1
Q
What is the ratio of boys to girls in ADHD (child and adult)?
A
- Childhood = Males 3:1
- Less difference in adulthood
2
Q
What are the general DSM criteria for ADHD?
A
- Persistent pattern of inattention and/or hyperactivity-impulsivity, 6 or more symptoms
- Adults 17+ at least 5 inattention symptoms required
- Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years
- Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities)
3
Q
What are the criteria for ADHD Inattentive type?
A
- 6+ of inattention for kids up to age 16
- 5+ for adolescents 17+ and adults.
- Symptoms present at least 6 months. Inappropriate for developmental level
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
- Often has trouble holding attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
- Often has trouble organizing tasks and activities.
- Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
- Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
- Is often easily distracted
- Is often forgetful in daily activities.
4
Q
What are the criteria for ADHD Hyperactive/Impulsive type?
A
- 6+ symptoms for kids up to 16
- 5+ for adolescents 17+ and adults.
- At least 6 months and is disruptive and inappropriate for development level)
- Often fidgets with or taps hands or feet, or squirms in seat.
- Often leaves seat in situations when remaining seated is expected.
- Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
- Often unable to play or take part in leisure activities quietly.
- Is often “on the go” acting as if “driven by a motor”.
- Often talks excessively.
- Often blurts out an answer before a question has been completed.
- Often has trouble waiting his/her turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or games)
5
Q
What are some differential diagnoses to consider with ADHD?
A
- Learning Disorders, Depression, Anxiety, PTSD, Giftedness
6
Q
How does ADHD interact with sleep disorders?
A
- Problems with sleep can exacerbate ADHD Sxs
- ## Psychostimulant medication can cause sleep disturbances for some (but can be calming/helpful with sleep for others)
7
Q
What are some overlapping ADHD & Giftedness characteristics
A
- Over- excitability
- Intensified activity of mind
- Organic surplus of energy
- Preoccupation w/ logic and theoretical thinking
- Strong affective expressions
8
Q
What does “twice exceptional” refer to?
A
- People who are gifted with ADHD
- They compensate for cognitive symptoms of ADHD well but at high cost
- They have inconsistent performance that is confusing and harmful to self concept
9
Q
What are attention, concentration, and memory
A
- Attention: focus on something in the moment. State of arousal. Allocation of cog resources. Behavioral and cog process of selectively concentrating on a discrete stimulus while ignoring perceivable stimuli
- Concentration: prolonged/sustained focus.
- Memory: Attention + concentration. Not just retrieval. Attention, encoding/learning, storage, and retrieval/recall
10
Q
What is executive functioning? What are some of its componenets?
A
- A set of mental processes including working memory, cognitive flexibility, and inhibitory control.
- Some conceptualize as Organization (gathering info
and structuring for evaluation) & Regulation
(evaluating available info and modulating responses
to environment)
- Some conceptualize as Organization (gathering info
- Inhibition: ability to stop actions, thoughts, behaviors
- Shifting: ability to think flexibly and move freely between situations
- Emotional Control: ability to bring rational thought to modulate emotional responses and feelings
- Initiation: ability to begin a task or activity and to independently generate ideas responses or problem solving strategies
- Working Memory: capacity to hold info in mind for purpose of completing a task
- Planning/Organization: bility to manage current and future oriented task demands
- Organization of Materials: ability to impose order on work, play, and storage spaces
- Self-Monitoring: ability to monitor own performance to measure against some standard
11
Q
What are some of the high level theories of ADHD?
A
- Executive Functioning model, Cognitive Energetic Model, Motivation & Delay Aversion, Sluggish Cognitive Tempo (SCT)
12
Q
What are the 3 core component of sluggish cognitive tempo? How do they fit/interact with other ADHD Sxs?
A
- Lethargy, underactivity, slowness
- Hypothesized as distinct from inattention and a function of earlier selective attention process
13
Q
What are some reasons that people get diagnosed with ADHD as adults?
A
- Misdiagnosis as child (depression, anxiety, etc.)
- Parents didn’t accept Dx
- Changes in workplace demands/tasks
- Changes in relationship demands
14
Q
What are some things that can mirror ADHD Sxs?
A
Medical issues, psychological issues, substance use, giftedness/intelligence, learning disability, reading, math, written expression, nonverbal
15
Q
What are the BRIEF-A, CAARS, and Wender Utah Rating Scale used for?
