Attention Deficit Hyperactivity Disorder (ADHD)


Article Author:
Warren Magnus


Article Editor:
Arayamparambil Anilkumar


Editors In Chief:
Sherry Gossman


Managing Editors:
Frank Smeeks
Scott Dulebohn
Erin Hughes
Sobhan Daneshfar
William Gossman
Pritesh Sheth
John Shell
Matthew Varacallo
Mark Pellegrini
James Hughes
Richard Ciresi
Phillip Hynes


Updated:
1/11/2019 1:42:49 PM

Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) has been a diagnosis of some controversy over the last century in psychiatric and psychological circles. Over the past 30 years, however, a consensus has come about regarding both the existence and clarity of the symptoms that make up the ADHD phenomenon, and more recently, how these manifest as the condition persists into adulthood. There has increased understanding both of the neurochemical and physiologic causation of ADHD and the techniques for effective management of the condition.

ADHD is a developmental disorder of executive functioning that impairs the ability to focus, increases impulsivity, and increases motor activity.  The condition is usually diagnosed between the ages of 6 to 12, but symptoms can persist into adulthood. Treatment of adults with persistent symptoms is becoming increasingly common.[1][2][3]

Etiology

ADHD has developmental components of both genetic and environmental factors. No single cause has been identified. Recent studies suggest that ADHD is polygenic, and a variety of genes contribute to the development of the disorder. At the neurochemical level, both dopamine and norepinephrine are implicated with pharmaceutical intervention targeting these neurotransmitters.[4]

Epidemiology

Current estimates put the incidence of ADHD at 3% to 5% of school-age children. The primary age of diagnosis is between 6 and 12. The persistence of symptoms that plague children throughout their academic career and into adulthood is becoming increasingly recognized. For people who suffered clear ADHD symptomatology as children, 50% to 80% have persistent symptoms in adulthood even though the core symptoms change to reflect adult behaviors. For high functioning individuals, diagnosis is often delayed until late adolescence or adulthood as academic functioning may have been minimally impaired during developmental years.[5][6]

Pathophysiology

Executive function occurs in the prefrontal cortex. Dopamine plays an essential role in the cortex in maintaining executive functioning. Dopaminergic neurons participate in the in the regulation of systems expectation, memory, activity, attention, reward, emotional state, and motivation. Neuroimaging techniques such as PET and functional MRI have demonstrated the poor functioning of the frontal and frontocortical pathways. In ADHD the dysfunctions fall mainly into activity, memory, reward and motivational areas. These functional issues create the hallmarks of ADHD, hyperkinesis, and distractibility. [7][8]

History and Physical

There are no specific physical findings for ADHD. Neuropsychological testing can document the degree of impulsivity and determine attentional and executive functioning deficiencies that suggest ADHD. Some authorities suggest that some behaviors are nearly pathognomonic, such as frequent speeding tickets being strong indicators in adult patients. Patients with ADHD demonstrate a high level of difficulties with time management and prioritization of tasks. They have difficulty initiating and completing tasks promptly. Often patients demonstrate difficulty changing tasks once a task set has begun. Additionally, symptoms of hyperkinesis and poor working memory are often present. Hyperkinetic behaviors, while most obvious in children, can be seen in adult patients often in more muted forms such as visible fidgeting on observation.

Evaluation

The diagnosis of ADHD is largely clinical though recently some neuropsychological tests have come about to test attention and focus. There is no imaging that confirms the diagnosis of ADHD, though when imaged the right prefrontal cortex, caudate nucleus, and globus pallidus are often smaller in patients with ADHD. Adults with ADHD symptomatology often have comorbid conditions such as depression or obsessive-compulsive disorder that developed in response to the ADHD-related dysfunctionality.

