylphenidate in efficacy; Takes 2-4 weeks to have an effect, and another 2-4 weeks to teach the maximal benefit; Little abuse potential

Answer 10

Atomoxetine

Question 11

ADRs:

• Adults: Insomnia and hypertension
• Children: abdominal pain, decreased appetite, dizziness, vomiting
• May have growth disturbances
• Some suicidal inclinations

Answer 11

Atomoxetine

- Can be stopped abruptly without withdrawal symptoms

Question 12

What are benefits and disadvantages of antidepressants in ADHD?

Answer 12

• TCAs have a benefit in ADHD, but are superior to the stimulants
• Benefits: Longer half-life; Reduce comorbid mood disorders; Low abuse potential; Do not exacerbate tic disorders
• Disadvantages: Anticholinergic effects, Cardiac adverse effects

Question 13

What causes ADHD?

Answer 13

Combination of environmental, genetic and biological factors

• Prenatal and perinatal exposure to cigarettes or alcohol increases risk 2-3 X
• Parent with ADHD – 8X increase in risk
• Twin study – genetics accounts for a 75% contribution
• Boys diagnosed 3X more frequently than girls

Question 14

What are the changes seen in ADHD?

Answer 14

1. Decreased brain volume, particularly in the corpus callosum, caudate, and cerebellum
2. Changes in dopamine systems in adults with ADHD (prefrontal cortex, involved in lack of attention and diminished memory)

Question 15

What are the benefits of stimulants for patients with ADHD?

Answer 15

1. reduction of hyperactivity, impulsivity, and inattentiveness (improves behavior)
2. reduce restless behavior
3. improves memory
4. seen best in children w/e comorbid sx (anxiety)
   - approx 30% adults and children do not respond to medication or cannot tolerate ADRs (increase of tics)

Question 16

Why do stimulant drugs (adderal, Ritalin) fall under the schedule II classification?

Answer 16

• Similar action to cocaine - risk of addiction

- Ritalin - euphoria (high abuse potential) - has been used for recreational use (snorted, IV)

Question 17

What are the Alpha-2 noradrenergic agonists?

Answer 17

1. Clonidine

2. Guanfacine

Question 18

Drug:
Monotherapy or with methylphenidate in children with ADHD and tic disorders; May also be useful in ADHD with a conduct disorder; Can help lessen insomnia – have a sedative effect

Answer 18

Alpha-2 noradrenergic agonist

Question 19

What role do therapists play with patients who take medication for ADHD?

Answer 19

1. Therapists need to assess behavior and attention span (Patients must cooperate with therapy; Ensure the patients are taking the medication)
2. Therapists need to assess blood pressure and HR (resting and during exercise)
3. Look for loss of appetite and insomnia
4. Consult with physician and teachers about providing the same structure during therapy as occurs during school