ADHD Flashcards
What is the triad of difficulties in ADHD?
inattention
hyperactivity
impulsivity
What does the triad of difficulties in ADHD usually co-occur with?
other impairing symptoms relating to self-regulation e.g. executive functioning, emotional regulation
How does adult ADHD differ from typical ADHD in children/.
less obvious symptoms of hyperactivity or impulsivity and more inattentive symptoms
What is the prevalence estimate of ADHD worldwide and is it thought to be over/under diagnosed?
approx. 5% and remains underdiagnosed and undertreated
Why do they think adults who present when older no longer meet diagnostic criteria for adhd?
Possibly because there is improvement in cortical thickness that allows the brain to compensate for cognitive deficits
What factors increase risk of ADHD?
Genetic predisposition (biggest precursor but may be turned on by one or more psychosocial factors)
perinatal precipitants
psychosocial adversity
together these may cause neuroanatomical brain changes leading to adhd features
What genes are thought to be involved in ADHD?
serotonin and dopamine transporter genes
What are the approx. percentages of risk of ADHD when parent has it and when sibling has it?
parent - 60%
sibling - 15%
List some perinatal factors in ADHD?
smoking and alcohol during pregnancy
prematurity
perinatal hypoxia
delivery problems
List some examples of psychosocial adversity that can increase risk of ADHD.
marital problems
low social class
large family size
emotional trauma
What does the typical brainmap pattern show in children with ADHD?
Underactive function in the frontal lobe
What is the neurochemistry of ADHD?
Excessively efficient dopamine-removal system (higher concentration of dopamine transporters)
Reduction of norepinephrine (can affect attention when acting as stress hormone)
Reduction of serotonin
What are the diagnostic criteria for child ADHD?
6 or more symptoms of inattentiveness
6 or more symptoms of hyperactivity & impulsiveness
Present before age 5
Reported by parents, school & seen in clinic
Symptoms affect daily life
What are the diagnostic criteria for adult ADHD?
5 or more of symptoms of inattentiveness
5 or more of symptoms of hyperactivity and impulsiveness
historical concerns since young age
affects different areas of life
What are the psychosocial interventions for mild, moderate and severe ADHD in children?
parent training social skills training sleep & diet behavioural classroom management strategies educational interventions
What are the psychosocial interventions for mild, moderate and severe ADHD in children?
parent training social skills training sleep & diet behavioural classroom management strategies educational interventions
What are the 1st line pharmacological treatments for moderate to severe ADHD?
1st line: stimulants - methylphenidate, dexamfetamine, lisdexamfetamine
What are the 2nd line pharmacological treatments for moderate to severe ADHD?
2nd line: SNRI - atomoxetine
What are the 3rd line pharmacological treatments for moderate to severe ADHD?
3rd line: alpha agonist - clonidine, guanfacine
What are the 1st line pharmacological treatments for moderate to severe ADHD?
4th line: antidepressants - imipramine or antipsychotics = risperidone
What are the mechanisms of action of methylphenidate and dexamphetamine?
Methylphenidate: blocks dopamine transporter so increases dopamine by decreasing dopamine reuptake
Dexamphetamine: as above but also increases norepinephrine and serotonin
What is the mechanism of action of SNRIs in ADHD?
Increase norepinephrine by blocking its transporter
What is the mechanism of action of alpha agonists in ADHD?
Reduce sympathetic stimulation
ADHD is almost as common in adults as it is in children. True/false
True
