Behavioural problems

Question 2

ADHD symptoms

Answer 2

At least 6 inattention sx, and or at least 6 hyperactivity sx that have

• started before 12years old.
  -occurred in 2 or more settings.
• been present for at least 6 months.
  -clearly interfered with /reduced quality of social, academic or occupational functioning.
• not occurred exclusively during the course of a psychotic disorder, not better explained by another disorder such as oppositional defiant disorder or conduct disorder.

Inattention sx: Fail to give close attention to detail or making careless mistakes in schoolwork, work or other activities.

• difficulty maintaining concentration when performing tasks of play activities.
• appearing not to listen to what is being said, as if mind is elsewhere, without any obvious distraction.
• failing to follow through on instructions or finish a task (not because of oppositional behaviour or failure to understand).

difficulty organising tasks or activities.

reluctance dislike or avoidance of tasks that require sustained mental effort.

Losing items necessary for tasks or activities such as pencils, mobile pones or wallets.

Easy distraction by extraneous stimuli

Forgetfulness with regard to daily activities.

Hyperactivity - impulsive symptoms
- fidgetting tapping hands or feet/squirming
leaving seat where remaining seated is expected.
Running about or climbing in situations where inappropriate. Adults - restlessness.

Inability to play or engage in leisure activities

Being on the go or acting as if driven by a motor

others may experience the person to be restless or difficult to keep up with

talking excessively.

blurting out answers

difficulty waiting turn

interrupting or intruding.

Question 3

ADHD management

Answer 3

Suspected in child:
assess social and educational impact.
can use Strengths + difficulties questionaire, conners rating scale.

If adverse effect on development or family life-
-watchful waiting for up to 10weeks and encourage self help and simple behavioural management.
- offering parents or carers a referral to group based ADHD focussed support.

If symptoms severe, watchful waiting not acceptable, behaviour/attention problems persist wiht moderate impairment following w. waiting/parent support programme. -> refer CAMHS/paeds/psychiatrist.

Suspected in adult:
Assess psychological, social, educational, occupation impact.
- if moderate/severe -> (W/o prior dx -> refer MH ADHD specialist)
-> prev ADHD -> refer general adult psychiatry

Question 4

Management of ongoing ADHD care.

Answer 4

Monitor effectiveness and adverse effects of drugs.
Montior weight - every 3months in <10yos.
3m ,6m then every 6m >10yo.
every 6m in adults

Height - every 6m in children

BP + HR - before + after each dose change, routinely every 6m

Seek specialist advice if drug tx results in tachycardia >120bpm, arrhythmia, SBP>95th centile/ clinically signiicant incresae on 2 occasions.

Seek sp advice if height significantly affected

if on dexamfetamine, lisdexamfetamine - advise - not drive if feel drowsy/dizzy, cant concentrate, blurred vision.