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Self-Assessment Questions

Psychiatry

Attention-Deficit/Hyperactivity Disorder: Review Questions

William R. Marchand, MD

Dr. Marchand is acting associate director, Department of Veterans Affairs VISN 19 MIRECC, and assistant professor of psychiatry and adjunct assistant professor of psychology, University of Utah, Salt Lake City, UT.
This work was supported by the Veterans Administration VISN 19 MIRECC.




Choose the single best answer for each question.

1. A 25-year-old man with adult attention-deficit/hyperactivity disorder (ADHD) presents to the psychiatrist for a follow-up appointment. Over the course of 6 months, several nonstimulant and stimulant pharmacologic treatments have been tried, but these were only partially effective or resulted in intolerable side effects. Currently, the patient is taking the maximum dose of a form of long-acting methylphenidate. He is responding to this regimen better than the previous options tried. However, he is still having breakthrough symptoms (ie, forgetfulness, difficulty with organization, and inability to sustain attention). Neurologic examinations at each visit have been normal. What is the most appropriate treatment for this patient?
  1. Continue current medication and refer for cognitive behavioral therapy (CBT)
  2. Continue current medication and refer to a neurologist
  3. Continue current medication and refer for psychological testing
  4. Continue medication management only
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2. A 19-year-old female college freshman reports problems with attention that are interfering with her school performance. During the visit, the physician notices that the patient is fidgeting with her hands and is restless. Based on the patient’s history and results of the 25-item Wender Utah Rating Scale administered in the office, the primary care physician determines that she has ADHD. A careful psychiatric review of symptoms reveals no evidence of a past or current mood disorder, and results from toxicology screening tests are normal, helping to rule out a substance use disorder. She does not have any psychiatric comorbidity or current medical conditions. Which of the following would be the most appropriate initial intervention for this patient?

  1. Reassurance and clinical monitoring
  2. Trial of an immediate-release amphetamine given 3 times/day
  3. Trial of a long-acting amphetamine given once in the morning
  4. Trial of a selective serotonin reuptake inhibitor (SSRI) given once in the morning
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3. A 28-year-old woman with ADHD presents for a follow-up appointment reporting that she is unable to tolerate her current stimulant treatment because of side effects, including headache, upset stomach, and insomnia. She has no significant past or present medical history, and she is not pregnant or nursing. She has no history of substance misuse and denies symptoms suggestive of psychiatric comorbidity. Which of the following agents should be tried next?

  1. Alprazolam
  2. Bupropion
  3. Lithium
  4. Quetiapine
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4. A 13-year-old girl is evaluated by her primary care physician and found to meet diagnostic criteria for ADHD. The evaluation reveals that the patient has had lifelong mild symptoms, but she has not experienced significant impairment until recently. In the last few months, the patient started having behavioral problems in school and her grades have fallen. There is no evidence of problems in the home, use of substances by the patient, or physical or sexual abuse. Which of the following comorbid conditions must be ruled out before initiating treatment for this patient?

  1. Delusional disorder
  2. Generalized anxiety disorder
  3. Major depression
  4. Schizophrenia
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5. A 16-year-old girl presents to her pediatrician with her mother reporting severe problems with attention and concentration. Both the patient and mother state that these symptoms interfere with the patient’s ability to function in school and wonder if ADHD is the cause. The mother states that her daughter’s inattention and difficulty concentrating are intermittent and seem to vary with her mood. The patient says she gets “down” and “blue” easily. The mother agrees but adds that the patient often has times in which she is “on top of the world,” during which she is very cheerful and full of energy. The patient’s friends tease her about being “the energizer bunny.” Episodes of being “down” usually last several weeks to over a month, and periods of high energy occasionally last for over a week. The mother states that the patient’s symptoms have worsened over the past year; she also reports that the patient has had temperament problems, even as an infant. What is this patient’s most likely diagnosis?
  1. ADHD with comorbid major depression
  2. ADHD with comorbid oppositional defiant disorder
  3. Pediatric bipolar disorder
  4. Recurrent major depression
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6. A 22-year-old woman previously diagnosed with ADHD presents to a psychiatrist requesting alternative treatment. She reports that she has tried multiple medications but has either experienced significant side effects or had minimal response. She has also tried CBT, but it was not helpful. She is a student and works part-time and feels that she is not able to function at her full potential because of inability to maintain focus and attention. Which of the following would be the most appropriate treatment recommendation?

  1. Biofeedback
  2. Organization and planning skills training
  3. Psychodynamic psychotherapy
  4. Social skills training
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7. A 15-year-old boy presents to the pediatrician with his mother for evaluation of possible ADHD. The mother states that she does not think her son has ADHD because he is not hyperactive at home. However, the patient’s teacher recommended an evaluation for ADHD because of poor school performance. The patient states he doesn’t always pay attention but could focus more in class if he wanted. Which of the following should be included in the evaluation of this patient?

  1. Chemistry panel
  2. Evaluation forms completed by the patient’s teachers
  3. Magnetic resonance imaging of the brain
  4. Thyroid function tests
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8. A primary care physician evaluates a 10-year-old boy with autism and determines that he has comorbid ADHD. The patient’s mother reports that his hyperactivity is disruptive at school and requests pharmacologic treatment for her child. Which of the following is correct regarding the initiation of medication in patients with autism and comorbid ADHD?

  1. Medication is not indicated for comorbid autism and ADHD
  2. Poor response to standard ADHD treatments is possible
  3. Stimulants should not be used in this patient
  4. Treatment should only be initiated by a child psychiatrist
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