7a. ADHD Flashcards
What is the definition for ADHD?
And what is the diagnostic cutoff for <17 year olds, and 17 year olds and older?
Age-inappropriate levels of inattention on the one hand and hyperactivity/impulsivity on the other hand
The diagnostic cutoff is 6 symptoms for <17 years of age and 5 symptoms for aged 17 and higher
What are symptoms of the inattentive presentation? (9x)
a. Often has poor attention to details/many careless mistakes
b. Often has trouble keeping attention on tasks/play activities
c. Often does not seem to listen
d. Often does not follow instructions and fails to finish
e. Often has trouble organizing activities.
f. Often avoids, dislikes, or refuses task taking a lot of mental
effort for a long period of time
g. Often loses things needed
h. Easily distracted
i. Often forgetful
What are symptoms of the hyperactivity/impulsive presentation? (9x)
a. Often fidgets or squirms in seat
b. Often gets up from seat where this is not expected
c. Often runs about/climbs (adolescents or adults: restless
feelings)
d. Often has trouble playing quietly
e. Often acts “on the go” or as if “driven by a motor”
f. Often talks excessively
g. Often blurts out answers before the question has ended
h. Often has trouble waiting one’s turn
i. Often interrupts or intrudes on conversation/activities
What are some other (important) criteria? (4x)
1) Some symptoms present <12yrs
2) Impairment present in 2 or more settings
3) Evidence of significant impairment in functioning
4) The symptoms are not better accounted for by another mental
disorder (mood/anxiety-, dissociative- or personality disorder)
Which presentation is the most prevalent, and which one the least prevalent presentation?
And which presentation is more common in boys and which one in girls?
ADHD-C is the most prevalent presentation, followed by ADHD-IN, with ADHD-HI being the least prevalent presentation (because in these children you often see inattentive problems as well)
ADHD-C and ADHD-HI are more common in boys, while ADHD-IN is a little bit more common in girls (maybe that’s why we see less girls with ADHD in clinical practice, because a dreamy girl is more acceptable than a disruptive boy).
What is the worldwide prevalence of ADHD?
And the distribution boys/girls?
How much of the children with ADHD is classified with only ADHD?
5%
4:1
1/3
What are 5 comorbidities of ADHD?
- Oppositional Defiant Disorder (ODD): pervasive, impairing oppositional behavior & tantrums, rule refusal, angry, spiteful, vengeful.
- Conduct Disorder: in a sense “severe ODD”; actual rule breaking, bullying, aggression to people/animals, destruction of property, theft.
- Anxiety Disorders: may be reactive because of academic and psychosocial problems; withdrawn, shy, fear of failure.
- Learning Disorders: particularly dyslexia
- Motor coordination problems
What are the percentages of persistance across adolescence and adulthood for:
- The full diagnostic criteria
- Functional impairment
- Impairing symptoms
- Full diagnostic criteria: 50% in adolescence and 15% in adulthood, which is quite a big decrease.
- Functional impairment: 75% in adolescence and 65% in adulthood.
- Impairing symptoms: inattention persists into adolescence and adulthood, and hyperactive/impulsive symptoms decline from childhood to adulthood.
What is the genetic contribution to variance in the population in ADHD symptoms? And explain where we have to deal with
70-80%
This seems a lot, but we have to deal with the “missing heritability” problem –> it is very difficult to find genes that may account for the high heritability
Why is it very difficult to find genes that may account for the high heritability of ADHD? (4x)
And how is this phenomena called?
Missing heritability problem
- They are genetically complex traits: not a few genes with large effects, but many genes with a small effect.
- ADHD is the extreme of a normal trait: the genetic effects associated with it are “complex cocktails” that are not easy to detect.
- There are a myriad of gene-x-gene and gene-x-environmental interactions.
- Neurobiological heterogeneity: there are multiple routes from gene to brain to behavior.
What are environmental factors for ADHD? (5x)
And which one is the hugest one?
The hugest one is: the environment of living with a parent with ADHD
- Maternal prenatal substance use: might be explained by gene-environment correlation, rather than exposure itself, since people with ADHD tend to smoke more, so if your mother also carries genes for ADHD, that might be associated with her having an increased risk of smoking during pregnancy. So what part is the genetic effect and what part is the effect of cigarette use?
- Exposure to toxins: e.g. pesticides, lead, PCBs.
- Diet: controversial –> some evidence that diet, including food colorants and poly-un-saturated fatty acids may have a small effect. Also, it is well known that people with ADHD tend to eat less healthy, but is this a cause or a consequence? Because impulsivity has a strong effect on for example binge eating.
- Media use and video gaming: these effects may also be bidirectional, because video gaming is a nice environment to be in for someone with ADHD (easier to be attentive). This is also associated with other family factors (some families watch a lot more tv and play more video games).
- Family adversity/social factors: low SES, family conflict, large family size, parental mental disorders.
What is:
- Gene-environment interaction?
- Passive gene-environment correlation?
- Evocative (reactive) gene-environment correlation?
- When 2 different genotypes respond to environmental variation in different ways an example for this is that psychosocial adversity interacts with risk genotype in producing hyperactive/impulsive behavior.
- Refers to the association between the genotype a child inherits from his parents and the environment in which the child is raised –> there is a genetic overlap between ADHD in the parent and ADHD in the child AND parenting skills will be less developed in ADHD parent. So less effective parenting skills AND genetic variance contribute to ADHD problems of the child.
- Refers to the association between an individual’s genetically influenced behavior and others’ reactions to that behavior –> having a child with ADHD increases parenting stress –> this increases negative parenting strategies –> this increases ADHD in the child.
Which areas may have a smaller average in brain volumes in ADHD? (7x)
And which areas may have a reduced thickness? (3x)
Brain volume:
- Total Cerebral Volume
- Splenium
- Cerebellum
- Caudate Nucleus
- (Pre)frontal lobes
- Anterior cingulate
- Medial temporal
Thickness:
- Dorsolateral prefrontal cortex (inhibition, EF)
- Ventromedial prefrontal cortex (EF, emotional processing, reward)
- Parietal cortex (spatial attention)
