10-28 ADHD

Question 1

Discuss subtypes and diagnosis of ADHD

Answer 1

innattentive
hyperactive-impulsive
—for either type, need 6 sx
combined
—need 6+ sx from EACH
Dx:
—6+ sx as above
—sx before 12 y/o (DSM-V)
—interruption of fxn in 2 domains (work, school, home, social)

Question 2

Describe catecholamine hypothesis of ADHD etiology and basic evidence that supports it.

Answer 2

Dysreg of DA and NE in CNS
—NE from LC —> incr signal:noise
—DA from SN + VTA —> locks out irrel; readies response
EVIDENCE
—imaging both structural and fxnal
—animal NE-DA ablation studies
—genetics linked to NE/DA
—drugs modulating NE and DA work
—PET: pre-motor and sup PFC

Question 3

Discuss FDA-approved medications for ADHD, including stimulants

Answer 3

methylphenidate - blocks DA/NE reuptake prot

amphetamine - encourages DA release

Question 4

Discuss FDA-approved medications for ADHD, including non-stimulants

Answer 4

atomoxetine = specific NRI

guanfacine = α2 agonist (less sedating, α2A specific)

clonidine XR = α2 agonist (more sedating)

Question 5

Describe potential problems with stimulants

Answer 5

reduced appetite and growth, insomnia, headaches/stomachaches, tics, moodiness, hallucinations, illicit use or diversion

Question 6

Briefly discuss off-label Rx treatments for ADHD.

Answer 6

off-label drugs:
—TCAs: incr NE (act as SNRI)
—bupropion: a “DNRI” (incr NE > DA)
—venlafaxine: SNRI (like atomoxetine)

Question 7

Briefly discuss behavioral treatments for ADHD.

Answer 7

CBT
parental education
coaching
routines
accommodations at school/work