ADHD and adolescent development

Describe the relationship between males and females in relation to ADHD

boys are 2x more likely to be diagnosed with ADHD than girls

Name some of the risk factors for ADHD

environmental: prenatal cigarette smoke exposure, alcohol, lead exposure

biological: low birth weight and prematurity

What is the presentation of ADHD?

inattention, motor hyperactivity, and impulsivity that is inappropriate for developmental stage

What is the DSM-V criteria for ADHD diagnosis

1. 6+ of the 9 symptoms (either or both categories)

2. symptoms present for 6+ months that causes functional impairment

3. symptoms onset prior to 12 yrs

4. 2+ settings (home and school for example)

5. symptoms cannot be explained by another disorder

6+ out of 9 inattentive behaviors persist for at least 6 months

ADHD inattention

6+ out of 9 hyperactive/impulsive behaviors persist for at least 6 months

ADHD hyperactive/impulsive

6+ out of 9 inattentive behaviors plus 6+ out of 9 hyperactive/impulsive behaviors persist for at least 6 months

ADHD combined

symptoms are clinically significant but do not meet the “6 out of 9” criteria for any category

ADHD other specified or unspecified

What is something when we try to diagnose peds/adolescnets that we always need to take into account/ rule out?

assess hearing and vision to rule out that as a cause for certain behaviors

are rating scales a diagnostic tool for assessing ADHD?

they are a tool but are not diagnostic

rating scales help determine what?

baseline behavior across various settings (like a parent form for home and a teacher form for school for example)

What are some common comorbidities associated with ADHD?

oppositional defiant disorder and conduct disorder

What is the management for ADHD for children under 6?

parent training behavior management is first line

if medication is needed always give methylphenidate rather than amphetamine

What is the management for ADHD for children over 6?

medication is the first line, supplemented with behavioral modifications

How is adolescence defined?

gradual development towards autonomy and adult decision making

What are the 4 areas of development for adolescents?

biological

cognitive

psychosocial

emotional

Explain asynchrony in adolescent development and the consequences of it

emotional development often develops after the other 3 areas of development

this can lead to increased risk taking behavior

What is the 2nd leading cause of death in patients aged 10-14 years old?

suicide

What is the pneumonic for assessing an adolescent patient’s psychosocial and risk-taking screening?

HEEADSSS: home, education/employment, eating/exercise, activities, drugs, sexuality, suicide (Depression), safety

What are two important things to remember when assessing an adolescent patient?

try to talk to them alone

thank them for sharing with you

provide anticipatory guidance

What is confidential when speaking with adolescent patients?

reproductive health, sexuality, gender identity and expression, substance use, and mental health

**there are exceptions**

What are the confidentiality exceptions? (must be reported)

someone is in imminent danger

suspicious of sexual or physical abuse of a minor

diagnosis of certain communicable diseases