Treatment / Management

Treatment of ADHD is historical and still relies heavily on stimulant medications as they act both on the dopaminergic and noradrenergic pathways. Mainstays of treatment remain methylphenidate (MPH) and dextroamphetamine (D-AMP). Longer acting and extended release formulations are becoming more commonly prescribed as the potential for abuse and diversion are lower. Newer non-stimulant medications act on a mix of pathways and offer another clinical option. Alpha-adrenergic blocking agents can be used alone or in concert with stimulant medications and provide some attentional benefit. These medications can also be used adjunctively to treat side effects of stimulant medications. Non-pharmacologic therapy includes parental training, cognitive behavioral therapy, and contingency training. [9][10][11]

In addition to the medical management of ADHD, often there is a need for significant psychological and emotional support. The cognitive and emotional differences that ADHD patients experience make interpersonal relationships more difficult and in children often impact their social and interpersonal functioning. As academic performance improves with pharmacotherapy, it may be necessary for outside counseling to provide the bridge to improving their social functioning. In adults, the functional differences have often resulted in significant adaptive responses and behaviors to make up or cover for the neuro-cognitive deficits. As the cognitive deficits improve, coaching to readapt patients to improved motivation, activity completion and prioritization may be necessary to help the patient fully integrate their new-found capabilities into their daily life. In some cases, vocational or academic skills retraining may be necessary as well. For adults diagnosed later in life, there may be a significant adaptive reaction that requires clinical support.

An exercise prescription for regular moderate to high-intensity cardiovascular exercise can positively impact cognition, confusion, and fatigue as well as improve self-motivation and short term memory. While transient, integrating exercise into the daily routine of an ADHD patient can significantly improve functioning for many patients. 

Dietary interventions that have shown some benefit include reducing simple dietary sugars and increasing dietary protein. Adding L-tyrosine rich foods such as soy products, milk, cheese, chicken, fish, turkey, avocados, chickpeas, pumpkin seeds, and the like can increase dopamine precursors but to date has shown little direct benefit to ADHD.

Omega-3 supplementation has been shown to be effective at improving academic measures of ADHD as the fractions of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) increase. DHA alone was found to be ineffective at improving ADHD symptomatology.[12][13]

Postoperative and Rehabilitation Care

For optimal results, the patient needs long-term followup. ADHD is not an illness where one can just prescribe pills and assume a cure. These patients and their families are also extremely anti-healthcare and medications- so one has to be patient and develop a trusting relationship. Individuals who show evidence of self-harm usually require admission.

Pearls and Other Issues

ADHD can be associated with a number of comorbidities including dyslexia, dyspraxia, Tourette Syndrome, major depression, oppositional defiant disorder, obsessive-compulsive disorder, and anxiety disorders.

The comorbid conditions can exist as a result of ADHD functional deficits and the impact on daily life such as obsessive behaviors that began as coping mechanisms to short-term memory or prioritization issues or depression that has roots in social functioning issues.

Comorbid learning disorders are common in the ADHD population and patients should be screened for these as well. Further, these patients need regular screening for substance abuse.

Enhancing Healthcare Team Outcomes

Childhood ADHD is not a benign disorder - later in life, there is also a risk of substance abuse and conduct disorders. Several studies indicate that with age these individuals have marital and interpersonal difficulties, become antisocial, have poor education performance, and are unable to hold on to jobs. Thus, long-term monitoring of these individuals is important.

ADHD carries significant morbidity and some evidence suggest that it may be a precursor later in life to schizophrenia or bipolar disorder. In addition, in children, ADHD also carries a risk of depression and self-harm behaviors. [14] [15] (Level V)

Evidence-based Approach

The one positive feature of ADHD is that it is treatable but the education of the patient and family is critical. The role of the nurse and pharmacist are indispensable. The key feature is that the family is also very demanding and suspicious of healthcare workers and their motives-thus it is vital to establish a relationship based on trust and honesty.

