ADHD

Question 1

features of Hyperkinetic Disorders

Answer 1

Inattention & lack of persistence in activities requiring concentration
Excessive activity
Impulsivity

Question 2

eitology of Hyperkinetic Disorders

Answer 2

More common in males

1-5% of children

Question 3

5 types of Hyperkinetic Disorders

Answer 3

Disturbance of activity and attention
Hyperkinetic conduct disorder
Other Hyperkinetic disorders
Hyperkinetic disorder
unspecified ADHD

Question 4

Comorbid associations with ADHD

Answer 4

Sleep disorders
Behavioural difficulties
Specific learning disabilities
Developmental Co-ordination Disorders
lSocial communication difficulties
Anxiety symptoms
Tic disorders e.g. Tourette syndrome 
Mood difficulties
Increased psychosocial factors

Question 5

Susceptibility ADHD genes

Answer 5

DRD4 Receptor 7-Repeat Alleles 
SLC6A3/DAT1 
DRD5
SLC6A4/5HTT
HTR1B

Question 6

DRD4 Receptor 7-Repeat Alleles

Answer 6

associated with overactivity & impulsivity

Question 7

SLC6A3/DAT1

Answer 7

Dopamine Transporter gene

Question 8

DRD5

Answer 8

Dopamine receptor gene

Question 9

SLC6A4/5HTT

Answer 9

Serotonin Transporter gene (associated with emotional volatility)

Question 10

HTR1B

Answer 10

Serotonin receptor gene (associated with emotional volatility)

Question 11

ADHD prognosis depends on 2 things

Answer 11

Depends on co-morbidity

Factors associated with persistence into adulthooD

Question 12

assessment for ADHD in school

Answer 12

Speak with Education staff
Observation in school setting
Standardised questionnaires for education staff

Question 13

assessment for ADHD depends on which aspects of a history

Answer 13

History from reliable informants
Systematic Enquiry
Past history, including
A developmental history
medical history 
family history

Question 14

4 main drugs for ADHD

Answer 14

Psychostimulants
Atomoxetine
Clonidine

Question 15

Psychostimulants

Answer 15

act on D1 receptors in the prefrontal cortex & D2 in the striatum

Question 16

Atomoxetine

Answer 16

acts on NA transporter in prefrontal cortex

Question 17

Clonidine

Answer 17

α-2 adrenergic receptor agonist

Question 18

Guanfacine

Answer 18

α2A adrenergic receptor agonist

Question 19

3 problems ADHD have in adulthood

Answer 19

have problems organising and planning
not attain academically as well as expected
find relationships and jobs harder to sustain

Question 20

discuss the debate about giving ADHD children medication

Answer 20

ideas of ADHD secondary to bad parenting, etc.
‘drugging’ your child
horror stories from papers/TV – ‘zombie’, etc.

Question 21

how to tackle ADHD medication debate

Answer 21

Give info / education / evidence available
no hidden agenda
allow YP/family to decide in their own time
ensure the patient is fully engaged & consents in the process

Question 22

4 clinical requirements for ADHD

Answer 22

Apparent before the child is age 7 years
Excessive for the child’s age & development
Pervasive i.e. evident in more than 1 environment e.g. at home and in school
Symptoms may worsen in the afternoon

Question 23

what 3 things need to be monitored in ADHD review

Answer 23

Regular review (<6 monthly) but more frequent when titrating meds
Monitor response to medication
Monitor side-effects
Monitor height, weight, pulse & BP

Question 24

how to manage environment of ADHD child

Answer 24

Provide a calm environment
Avoid too many distracting stimuli when you want the child to concentrate
Initially, avoid situations that require quiet, still behaviour for long periods
Maintain structure and supervision longer than you think should be necessary

Question 25

how does Elvanse (lisdexamfetamine) | work

Answer 25

Acts to increase available DA and NA Given/adsorbed as a pro-drug (inactive) Metabolised to dexamphetamine by red blood cells at set rate Rapid onset of action, lasts 13 hours

Question 26

side effects of Elvanse (lisdexamfetamine)

Answer 26

dizziness, drowsiness

Question 27

features of ADHD assessment

Answer 27

``` Direct Observations in ≥ 1 setting Psychoeducational Assessment Structured Questionnaires Identifying co-morbid (mental) health problem Developmental history Develop a formulation ```

Question 28

Guanfacine

Answer 28

Non-stimulant selective central alpha2A-adrenergic receptor agonist

Question 29

is ADHD inheritable

Answer 29

linked to twins | Genetic-environment interactions

Question 30

Neurobiological factors of ADHD

Answer 30

``` ADHD-Associated Executive Difficulties Organisation Planning Working memory Attention Response inhibition Impulse control ```

Question 31

MRI features of ADHD

Answer 31

smaller brain volume – frontal & parietal cortex smaller basal ganglia right dorso-lateral prefrontal lobe reduced smaller cerebellar vermis Attentional systems involve → Anterior Fronto-striatal networks posterior parieto-cerebellar circuits

Question 32

Additional assessments

Answer 32

hearing and vision screening checks (low threshold) screening for neurological signs & physical anomalies   Baseline height & weight (record on growth chart) Baseline blood pressure & heart sounds

Question 33

2 psychostimulants

Answer 33

Methylphenidate | Dexamphetamine (DEX)

Question 34

Methylphenidate (MPH)

Answer 34

blocks DA & NA re-uptake via transporter

Question 35

Dexamphetamine (DEX)

Answer 35

releases DA stored in presynaptic vacuoles