Group- ADHD

Question 1

1. List the diagnostic criteria for attention-deficit hyperactivity disorder.

Answer 1

i. Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development
1. Inattention: 6 or more of the following persisted for at least 6mo (symptoms are not solely a manifestation of oppositional behavior, defiance, hostility or failure to understand tasks or instructions
a. Fails to give close attention to details or makes careless mistakes in schoolwork
b. Difficulty sustaining attention in tasks
c. Often does not seem to listen when spoken to directly
d. Often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace
e. Often has difficulty organizing tasks and activities
f. Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort
g. Often looses things necessary for tasks or activities
h. Is often easily distracted by extraneous stimuli
i. Is often forgetful in daily activities
2. Hyperactivity and impulsivity (6+ have persisted for at least 6mo)
a. Fidgets with or taps hands or feet or squirms in seat
b. Often leaves seat in situations in which remaining seated is expected
c. Often runs about or climbs in situations where it is inappropriate
d. Often unable to play or engage in leisure activities quietly
e. Often talks excessively
f. often blurts out answers before question is complete
g. often has difficulty waiting hi or her turn
h. often interrupts or intrudes on others
3. several symptoms were present prior to age 12
4. several symptoms are present in two or more settings
5. evidence that symptoms interfere with or reduce quality of life, and cannot be explained by another disorder

Question 2

2. Describe the epidemiology, and pathophysiology of ADHD.

Answer 2

symptoms are often present before age 3, but diagnosis is not made until child is in a structured school setting, average age of dx. is 7 years

Pathophysiology: (multifactorial) genetic basis,

1. paternal antisocial behavior, maternal depression, prenatal tobacco exposure, young maternal age at birth, LBW and premature birth, amount exposure to video games and TV during dvelopment (risk factors)
2. neuroanatomical differences: reductions in overall brain volume, gray matter volume, and cortical thickness in the frontal, temporal, parietal and occipital association cortices, higher volumes of white matter
3. NT associated with ADHD: Epi, DA, NE and stressful events, emotional deprivation and disruptions to family contribute to development of ADHD symptoms

Question 3

2. Describe the clinical presentation and prognosis of ADHD

Answer 3

hyperactivity, impulsivity, inattention to a greater degree than would be expected given their level of development: difficulty sitting still, not able to complete work appropriately, unable to follow directions, seem to be unable to listen, difficulty waiting, emotionally labile and even explosive or irritable

prognosis: 90% response with stimulants

Question 4

3. List the treatments available for ADHD, including psychotropic medications and psychosocial interventions

Answer 4

Stimulant medications: methylphenidate or detroamphetamine salts (some risk with cardioactive medications or heart defects, some appetite suppression)
non-stimulant atomoxetine

psychological interventions: accommodations in school, minimize distraction, increase assistance with organizational skills, emphasize development of appropriate study skills; Parent education regarding screen time