Both the nurse and pharmacist need to encourage the use of medications, improvement of social skills, structure time, control behavior, and direct positive cognitive behavior. Further, these individuals need to be screened for substance abuse and other behavior problems. There are many educational resources that can be given to the patients and their families. In addition, there is also a hotline - the National Resource Center (1-800 233 4050) that parents can call and speak to a health information specialist.

Evidence indicates that an integrated approach with a team of professionals dedicated to ADHD may help reduce the barriers to treating these patients. It is important to set endpoints in treatment because the disease can be treated but is not curable. [1][16](level V)


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE courses, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Attention Deficit Hyperactivity Disorder (ADHD) - Questions

Take a quiz of the questions on this article.

Take Quiz
What is the most commonly used agent in hyperkinetic children?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
The Diagnostic and Statistical Manual of Mental Disorders criteria for a diagnosis of attention-deficit/ hyperactivity disorder states that behavior must be developmentally inappropriate and present prior to what age?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Jane, a 7-year-old, has been performing poorly in school. Her teacher reports that she constantly fidgets and often blurts out answers. She has difficulty waiting for her turn and is a disruptive influence on the class. For what disorder should she be screened?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Attention deficit hyperactivity disorder is NOT treated with which of the following drugs?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which medication is used to treat attention deficit hyperactivity disorder?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
How does methylphenidate help in managing attention deficit hyperactivity disorder?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What activity is most suitable for a child with attention-deficit/ hyperactivity disorder?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the next best step in a patient with attention-deficit/hyperactivity disorder who has mastered visual attending?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the best method of communicating with patients diagnosed with attention-deficit/ hyperactivity disorder?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
John is a 6-year-old child recently diagnosed with attention-deficit/hyperactivity disorder (ADHD). His mother asks if he will have this condition for the rest of his life. What is the best response?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which statement is true of adult attention deficit hyperactivity disorder (ADHD)?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is the best advice for diet in a child with attention-deficit/hyperactivity disorder (ADHD)?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Parents of a 9 year old bring their son in for treatment of severe ADHD. They were advised by his teacher to get him on medication. The parents agree there is a problem but request alternative treatment. Which of the following is the best management?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
An 8 year old is having problems with focus at school. The parents say the teacher reports he disrupts the class and the patient says he hates math and social studies. The parents don't feel there is a problem and the father states the same things were said about him in school. Now he is a successful salesman. Which of the following would be the best management?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 10-year-old boy is brought in by his parents as his school performance has deteriorated over the past two years. His teacher states that he will not sit in his seat and disrupts the class by talking. He is not completing his assignments at school or his homework. Birth history and development were normal. Physical exam including neurological exam is normal. The child is cooperative but fidgets. Select the most likely diagnosis.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A child has poor visual attention cause problems with school work. What should the OT recommend as a sensory environment adaptation that would be most helpful?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient is attending occupational therapy as part of a partial hospitalization mental health program finds it difficult to concentrate due to crowded conditions. What would be the best environmental strategy to allow the patient to do problem-solving tasks?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
While evaluating a patient with ADHD an OT should be aware of:



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
When evaluating an adult's attention during a craft activity, on which of the following should the OT focus?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient with traumatic brain injury is working with an OT group but instead of staying with his task he spends much of time watching the patient next to him work. This probably indicates an issue with:



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
An OT is working with a child with ADHD, hyperactive type on improving attention span. The activity is a jigsaw puzzle with many pieces. When confronted with the task the child pushes them off the table and throws them around. Which of the following would restructure the activity to improve the chance of success?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient with mental illness has been hired for a clerical position but is worried that easy distractibility may affect her job performance. Select the most appropriate intervention.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A school based occupational therapist is asked to improve the environment for students with ADHD. Select the best adaptation that would improve learning but not affect other students.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
An 8-year-old child is having difficulties remaining seated during class. She wiggles and stands, disrupting the class. The child receives assistance with special education and after school attends a sensory integration program. Which of the following would help the child remain focused?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is least likely in a child with attention-deficit/ hyperactivity disorder?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Select the incorrect statement about attention deficit hyperactivity disorder (ADHD).