A
Assess ADHD
16
Q
What are some common neurocognitive deficits among people with ADHD?
A
- Divided and sustained attention
- Working memory
- Verbal and nonverbal fluency
- Planning and organization
- Impulsivity / response inhibition
- Cognitive flexibility
- Information processing speed
17
Q
What must you include in a report when you diagnose someone with ADHD for the first time as an adult?
A
Explanation as to why they weren’t previously diagnosed
18
Q
What should you include in recommendations section for ADHD:
A
- Tailored to profile.
- Address skill deficits
- EF coaches
- Social Skills training
- Target environmental issues
- Address co-occuring diagnoses
- Specialist referrals
- Lifestyle modifcations
19
Q
What are some treatments for ADHD?
A
- Behavioral parent training
- Behavioral classroom management
- Behavioral peer intervention
- Organizational training
20
Q
What are some common differential diagnoses with PTSD?
A
- TBI or Post-Concussive Syndrome (PCS)
- Depression
- Substance use
- Malingering
21
Q
What aspects of intellectual functioning are most impacted by PTSD?
A
- Verbal functioning (more impacted that non-verbal)
- Attention, executive, & prefrontal functioning
22
Q
What are some key differences between concussion and post-concussive syndrome?
A
- Concussion: includes nausea, vision problems, confusion, memory loss
- PCS: Difficulty reading, concentration deficiencies, depression/anxiety, insomnia
23
Q
Do you need neuroimaging to confirm Mild Neurocognitive Disorder?
A
No!
24
Q
Do you need neuroimaging to confirm Major Neurocognitive Disorder?
A
Yes!
25
What are the differences between Mild and Major Neurocognitive Disorder?
Mild:
- Functional Independence has mild decline but not impaired
- Recovery weeks to months
Major:
- Functional Independence is impaired
- Recover months to years
26
What are some recommendations for mTBI
- Rest
- Avoid another blow or jolt to head.
- Coordinate w/ clinical team to decide when its safe to drive, physical activity, use equipment. Reaction time may be slower after a brain injury.
- Eliminate alcohol and other drugs.
27
What are some compensatory strategies for mTBI?
- Taking frequent breaks
- Alternate between high and low attentional demand activities
- Take extra time to complete tasks to ensure accuracy
- One task at a time (avoid multi-tasking)
- Write out info if doing multiple tasks to reduce cognitive load
- More complex tasks in the morning (or optimal alertness)
- Memory aids: notes, reminders, calendars, and repetition
- Minimizing background distractions
28
What is the recommendation for cardio exercise after mTBI?
- 20 mins with a heart rate greater than 120 (depending on age) at least every other day.
- Stepwise progression
29
What are some signs of malingering?
- Inconsistent symptom presentation
| - Exaggeration of level of function before the event or condition in question
30
What areas of intellectual functioning tend to improve as people age?
- Vocabulary, reading, verbal reasoning
31
What are some unique aspects of delerium?
- Rapid onset
| - Symptoms to fluctuate in severity throughout day
32
What is the age below which dementia is considered early onset?
65
33
What are the overlapping Symptoms between depression and cognitive decline
- Loss of interest in once-enjoyable activities
- Social withdrawal
- Sleep disturbance
- Impaired cognition: concentration, memory
34
What are some things to keep in mind when making recommendations to older adults?
- Future planning. Encourage involvement in planning early
- Address common issues even if to note that they are risks
- Pain / Sleep / Hallucinations / More assistance needs
- Balance safety and independence:
- Encourage engagement in activities within ability.
- Accommodate as symptoms progress and needs change
- Family often is either helping too little or too much
- CRITICAL to keep them socially engaged
35
What are some things to keep in mind during feedback sessions with older adults?
- Session should include others (e.g., partner/spouse, adult children)
- Talk directly to the patient not just about them
- Talk about strengths (current and pre-morbid)
- Slow down what you say, provide info several times in different ways
- Respond to emotion always. Don’t argue.
36
What are three details of the clinical history/presenting problems that are critical for all neurocognitive changes, but in particular is critical for older adults when neurodegenerative disease is possible?
- Onset, course/progression, severity
PGSP Assessment Comp
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