A 5-Question Quiz on ADHD

Question 1

In which of the following ways does the hyperactivity component of ADHD typically manifest in adults?

A. Motor tics

B. Pressured speech

C. Restlessness

D. Physical aggression

Answer: C. Restlessness

Discussion

The clinical presentation and functional effects of ADHD in adults vary greatly from their child and adolescent counterparts. As patients mature and their roles and responsibilities evolve, the functional impairments and symptom presentation evolve in response, thereby presenting a barrier to fulfilling diagnostic criteria.

Perhaps the most significant evolution of symptoms occurs in the hyperactivity-impulsivity domain. It is often assumed that these symptoms fade or resolve entirely in adults as they grow older. However, maturation results in a shift in this symptom cluster, and it evolves from behavioral to cognitive—adult patients feel restless as opposed to running around and being disruptive in school.

For more on this topic, see “Adult ADHD: A Review of the Clinical Presentation, Challenges, and Treatment Options” by Jennifer A. Reinhold, PharmD, BCPS, BCPP, on which this question is based.

Question 2

Which of the following is not a common comorbid psychiatric disorder in children with ADHD?

A. Anxiety disorders

B. Eating disorders

C. Depressive disorders

D. Oppositional/conduct disorders

Question 3

A number of psychotherapy approaches for ADHD demonstrate evidence-based effectiveness. Which of the following have shown the best chance of success?

A. Behavioral management

B. Social skills training

C. Other approaches (eg, alternative treatments)

D. All of the above

Although most patients with ADHD respond favorably to psychostimulants, some do not respond to treatment. In those cases, an EEG may be useful. A number of studies found variable rates of EEG abnormalities in children with ADHD. Findings from one study[1] suggests several indications for an ECG in a child with ADHD:

• Personal or family history of seizures

• Inattentive episodes characterized by excessive daydreaming and/or periodic confused states

• Comorbid episodic, unprovoked temper or rage attacks

• Frequently recurring headaches

• A history of head trauma, encephalitis, or meningitis preceding the onset of ADHD

• Abnormalities on neurological examination

Reference

1. Millichap JG. Attention deficit-hyperactivity disorder and the electroencephalogram. Epilepsy Behav. 2000;1:453-454.

For more on this topic, see The Electroencephalogram in the Management of Psychiatric Conditions, by Nash N. Boutros, MD, on which this quiz question is based.

Answer: A. True

Discussion

A failure to obtain information on a family’s cultural view can rupture the therapeutic relationship. Family background is so important that DSM-5 expanded the cultural formulation interview. Furthermore, examining the family’s cultural view may increase long-term adherence and investment in treatment.

For more on this topic, see Pediatric ADHD and the Cultural Psychotherapeutic Model, by Martin J. La Roche, PhD, Olivia Carrick, MD, Paul Hammerness, MD, on which this question is based.

This article was created on June 29, 2016 and has since been updated. -Ed