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Term 5: Behavioral Science > 6/8- Attention Disorders and Treatment > Flashcards

6/8- Attention Disorders and Treatment Flashcards

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1
Q

T/F: Attention disorders are behavioral disorders caused by excessive restlessness and distractability, a problem that usually remits during childhood but occasionally persists into adulthood

A

False. This is the hold conceptualization

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2
Q

What are attention problems/disorders?

A

Complex disorder in unfolding development of the unconscious self-management system of the brain

  • A problem of chemical dynamics in the brain
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3
Q

Impairments with attention disorders include what?

A

Chronic difficulties in self regulation by emotion

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4
Q

When do symptoms become apparent with attention disorders?

A

Symptoms may be noticeable in childhood, but may not be apparent until the individual encounters challenges of adolescence or adulthood

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5
Q

T/F: Attention disorders are genetic

A

True: appear to be primarily genetic, though environmental stressors and support may modify expression of symptoms (environment may make it better or worse!)

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6
Q

T/F: attention disorders increase risk of other comorbidities across the lifespan?

A

True

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7
Q

ADHD Criteria?

A
  • Symptoms present before the age of 7
  • Symptoms are present in more than 1 setting
  • Symptoms may be primarily inattentive, hyperactive/impulsive or a combination of both
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8
Q

Inattentive symptoms?

A
  • Makes careless mistakes; poor attention to detail
  • Has difficulty sustaining attention
  • Does not seem to listen
  • Does not follow through or finish tasks
  • Avoids activities that require sustained mental effort
  • Loses things easily
  • Is easily distracted
  • Is forgetful
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9
Q

Hyperactivity/impulsivity symptoms?

A

Hyperactivity:

  • Fidgets, squirms
  • Has difficulty remaining seated
  • Runs or climbs excessively (children), experiences subjective restlessness (adults)
  • Has difficulty with quiet activities
  • Is “on the go” or “driven by a motor”
  • Talks excessively

Impulsivity:

  • Blurts out answers before questions are completed
  • Are impatient
  • Often interrupts others
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10
Q

T/F: If someone has inattention/trouble focusing, the diagnosis to consider is ADHD

A

False; inattention is a symptom of many disorders

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11
Q

Inattention may be a symptom of what disorders?

A
  • ADHD
  • Mood disorders
  • Anxiety disorders
  • Thought disorders
  • Pervasive developmental disorders
  • Learning disorders
  • Personality disorders
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12
Q

T/F: You can have ADHD (attention deficit hyperactivity disorder) that presents as inattentive

A

True

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13
Q

__% of children aged 3-5 meet the criteria for ADHD

A

2-6% of children aged 3-5 meet the criteria for ADHD

(increasingly diagnosed in ages 2-3) … some concerns arisen about using diagnostic criteria in such a young age group (need to wait until ~5 yo)

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14
Q

Early symptoms of ADHD are considered predictive of what?

A

Later behavioral problems

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15
Q

__% of children in elementary school meet criteria for ADHD? What is the distribution in gender?

A

3-7% of children in elementary school meet criteria for ADHD

Gender distribution varies:

  • Boys more hyperactive
  • Girls more inattentive
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16
Q

Elementary school aged kids with ADHD are at higher risk for what?

A
  • Grade retention
  • Special education
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17
Q

__% of pts diagnosed with ADHD as children continue to have the full clincial syndrome in adolescence?

A

78% of pts diagnosed with ADHD as children continue to have the full clincial syndrome in adolescence

18
Q

Characteristics of ADHD in adolescents?

A
  • Physical hyperactivity diminishes but inattention and impulsivity persists
  • Have worse driving habits, more accidents, and more speeding tickets
  • More consequences of sexuality
  • More challenges in gaining teen’s cooperation with diagnosis and treatment
19
Q

__% of children with ADHD continue to have symptoms in adolescence and adulthood?

A

30-70% of children with ADHD continue to have symptoms in adolescence and adulthood (4.4% prevalence)

20
Q

Characteristics/impact of ADHD in adults?

A
  • May influence job selection
  • May tend to overwork due to inefficiency
  • May have low frustration tolerance or relationship problems
  • Impulsivity may be seen in driving, managing finances
  • May have low self-esteem due to chronic feelings of underachievement
21
Q

T/F: ADHD is something children commonly outgrow

A

False

  • 78% continue into adolescence
  • 30-70% continue into adulthood
22
Q

Questions you can ask when taking a history of attention problems?

A
  • Sitting through a movie
  • Reading for pleasure
  • Video games (may reveal inability to disengage*)
  • Taking notes in class
  • Organization skills, misplacing things
  • Keeping their room in order
  • Daydreaming
  • Quickly lose interest
  • Participation in conversations, interrupting, perception of peers
  • Moodiness, frustration tolerance

*Thus, ADHD may not only involve inattention but also inability to remove attention from something that is especially stimulating

23
Q

Neuropsychological testing focuses on what in assessing ADHD?

A
  • Processing speed (WAIS III)
  • Attention tests (Continuous Performance Test)
  • Working memory tests (remember fewer details of story, but doesn’t decrease over time like dementia)
  • Executive functioning (Wisconsin Card Sorting)– areas of difficulty suggest involvement of frontal cortex or regions projecting to the frontal cortex
24
Q

What are some neuroimaging results seen in ADHD?

A
  • Large MRI study demonstrated smaller brain volumes that did not normalize with maturity
  • PET studies identified abnormalities of cerebral metabolism in the prefrontal and premotor areas of the frontal lobe in ADHD adults who had children with ADHD
25
Q

Treatment for attention disorders?