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A young boy has decreased attention span, normal intelligence, and hyperactivity. Which of the following would be an appropriate medication?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
The mother of a 6-year-old reports that her son has been doing poorly at school and is easily distractible. For the past year, he has been talking more, interrupts, and has difficulty sitting still. His teacher has said that he has poor concentration for activities that need mental effort. Which of the following is the most likely diagnosis?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 7-year-old boy with attention-deficit/hyperactivity disorder (ADHD) is started on methylphenidate but does not respond. Which of the following could be the next step?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which region of the brain is noted to have decreased activity on functional neuroimaging in patients with attention deficit hyperactivity disorder?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 6-year-old girl is brought to a child and adolescent mental health practitioner because she is constantly in trouble at school for not paying attention, blurting out answers in class, and disrupting other students. This is starting to interfere with her keeping friends at school because she is always in trouble with the teacher. During the exam, the child fidgets with everything and is "bouncing off the walls" with energy. The same behaviors are present at home and at church according to the mother. Her language and motor skills are appropriate. Psychoeducational testing was done and she has no learning disorder. Which of the following is the most likely diagnosis?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is true regarding attention-deficit hyperactivity/disorder (ADHD) in the pediatric population?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which treatment is used for attention-deficit/ hyperactivity disorder?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which is not part of the diagnosis of attention deficit hyperactivity disorder?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 10-year-old boy is started on methylphenidate for attention-deficit/hyperactivity disorder (ADHD). Select the incorrect statement about treating this condition.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 5-year-old is brought in for evaluation at the recommendation of his teacher. He has some developmental delays, but the major issue is that he is not able to sit still and is very active. His favorite activities are video games and watching cartoons. Which of the following would not be part of the initial assessment?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 5-year-old boy in kindergarten is evaluated with the Conner Scales and it indicates that he is oppositional and hyperactive. His behavior is impacting him at school and at home. Which of the following is not an initial step in management?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 5-year-old boy is started on stimulant medication for ADHD and oppositional problems. He has improvement in attention and sitting still but gets into fights on the playground during recess. Which of the following would be least useful in determining whether changes in medications are needed?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 6-year-old in first grade is on stimulant medication for attention-deficit/hyperactivity disorder (ADHD) and has a developmental language disorder. At the end of the year, the teacher feels he will not be able to read and should not be in a regular classroom. Which of the following is the least preferable strategy?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following behavioral inventories would not be used with a 7-year-old with possible problems with learning and attention at school?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A mother of a child with ADHD is concerned that food additives and sugar are the cause of his problems. Select the least useful intervention.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 7-year-old presents with a 6-month history of trouble organizing tasks and activities, being easily distracted, talking excessively, and squirming in his seat. He has had interventions with behavioral techniques with minimal results. Which medication would be considered first-line treatment?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Select the condition that would not improve long-term success in children with attention and learning disorders.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 7-year-old boy is brought to the office as the parents have concerns about his behavior and performance in school over the past 6 months. His teacher has noticed that he is disruptive in class, cannot sit still at his desk, inappropriately blurts out answers to questions without being on, and has difficulty staying on task to complete his daily assignments. His performance on school exams has dropped, which the teacher believes to be due to making more careless mistakes. Also, his hockey coach has reported that he often cannot wait his turn in line during drills. Which of the following is the best next step in management of this patient?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A caregiver brings a child to the pediatric clinic to investigate a statement made by the teacher suggesting that the child has attention-deficit/hyperactivity disorder. Which of the following signs and symptoms are consistent with this diagnosis? Select all that apply.



