ADHD

Question 1

Major findings from the MTA study

Answer 1

Largest RCT EVER of any childhood psychiatric disorder

number of children= 579 ages 7-9.9

findings:

Medication better than behavioral therapy for core symptoms

Medication equal to behavioral therapy for:

• classroom observed behaviors
• social skills ratings
• peer sociometric ratings
• academic achievement

Question 2

History

Answer 2

1. Fidgety Phils
2. Minimal Brain Dysfunction (damage) (1900-1950)
3. Hyperkinetic/Hyperactivity Syndrome (1950-1969)
4. Recognition of Attentional Impairment and Impulsivity (1970-1979)
5. Diagnostic Criteria (DSM III) and “ADD” with or without hyperactivity (1980)
6. ADD becomes ADHD (1987)
7. ADHD (inattentive, hyperactive, combined subtypes) (1994)

Question 3

Functional Criteria

Answer 3

• 6-9 symptoms in either or both categories
• inattentive; hyper-impulsive; or combined type
• persisting for at least 6 moths
• some symptoms present before 12 years old
• impairment in 2 or more settings
• social/academic/occupational impairment

Question 4

Diagnostic Criteria for Hyperactive/impulsive

Answer 4

• fidgets
• leaves seat
• run or climbs excessively (or restlessness)
• difficulty engaging in leisure activities quietly
• “on the go” or “driven by a motor”
• talks excessively
• blurts out answers before question is complete
• difficulty waiting turn
• interrups or intrudes on others

Question 5

Diagnostic Criteria for Inattention

Answer 5

• makes careless mistakes/ poor attention to detail
• difficulty sustaining attention in tasks/play
• does not seem to listen when spoken to directly
• difficulty following instructions
• difficulty organizing tasks/activities
• avoids tasks requiring sustained mental effort
• loses items necessary for tasks/activities
• easily distracted by extraneous stimuli
• often forgetful in daily activities

Question 6

Natural History

Answer 6

• age related changes
  
  • preschool (3-5) - hyperactive/impulsive
  • school age (6-12) - combination symptoms
  • adolescence (13-18) - more inattention with restlessness
  • adult (18+)- largely inattention with periodic impulsivity
• rule of “thirds”
  
  • 1/3 –> complete resolution
  • 1/3 –> continued inattention, some impulsivity
  • 1/3 –> early ODD/CD, poor academic achievement, substance abuse, antisocial adults

Question 7

Factors important in making a convincing diagnosis

Answer 7

• available “tests” (non specifically for ADHD) are primarily Continuous Performance Tests ( CPTs)
• Clinical Interview
• Collateral Interview
• “some” symptoms by age 7
• symptoms in at least 1 setting ( group settings are a must)
• rating scales
• treatment trial

Question 8

Symptoms and prevalence of ADHD and subtypes

Answer 8

• worldwide prevalence is 3-7%

- 2/3 of children with ADHD are present with at least one comorbid Axis I disorders

Question 9

Age, Gender, and Race related differences in ADHD

Answer 9

• males: females = 2: 9.1
• girls typically show less hyperactivity, fewer conduct problems, and less externalizing behavior
• 3-7% school children in US are affected
• more diagnosis in inner city ( racial minorities)

Question 10

Impairments in executive functioning

Answer 10

Executive function battery correctly differentiated 77% ADHD vs non ADHD

• response inhibition
• vigilance
• working memory
• difficulties with planning