A

- Stimulants

- Atomoxetine

- Clonidine

- Guanfacine

Non-Stimulant Medications:

  • Tricyclic antidepressants (TCAs)
  • Monoamine oxidase inhibitors (MAOIs)
  • Buproprion
  • SSRIs, SNRIs

Behavioral treatments

Academic and workplace modifications

26
Q

Stimulants used for treating attention disorders have what characteristics?

A
  • Structurally similar to endogenous catecholamines
  • Have dopaminergic and noradrenergic neurotransmission but differ between compounds (part basis for pt selection)
  • Improve cognitive performance but do not necessarily normalize performance
27
Q

What are some commonly used stimulants for attention disorders?

A
  • Methylphenidate (Ritain, Concerta)
  • D-methylphenidate (Focalin)
  • D-amphetamine (Dexedrine)
  • Mixed amphetamine salts (Adderall)
  • Lisdexamfetamine (Vyvanse)
28
Q

Stimulant Dosing Comparison (table)

A
29
Q

What is the longest-acting stimulant? How long?

Shorter-acting?

Shortest-acting?

A

10-12 hours (take 1x/day)

  • Long acting methylphenidate (Concerta)
  • Mixed amphetamine salts- extended release (Adderall XR)

4-6 hours (take 2x/day)

  • Mixed amphetamine salts (Adderall)
  • D-methylphenidate (Focalin)

3-4 hours (take 3x/day):

  • Immediate release Methylphenidate (Ritalin)
30
Q

Side effects of stimulant medications?

A
  • Appetite suppression (unclear impact on growth)
  • Sleep disturbances, mood disturbances
  • “Dull” feeling - Irritability, anxiety
  • Psychosis, mania (in overdose)
  • Restlessness
  • Awareness of peaks
  • Headaches
  • Tic disorders
  • GI problems
  • Increased pulse and BP
  • Lethargy, fatigue
  • Potential for abuse (no clear evidence)
  • SUDDEN CARDIAC DEATH- particularly if there is an underlying hear defect or disease
31
Q

What is Atomexetine?

Class:

Approved for:

Results in:

Side effects:

Requires:

Abusable (yes/no):

Dose frequency:

A

Atomexetine:

Non-stimulatory

Class: specific NE re-uptake inhibitor

Approved for: children and adults

Results in: improved performance on neuropsychological measures

Side effects:

  • Appetite decrease* (more in kids; may cause poor nutrition)
  • GI symptoms
  • Mild increase in BP and pulse
  • Rare and serious hepatotoxicity (TEST QUESTION)

Requires: titration to target dose

Abusable (yes/no): No

Dose frequency: Daily

32
Q

What is the “good grade” pill refer to?

A
  • Non-specific performance enhancement and increased alertness
  • Though not necessarily casual, increased use of alcohol and cannibis are predictors of non-medical use of stimulants
33
Q

T/F: The most common demographic to mis-use Adderall are competitive students using it to improve grades/school performance

A

False

34
Q

What is Clonidine?

Class:

Uses:

Side effects:

A

Clonidine

Class: alpha adrenergic agonist

Uses: primarily for HTN, but also for hyperactivity and impulsivity symptoms

Side effects:

  • Sedation
  • Hypotension
  • Dry mouth
  • Depression
  • Rebound hypertension
35
Q

The “epidemic of ADHD”: why was there such a difference in diagnosis/prevalence of ADHD geographically (e.g. NC > CA)?

A

Predictors of diagnosis was educational policy!

  • No Child Left Behind (linking school financing with standardized test performance) resulted in increased ADHD diagnosis rates
  • Nationwide ADHD diagnosis increased by 22% in the 1st 4 years after NCLB
36
Q

What is Guanfacine?

Class:

Uses:

Side effects:

A

Guanfacine:

Class: more selective alpha antagonist than clonidine

Uses: treatment for impulsive/hyperactive symptoms

Side effects:

  • Less sedating than clonidine
  • Less hypotensions than clonidine
  • Dry mouth
  • Depression
  • Rebound hypertension
37
Q

What are some additional non-stimulant medications for ADHD?

A
  • Tricyclic antidepressants (TCAs)
  • Monoamine oxidase inhibitors (MAOIs)
  • Buproprion
  • SSRIs, SNRIs
38
Q

What do behavioral treatments for ADHD include?

A

These are the mainstay! “Medications are like a bandaid”

  • Prioritizing demanding activities to most productive times
  • Tutoring
  • Compensatory behaviors (list making, reminders)
  • Career advice
  • Supportive psychotherapy
  • Group psychotherapy
  • Family psychotherapy
  • Coaching
39
Q

How are stimulants capable of treating something that seems to be a result of over-stimulation (ADHD)?

A

Stimulating part of the brain that is inactive, which in turn, calms down the frontal lobes

40
Q

What academic and workplace modifications can be used to help with ADHD?

A
  • Limited interruptions in the workplace
  • Modified exams
  • Access to class notes
  • Taping lectures
  • Extended testing time
  • Testing in isolated environment
  • Reasonable modifications of degree plans
41
Q

T/F: ADA is a protected diagnosis

A

True

42
Q

T/F: Workplace modifications are not practical to help with ADHD because they inconvenience the workplace

A

False (ideally).

Patients are entitled to reasonable request for modifications

Term 5: Behavioral Science (24 decks)

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