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Attention Deficit Hyperactivity Disorder (ADHD) - References

References

Smith ZR,Langberg JM, Review of the Evidence for Motivation Deficits in Youth with ADHD and Their Association with Functional Outcomes. Clinical child and family psychology review. 2018 Aug 23     [PubMed]
Du Y,Fu Z,Calhoun VD, Classification and Prediction of Brain Disorders Using Functional Connectivity: Promising but Challenging. Frontiers in neuroscience. 2018     [PubMed]
Kelly BD, Attention-deficit hyperactivity disorder: a clinical review of the concept, diagnosis and management. Irish journal of psychological medicine. 2018 Sep     [PubMed]
Anjum I,Jaffery SS,Fayyaz M,Wajid A,Ans AH, Sugar Beverages and Dietary Sodas Impact on Brain Health: A Mini Literature Review. Cureus. 2018 Jun 7     [PubMed]
Mowlem FD,Rosenqvist MA,Martin J,Lichtenstein P,Asherson P,Larsson H, Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. European child     [PubMed]
Dall'Aglio L,Muka T,Cecil CAM,Bramer WM,Verbiest MMPJ,Nano J,Hidalgo AC,Franco OH,Tiemeier H, The role of epigenetic modifications in neurodevelopmental disorders: A systematic review. Neuroscience and biobehavioral reviews. 2018 Jul 29     [PubMed]
Miguelez-Fernandez C,de Leon SJ,Baltasar-Tello I,Peñuelas-Calvo I,Barrigon ML,Capdevila AS,Delgado-Gómez D,Baca-García E,Carballo JJ, Evaluating attention-deficit/hyperactivity disorder using ecological momentary assessment: a systematic review. Attention deficit and hyperactivity disorders. 2018 Aug 21     [PubMed]
Charach A, Hyperactive Boys Grown Up. Journal of the American Academy of Child and Adolescent Psychiatry. 2018 Aug     [PubMed]
Gavin B,McNicholas F, ADHD: science, stigma and service implications. Irish journal of psychological medicine. 2018 Sep     [PubMed]
Honorio Neto F,Tatlow-Golden M,Mulligan A,Gavin B,McNicholas F, Attitudes and reported practice of paediatricians and child psychiatrists regarding the assessment and treatment of ADHD in Ireland. Irish journal of psychological medicine. 2018 Sep     [PubMed]
Castells X,Blanco-Silvente L,Cunill R, Amphetamines for attention deficit hyperactivity disorder (ADHD) in adults. The Cochrane database of systematic reviews. 2018 Aug 9     [PubMed]
Huang CJ,Huang CW,Hung CL,Tsai YJ,Chang YK,Wu CT,Hung TM, Effects of Acute Exercise on Resting EEG in Children with Attention-Deficit/Hyperactivity Disorder. Child psychiatry and human development. 2018 Jun 5     [PubMed]
Goode AP,Coeytaux RR,Maslow GR,Davis N,Hill S,Namdari B,LaPointe NMA,Befus D,Lallinger KR,Bowen SE,Kosinski A,McBroom AJ,Sanders GD,Kemper AR, Nonpharmacologic Treatments for Attention-Deficit/Hyperactivity Disorder: A Systematic Review. Pediatrics. 2018 Jun     [PubMed]
Cohen E,Wang CJ,Zuckerman B, Specialized Care without the Subspecialist: A Value Opportunity for Secondary Care. Children (Basel, Switzerland). 2018 Jun 4     [PubMed]
Imboden AD,Fehr KK, Collaborative Care of Attention Deficit Hyperactivity Disorder: An Innovative Partnership to Serve Rural Pediatric Patients. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates     [PubMed]
Froehlich T,Fogler J,Barbaresi WJ,Elsayed NA,Evans SW,Chan E, Using ADHD Medications to Treat Coexisting ADHD and Reading Disorders: A Systematic Review. Clinical pharmacology and therapeutics. 2018 Jul 27     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Nurse-Holistic. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Nurse-Holistic, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Nurse-Holistic, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Nurse-Holistic. When it is time for the Nurse-Holistic board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Nurse-Holistic.