Attention-deficit hyperactivity disorder — formative SAQs

SAQ 1 (10)

A 7-year-old is referred because the teacher says “ADHD tablets please.” Homework is unfinished. Nightly sleep is about 8 hours with a tablet in bed. Vision has not been checked for two years. Parent reports the child is “fine at weekends.” [1]

1. Define ADHD using multi-setting and impairment criteria. (2) [1]
2. List four reversible or alternative contributors you must assess before labelling. (2) [1] [20]
3. Outline your multi-informant assessment plan. (3) [1]
4. State two reasons a same-day stimulant prescription is unsafe here. (3) [1] [12] [20]

Model answer

Definition. Neurodevelopmental pattern of impairing inattention and/or hyperactivity-impulsivity inconsistent with developmental level, present ≥6 months, onset before age 12, in ≥2 settings, with clear functional interference and not better explained by another condition. [1]

Contributors. Short sleep/screen-related sleep debt; uncorrected vision; learning disorder; hearing problem; anxiety/trauma; normal high activity without multi-setting impairment. [1] [20]

Assessment plan. Child voice; parent developmental history; teacher scales/report; sleep and sensory screens; growth/BP/HR baselines; comorbidity and safeguarding screen; synthesis meeting. [1]

Why not same-day stimulant. Diagnosis incomplete (single setting claim, no teacher instrument yet); sleep opportunity inadequate; vision unchecked; risk of overdiagnosis from pressure without multi-informant evidence. [1] [12] [20]

SAQ 2 (10)

An 9-year-old has confirmed moderate-severe combined ADHD after multi-setting assessment. Sleep is adequate. Cardiac history is negative. Family accepts multimodal care. [1]

1. Outline first-line non-pharmacological components. (2) [1]
2. Propose a stimulant initiation and monitoring framework. (4) [1] [3] [15]
3. Give atomoxetine and guanfacine XR alternatives with key monitoring. (3) [13] [14]
4. State one MTA trial teaching point relevant to counselling. (1) [4]

Model answer

Non-drug. Psychoeducation; parent behavioural training; classroom strategies/accommodations; school partnership for function goals. [1]

Stimulant plan. Prefer long-acting methylphenidate product-specific morning start (or IR framework e.g. 5 mg 2–3 times daily with weekly titration toward response, product max often around 60 mg/day — check label). Monitor height/weight, BP, HR, appetite, sleep, mood/tics, diversion and school function. [1] [3] [15]

Alternatives. Atomoxetine start ~0.5 mg/kg/day then target ~1.2 mg/kg/day (max ~1.4 mg/kg/day or 100 mg); watch GI effects, mood, rare hepatic injury. Guanfacine XR start 1 mg daily, up by 1 mg/week (often 1–4 mg); watch sedation, hypotension, bradycardia; taper after prolonged use. [13] [14]

MTA. At 14 months carefully managed medication (± behaviour) beat behavioural treatment alone for core ADHD symptoms. [4]