ADHD - Butterfield

Question 1

What is ADHD?

Answer 1

Some combination of
Inattentiveness (excessive)
Hyperactivity
Impulsivity

Question 2

What is the prevalence of ADHD? Male-female ratio?

Answer 2

Children 3-7%
Adults 4%

2:1 - 5:1**

**Women are likely underdiagnosed since they are less likely than boys to be hyperactive, which is bothersome to others, leading to more frequent diagnosis.

Question 3

What are the DSM5 types of ADHD? (3)

Answer 3

Inattentive type
Hyperactive type
Combined type

Question 4

Characteristics of inattentive type ADHD? (6)

Answer 4

1) Careless mistakes
2) Difficulty sustaining attention
3) Often does not seem to listen when spoken to directly
4) Poor follow through
5) Often avoids, dislikes, or is reluctant to do tasks that require sustained mental effort (e.g. homework, notes, taxes, etc)
6) Is often forgetful in daily activities

Question 5

Characteristics of hyperactive type ADHD? (5)

Answer 5

1) Fidgeting; Difficulty sitting still
2) Often unable to play or take part in leisure activities quietly.
3) “Driven by a motor” (high energy level)
4) Often talks excessively.
5) Often has trouble waiting for turn

Question 6

DSM5 diagnostic criteria?

Answer 6

1) 6 or more symptoms in either (or both) category; (5 symptoms for older than 17 y.o.)
2) Several symptoms present before age 12
3) Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities).
4) There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
5) Not better explained by something else.

Question 7

What is the gold standard for diagnosis?

Answer 7

Good diagnostic history and exam.

Must rule out other causes (Depression, anxiety, abuse, poor sleep/nutrition, etc)

Question 8

True or false: Hyperactivity as a child decreases your chances of graduation from high school, college, professional school AND increases your chances of being incarcerated.

Answer 8

True. (2-4x)

Question 9

True or false: hyperactivity doubles your risk for tobacco risk, quadruples your risk for drug abuse, and increases your risk for antisocial disorder 9x.

Answer 9

True.

Question 10

What are some comorbidities of ADHD?

Answer 10

MDD, Oppositional disorder, conduct disorder, phobias, separation anxiety, etc.

Question 11

How can ADHD lead to Oppositional Defiant Disorder or Depression?

Answer 11

• ->ADHD is annoying and irritating to others
• ->Frequent negative messages
• ->Development of negative sense of self
• ->Anger and devaluation = defense
• ->Frequently develop Oppositional Defiant Disorder or –>Depression

Question 12

What is the best evidence based Tx for ODD?

Answer 12

Parent Management Training

Question 13

What is the response rate to medication for ADHD?

Answer 13

90%

Question 14

Why are stimulants used to treat ADHD?

Answer 14

Effective and typically well-tolerated
Rule of thumb: About 80-90% reduction in symptom burden with right dose
Improve quality of life generally
Less symptoms –> less annoying –> better self-esteem
Evidence suggestive of protective effects developmentally

Question 15

What are the two classes of stimulants used to treat ADHD?

Answer 15

Amphetamines (Adderall)

Methylphenidates (Ritalin)

Question 16

ADHD often progresses into adulthood 65%. How does the disease change over time?

Answer 16

Hyperactivity tends to decrease with time (Rare by late adolescence)

Inattentive symptoms, restlessness and impulsivity, and attentional problems remain

Adults are much more likely to abuse alcohol/drugs with untreated ADHD. Early treatment can decrease this risk significantly.