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ICM > 1: ADHD > Flashcards

1: ADHD Flashcards

1
Q

prevalence and impact of ADHD

A
  • prevalence rate: 6-10%

- male more than females

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2
Q

diagnostic criteria for inattention symptoms of ADHD

A

need at least 6 of the following:

  • fails to give close attention to details/ makes careless mistakes
  • difficulty sustaining attention
  • doesn’t seem to listen when spoken to directly
  • doesn’t follow through on instructions/fails to finish work
  • difficulty organizing tasks and activities
  • avoids tasks requiring sustained mental effort
  • loses things necessary for tasks/activities
  • easily distracted by extraneous stimuli
  • forgetful in daily activities
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3
Q

diagnostic criteria for hyperactivity-impulsivity symptoms of ADHD

A

need at least 6 of the following:

  • difficulty playing/engaging in activities quietly
  • always on the go or acts as if driven by a motor
  • talks excessively
  • blurts out answers
  • difficulty waiting in lines or awaiting turn
  • interrupts or intrudes on others
  • runs about or climbs inappropriately
  • fidgets with hands or feet or squirms in seat
  • leaves seat in class/situations when expected to sit
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4
Q

general diagnostic criteria for ADHD

A
  • symptoms present before age 12
  • clinically significant impairment in social or academic/occupational functioning
  • symptoms that cause impairment in 2 or more settings
  • not due to another disorder
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5
Q

three subtypes of ADHD

A
  • combined type
  • predominantly inattentive subtype
  • predominantly hyperactive/impulsive subtype
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6
Q

describe the combined type of ADHD

A
  • clinical levels of both inattention and hyperactivity/impulsivity
  • most common subtype
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7
Q

describe the predominantly inattentive type of ADHD

A
  • clinical levels of inattention only
  • often not identified until middle school
  • sluggish cognitive tempo
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8
Q

describe the predominantly hyperactive/impulsive type of ADHD

A
  • clinical levels of hyperactivity/impulsivity only

- more common among very young children prior to school entry

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9
Q

associated peer problems

A
  • inattentive sx -> ignored
  • hyperactive/impulsive sx -> actively rejected
  • not deficient in social reasoning/understanding, but rather the execution of appropriate social behavior
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10
Q

associated family dysfunction/parental issues

A
  • no clear causal relationship b/w family problems and ADHD

- family probs can impact the severity and developmental course/outcomes of ADHD

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11
Q

associated problems with self-esteem

A
  • inflated: positive illusory bias (Hoza)

- low self esteem associated with co-morbid depression

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12
Q

developmental course of ADHD

A
  • persistent across lifespan in most cases
  • inattention remains stable
  • hyperactivity declines with age
  • adult outcomes including psychiatric comorbidity (conduct disorder or depression or anxiety)
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13
Q

etiological factors of ADHD: heritability

A

.80-.85 (extremely high)
-environmental factors are not the cause, but may contribute to the expression, severity, course, and comorbid conditions

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14
Q

etiological factors of ADHD: prefrontal lobe dysfunction

A
  • involved in inhibition, executive functions

- abnormal brain activation during attention and inhibition tasks

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15
Q

etiological factors of ADHD: genes involved in dopamine regulation

A
  • dopamine transporter DAT1 gene implicated
  • 7 repeat of dopamine receptor gene DRD4 implicated
  • gene x environment interactions
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16
Q

etiological factors of ADHD: possible differences in size of brain structures

A
  • prefrontal cortex
  • corpus callosum
  • caudate nucleus
17
Q

ADHD differences in brain structure and function

A
  • diffs in brain maturation, structure, fxn - particularly in frontostriatal circuitry (prefrontal cortex, basal ganglia, cerebellum)
  • these areas are associated with executive fxn abilities:
    • attention, spatial working memory, short term memory
    • response inhibition and set shifting
18
Q

what neurotransmitters are different in ADHD?

A
  • *dopamine
  • norepi (mostly a dopamine prob, but dopa makes norepi)
  • epi
  • serotonin

dopamine associated with approach and pleasure-seeking
norepi role in emotional/behavioral regulation

19
Q

executive functioning deficits

A

deficits in cognitive processes which activate, integrate, and manage other brain functions (sx overlap with ADHD, but not all kids with ADHD have EF deficits)

  • cognitive: working memory, planning, organizing strategies
  • language: verbal fluency, communication
  • motor: response inhibition, motor coordination
  • emotional: self-regulation of emotion, frustration tolerance
20
Q

what is the basis of executive functioning deficits in ADHD?

A

behavioral disinhibition - a performance, rather than knowledge, deficit

21
Q

evidence-based assessment of ADHD

A
  • teacher and parent-completed questionnaires (Connor scales)
  • structured clinical interview with parent(s)
  • IQ/achievement testing to screen for learning disabilities (50% comorbidity)
  • behavioral observations at home and school
  • no medical screen, cognitive test, or brain imaging technique can detect ADHD
  • kids with ADHD can focus long enough to watch TV, play video games or sit still at doc’s office
22
Q

well-established ADHD treatments

A
  • stimulant meds
  • behavioral interventions
    • behavioral parent training
    • behavioral classroom management
    • intensive summer treatment programs
23
Q

what are the best known stimulant meds for ADHD?

A

methylphenidate

  • Ritalin
  • Concerta
  • metadate

dextroamphetamine
-Adderall

24
Q

how do these stimulant meds reduce ADHD symptoms (mechanism of action)?

A
  • block reuptake of norepi, dopamine and facilitate their release
  • enhances norepi, dopamine availability in certain brain regions: prefrontal cortex, basal ganglia
25
Q

how do these stimulant meds reduce ADHD symptoms (visible behavior changes)?

A
  • extremely effective short term
  • decrease disruption in class
  • increase academic productivity and on-task behavior
  • improve teacher ratings of behavior
26
Q

common side effects of ADHD stimulant meds

A
  • insomnia

- decreased appetite

27
Q

what is an alternative non-stimulant medication for ADHD?

A

strattera/atomoxetine

  • non-stimulant alternative
  • could need 4-6 weeks to work
  • hasn’t been studied as long as the stimulants
  • smaller effect size relative to stimulants
28
Q

limitations of stimulant treatment

A
  • individual differences in response (80% respond)
  • limited impact on domains of fxnal impairment
  • does not normalize behavior (managed, but not cured)
  • family problems beyond scope of medication
  • no long-term effects established
  • long-term use rare
  • limited parent/teacher satisfaction
  • some families not willing to try meds
29
Q

ADHD behavioral treatment components

A
  • psychoeducation about ADHD
  • structure/routines
  • clear rules/expectations
  • attending/rewards
  • planned ignoring
  • effective commands
  • time out/loss of privileges
  • point/token systems
  • daily school-home report card
  • intensive summer treatment programs
30
Q

multi-modal treatment study for ADHD (MTA) - describe the set up/parameters

A
  • 6 sites
  • 579 kids, 7-9 y/o
  • ADHD, combined type
  • assigned to 14 months of:
    • med management
    • intensive behavior therapy
    • combined treatment
    • treatment as usual in the community (TAU)
31
Q

MTA results

A
  • all groups showed reduced ADHD over time
  • meds alone + combined therapy did better than behavior therapy alone and TAU
  • combined tx was often not better than meds alone
  • higher med doses were needed in meds alone group relative to combined tx group

ICM (26 decks)

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