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Attention-deficit/hyperactivity disorder (ADHD)
ADHD is diagnosed when there are enough symptoms of inattention or of hyperactivity-impulsivity, some of which appeared before age 12 and are seen in more than one setting; from age 6 the main treatment is a stimulant together with behavioural intervention.
Why it matters in the exam
Exam questions present a child who struggles at school, forgets, interrupts and cannot sit still, and ask about the conditions for diagnosis and the treatment. Remember: at least 6 symptoms in one domain (5 from age 17), a duration of at least 6 months, some symptoms before age 12, presence in at least two settings (for example home and school), and impaired function. Before the diagnosis, hearing and vision problems, obstructive sleep apnoea, absence seizures, thyroid disease, anxiety, depression and learning disorders are excluded — and are also sought as comorbidities.
Treatment depends on age: at 4–5 years parent behaviour training comes first, with methylphenidate added only if there is no improvement; from age 6 stimulants (methylphenidate or amphetamines) are first line, together with behavioural and educational intervention. Before stimulants, ask about fainting, chest pain and sudden death in the family, and check blood pressure and pulse. Side effects: reduced appetite, insomnia, slight slowing of growth and a rise in heart rate and blood pressure. Non-stimulant alternatives: atomoxetine (a warning about suicidal thoughts in the young) and α2 agonists (guanfacine, clonidine), which also suit children with tics. In adults ADHD often persists, and there the risk of stimulant misuse is also assessed.
Key points
- 6 symptoms, 6 months, before age 12, in two settings.
- Exclude hearing, vision, sleep, absence seizures and thyroid disease.
- Age 4–5: parent training first; from age 6: stimulants and behavioural intervention.
- Side effects: appetite, sleep, growth, pulse and blood pressure.
- Alternatives: atomoxetine, guanfacine, clonidine.
Summary table
| Topic | Criterion or finding | Treatment | Exam notes |
|---|---|---|---|
| Diagnosis | At least 6 symptoms in one domain (5 from age 17), 6 months, before age 12, in two settings | — | Questionnaires from parents and teachers |
| Exclusion and comorbidity | Hearing, vision, sleep apnoea, absence seizures, thyroid, anxiety, learning disorders | — | Common comorbidities: oppositional defiance, learning disorders, tics |
| Age 4–5 | — | Parent behaviour training; methylphenidate if no improvement | Behaviour before medication |
| From age 6 | — | Stimulants (methylphenidate, amphetamines) with behavioural intervention | First line |
| Before stimulants | Fainting, chest pain, sudden death in the family | Blood pressure and pulse; ECG as needed | Side effects: appetite, sleep, growth |
| Alternatives | No response, side effects, tics, misuse risk | Atomoxetine, guanfacine, clonidine | Atomoxetine — suicidality warning |
Free exam questions
איזו המלצה תינתן להורי הילד, שסובל מ ADHD ומטופל בתכשיר על בסיס Methylphenidate , שמודאגים מעיכוב פוטנציאלי בגדילתו? (the question as examined, in Hebrew)
- א. לא לדאוג, כי אין עדויות מחקריות לעיכוב בגדילה
- ב. לעבור לתכשירים על בסיס אמפטמינים
- ג. לעשות drug holidays המאפשרים פיצוי בגדילה
- ד. לעבור לטיפול התנהגותי
באיזו מבין האבחנות הבאות מופיע Irritable Mood כאחד הקריטריונים ? (the question as examined, in Hebrew)
- א. Attention-Deficit/Hyperactivity Disorder
- ב. Antisocial Personality Disorder
- ג. Intermittent Explosive Disorder
- ד. Oppositional Defiant Disorder
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Sources
- DSM-5-TR, American Psychiatric Association, 2022 — Attention-Deficit/Hyperactivity Disorder
- AAP Clinical Practice Guideline, 2019 — Diagnosis, evaluation and treatment of ADHD in children and adolescents
- NICE guideline NG87, 2018, updated 2019 — Attention deficit hyperactivity disorder: diagnosis and management
- Kaplan and Sadock's Synopsis of Psychiatry, 12th edition (2021) — Attention-Deficit/Hyperactivity Disorder
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.