the PMHNP Podcast: ADHD - Criteria, Scientific Foundations, and Treatments

Описание: For help preparing for your PMHNP (ANCC or AANP) certification exam, go to www.PMHNPtesting.com

The PMHNP Podcast’s ADHD series, crafted for Psychiatric-Mental Health Nurse Practitioner (PMHNP) students preparing for the PMHNP-BC certification exam, provides a comprehensive exploration of Attention-Deficit/Hyperactivity Disorder (ADHD), a neurodevelopmental disorder impacting children, adolescents, and adults. This series equips students with evidence-based knowledge and clinical skills to excel in diagnosing, treating, and managing ADHD, ensuring readiness for both the certification exam and patient-centered practice.

The series begins with the DSM-5 diagnostic criteria, detailing the requirements for ADHD: persistent inattention, hyperactivity, and/or impulsivity present before age 12, observed in two or more settings, and causing significant impairment. Children under 17 need six symptoms per domain (inattention or hyperactivity-impulsivity), while those 17 and older require five. The three presentations—combined, predominantly inattentive, and predominantly hyperactive-impulsive—are emphasized for accurate diagnosis in exam scenarios.

Differential diagnoses are explored to distinguish ADHD from conditions like anxiety, mood disorders, learning disorders, and medical issues (e.g., thyroid dysfunction). Key differentiators include symptom onset, context, and comorbidities, with clinical interviews and collateral data from parents or teachers critical for ruling out mimics, a common focus in certification questions.

The scientific foundations of ADHD highlight its neurobiological basis: dysregulated dopamine and norepinephrine signaling in the fronto-striatal-cerebellar circuit, involving structures like the prefrontal cortex (executive function), basal ganglia (impulsivity), and cerebellum (timing). Genetic factors (70–80% heritability) and environmental influences (e.g., prenatal toxin exposure) are also addressed, providing a framework for explaining ADHD’s etiology to patients.

Screening focuses on validated tools, such as the Vanderbilt ADHD Diagnostic Rating Scale for children (ages 6–12) and the Adult ADHD Self-Report Scale (ASRS-v1.1) for adults (18+). The critical role of parents and teachers in confirming symptoms across settings is stressed, ensuring ecological validity. Students learn to integrate multisource data, a skill tested in exam vignettes.

Adult ADHD diagnosis, particularly for those undiagnosed in childhood, addresses challenges like retrospective recall, atypical symptoms (e.g., disorganization), and high comorbidity rates (e.g., anxiety in 50% of cases). Approximately 2–3% of adults are diagnosed late, often women, requiring tools like the ASRS and thorough histories to meet DSM-5’s age-of-onset criterion.

Pharmacological treatments outline a treatment hierarchy: stimulants (e.g., methylphenidate, Vyvanse) are first-line, with 70–80% efficacy, increasing dopamine and norepinephrine. Non-stimulants (e.g., atomoxetine, guanfacine) are second-line, ideal for patients with substance use concerns or tics, while bupropion is third-line. Age-specific approvals, mechanisms, and side effects (e.g., insomnia, tics) are detailed for exam preparation.
Management of tics in stimulant-treated patients involves initial dose reduction, followed by non-stimulants (e.g., guanfacine) or Comprehensive Behavioral Intervention for Tics (CBIT). This stepwise approach, grounded in AACAP guidelines, prepares students for clinical decision-making scenarios.

Psychotherapy covers evidence-based options: behavioral therapy for children (ages 4–12), rooted in operant conditioning, uses token economies and parent training. Cognitive behavioral therapy (CBT) for adolescents and adults (13+) employs techniques like the Pomodoro method, while social skills training and mindfulness address social deficits and emotional regulation, respectively. These therapies, supported by randomized controlled trials, enhance patient outcomes.

Evidence-based resources include professional organizations (e.g., APNA, CHADD), clinical texts (e.g., Stahl’s Psychopharmacology, ANCC Review Manual), and databases (e.g., PubMed, CINAHL), providing students with tools for exam preparation and clinical practice. These resources align with guidelines from AACAP and NIMH, ensuring relevance.

Practice questions challenge students with graduate-level, patient-centered scenarios, testing integration of diagnosis, treatment, and education concepts. Rationales draw on clinical guidelines, reinforcing critical thinking for the exam. - Available in the Student Portal at www.PMHNPtesting.com

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