Practice questions for this Podcast are available at https://pmhnpstudentportal.com/podcast-practice-qs
As future PMHNPs, you’re equipping yourselves to make a real difference for children, adolescents, and adults with ADHD, and this Podcast was designed to give you the tools to excel—both on the PMHNP-BC certification exam and in clinical practice. Let’s recap the journey, highlight the core lessons, and look forward to how you’ll apply this knowledge to empower your patients.
We began with the DSM-5 criteria, laying the foundation for diagnosing ADHD. You learned that inattention, hyperactivity, and impulsivity must be present before age 12, across two or more settings, causing significant impairment. For kids, it’s six symptoms per domain; for those older, five. This framework is your diagnostic compass, and for the exam, expect to differentiate ADHD presentations—combined, inattentive, or hyperactive-impulsive—through case scenarios.
Next, we tackled differential diagnoses, a critical skill for ruling out mimics like anxiety, mood disorders, or learning disabilities. You learned to focus on onset, context, and co-occurring symptoms, using tools like clinical interviews and collateral data from parents or teachers. This ensures you avoid misdiagnosis, a common exam pitfall, and deliver patient-centered care.
Our exploration of ADHD’s scientific foundations revealed its neurobiological roots: reduced dopamine and norepinephrine signaling in the fronto-striatal-cerebellar circuit. From the prefrontal cortex’s role in executive function to the basal ganglia’s impact on impulsivity, understanding these mechanisms helps you explain ADHD to patients and justify treatments like stimulants, which we’ll revisit shortly.
Screening was another key focus, where you mastered tools like the Vanderbilt ADHD Diagnostic Rating Scale for kids and the Adult ADHD Self-Report Scale for adults. We emphasized the vital role of parents and teachers in providing ecological validity, ensuring symptoms are consistent across settings. For the exam, know these tools’ age ranges and how to integrate multisource data.
Diagnosing adults with ADHD, especially those undiagnosed in childhood, brought unique challenges. You learned to navigate retrospective recall, atypical symptoms like disorganization, and comorbidities like anxiety, which affect 50% of ADHD adults. With 2–3% of adults diagnosed late, often women, tools like the ASRS and thorough histories are your allies.
Our pharmacological treatments segment covered the hierarchy of options. Stimulants like methylphenidate and Vyvanse are first-line, boosting dopamine for 70–80% response rates, but side effects like insomnia or tics require monitoring. Non-stimulants like atomoxetine and guanfacine are second-line, ideal for substance use concerns or tics, while bupropion is a third-line option. For the exam, memorize age approvals and mechanisms, like Vyvanse’s dopamine release.
Speaking of tics, we addressed what to do when a patient on stimulants develops them. Reducing the dose is the first step, followed by non-stimulants like guanfacine or behavioral interventions like CBIT. This stepwise approach, grounded in AACAP guidelines, is a must-know for clinical vignettes.
Psychotherapy offered a non-pharmacological lens, with behavioral therapy leading for kids, using operant conditioning to reinforce positive behaviors through token economies. CBT shines for teens and adults, teaching time management via the Pomodoro technique, while social skills training and mindfulness add depth. These therapies, supported by RCTs, empower patients to manage ADHD’s challenges.
Patient and family education was our bridge to empowerment, emphasizing ADHD’s neurobiology, treatment options, and strategies like routines and 504 Plans. A well-crafted handout, as we outlined, reduces stigma and boosts adherence, addressing misconceptions like “ADHD is just laziness.” For the exam, expect to tailor education to diverse needs.
Finally, we provided evidence-based resources, from CHADD’s patient guides to PubMed’s research articles, ensuring you have the tools to stay current. The ANCC Review Manual and AACAP guidelines are your exam lifelines, while APNA and NIMH support clinical practice.
References
American Academy of Child and Adolescent Psychiatry. (2007). Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 46(7), 894–921. https://doi.org/10.1097/chi.0b013e318054e724
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
American Psychiatric Nurses Association. (n.d.). Resource center. Retrieved July 2, 2025, from https://www.apna.org/resources/
American Association of Nurse Practitioners. (n.d.). Psychiatry and mental health resource center. Retrieved July 2, 2025, from https://www.aanp.org/practice/clinical-resources/psychiatry-and-mental-health
Barkley, R. A. (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed.). Guilford Press.
Cairncross, M., & Miller, C. J. (2020). The effectiveness of mindfulness-based therapies for ADHD: A meta-analytic review. Journal of Attention Disorders, 24(5), 627–643. https://doi.org/10.1177/1087054715625301
Children and Adults with Attention-Deficit/Hyperactivity Disorder. (n.d.). National resource center on ADHD. Retrieved July 2, 2025, from https://www.chadd.org/ and https://www.help4adhd.org/
Faraone, S. V., Biederman, J., & Mick, E. (2006). The age-dependent decline of attention deficit hyperactivity disorder: A meta-analysis of follow-up studies. Psychological Medicine, 36(2), 159–165. https://doi.org/10.1017/S003329170500471X
National Institute of Mental Health. (n.d.). Attention-deficit/hyperactivity disorder (ADHD). Retrieved July 2, 2025, from https://www.nimh.nih.gov/health/topics/adhd
Rhoads, J. (2021). Clinical consult to psychiatric mental health management for nurse practitioners (2nd ed.). Springer Publishing Company.
Safren, S. A., Sprich, S., Mimiaga, M. J., Surman, C., Knouse, L., Groves, M., & Otto, M. W. (2010). Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: A randomized controlled trial. JAMA, 304(8), 875–880. https://doi.org/10.1001/jama.2010.1192
Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press.
Volkow, N. D., Wang, G. J., Kollins, S. H., Wigal, T. L., Newcorn, J. H., Telang, F., Fowler, J. S., Zhu, W., Logan, J., Ma, Y., Pradhan, K., Wong, C., & Swanson, J. M. (2009). Evaluating dopamine reward pathway in ADHD: Clinical implications. JAMA, 302(10), 1084–1091. https://doi.org/10.1001/jama.2009.1308
Wolraich, M. L., Hagan, J. F., Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., Holbrook, J. R., Lehmann, C. U., Lessin, H. R., Okechukwu, K., Pierce, K. L., Winner, J. D., & Zurhellen, W. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 144(4), e20192528. https://doi.org/10.1542/peds.2019-2528
