Self Assessment

  1. You are obtaining a clinical history from a mother of a 7 year old child. You would like to inquire about specific examples of inattentive, hyperactive and impulsive behaviors. List three behaviors related to:
    (a) Inattention:
    1.___________________
    2.___________________
    3.___________________
    (b) Hyperactivity:
    1.___________________
    2.___________________
    3.___________________
    (c) Impulsivity.
    1.___________________
    2.___________________
    3.___________________
  2. What percentage of the pediatric population is affected by AD/HD?
    (a) <1%
    (b) 1-2%
    (c) 3-5%
    (4) 7-10%
  3. Children with AD/HD exhibit symptoms of inattentiveness, impulsivity and increased activity:
    (a) most prominently at home
    (b) most prominently at school
    (c) equally in all environments
    (d) in at least more than one environment
  4. You have just diagnosed AD/HD in a 3rd grade child. His past academic performance has been significantly below average. How might you ensure that this child does not have a learning disability?
    (a) wait to see if the child fails a grade
    (b) begin treatment for AD/HD and see if grades improve
    (c) make a referral to the school's child study team
    (d) AD/HD explains the child's poor performance, he is unlikely to have a learning disability.
  5. Evidence is accumulating that attention is a neuropsychological function and that AD/HD is a biologically based disorder.

    (A) Concerning the epidemiological data supporting a biologic origin of AD/HD which one of the following is true:

    (a) The incidence of AD/HD in the parents of children diagnosed with AD/HD is 50% suggesting an autosomal dominant disorder.
    (b) The link between adverse family and perinatal factors with hyperactivity is strong.
    (c) Statistical analysis estimates that genetic effects account for 50% of the explainable variance in hyperactivity and inattentiveness among twin pairs.
    (d) none of the above

    (B) Concerning the biochemical data supporting a biologic origin of AD/HD which one of the following is not true:

    (a) methylphenidate exerts its effect primarily via modulation of dopamine levels
    (b) clonidine is an alpha-2 noradrenergic agonist and is most effective in treating hyperaroused/aggressive behaviors
    (c) behavioral-biochemical correlative data show no correlation between changes in urinary noradrenergic metabolites and clinical response to medications.
    (d) medications which increase serotonin levels improve symptoms of AD/HD

    (C) Concerning neuroanatomical studies which support the biological basis of AD/HD which one of the following is true:

    (a) morphologic analysis reveals that patients with AD/HD have enlarged right frontal lobes
    (b) glucose metabolism is increased on PET scans of patients with AD/HD
    (c) the left hemisphere is dominant in mediating attention
    (d) prefrontal damage causes disturbances in drive and executive control resulting in impulsive actions
  6. With multimodal therapy 60-90% of patients will experience improvements. Improvement have been documented in which of the following :
    (a) social interaction
    (b) self control
    (c) academic performance
    (d) all of the above
  7. Behavioral therapy and environmental adjustments should accompany stimulants in treating AD/HD:
    (a) only at home
    (b) only at school
    (c) at school and at home
    (d) stimulant medication alone is an effective treatment
  8. Referral to a mental health provider should be considered if:
    (a) the child has a comorbid psychiatric disorder
    (b) family dynamics prevent effect behavior therapy by the primary care provider
    (c) behavioral symptoms are complex
    (d) all of the above
  9. List 3 environmental adjustments you might recommend to:
    (A) The parents of a child with AD/HD:
    1.________________________
    2.________________________
    3.________________________

    (B) The teacher of a child with AD/HD
    1.________________________
    2.________________________
    3.________________________
  10. Which one of the following is true:
    (a) the best choice of medication for a 7 year old with AD/HD complicated by significant aggressive/hyperaroused behaviors might be clonidine
    (b) methylphenidate should never be used in a patient with a tic disorder
    (c) pemoline is a first line agent for the treatment of AD/HD
    (d) clonidine can be held on weekends and holidays
  11. You have started a child on stimulant medication and his mother is now calling concerned about decreased appetite. Which one of the following should she do?
    (a) limit snacking
    (b) stop the medication/switch to a different medication
    (c) force meals
    (d) give medication with meals
  12. Concerning placebo controlled trials in clinical practice, which one of the following is true?
    (a) they are not ethical
    (b) they can help make the diagnosis of AD/HD
    (c) they can clarify placebo effects, side effects and reinforce benefit of medication
    (d) they are complicated and take too long to be useful in clinical practice
  13. AD/HD formal ratings scales (e.g. AD/HD Diagnostic Rating Scale) are useful in clinical practice because they:
    (a) confirm the diagnosis of AD/HD
    (b) identify the cause of inattention, impulsivity and increased activity
    (c) allow objective measurement of effectiveness of therapy
    (d) all of the above
  14. Concerning the discontinuation of stimulant therapy, which one of the following is true:
    (a) medications should always be held on weekends/holidays
    (b) drug holidays must be given every one to two years to maintain effectiveness
    (c) medications should be stop in adolescence since AD/HD is outgrown
    (d) parents should be allowed to decide if children need stimulant medication seven days a week/ year round