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TAS Development ✅ > ADHD ✅ > Flashcards

ADHD ✅ Flashcards

1
Q

What does ADHD consist of?

A
  • Hyperactivity
  • Impulsivity
  • Inattention
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2
Q

What is the prevalence of ADHD amongst school-age children?

A

Depending on diagnostic criteria, ranges from 1-2% to 3-9%

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3
Q

How does the prevalence of ADHD compare between boys and girls?

A

3x more common in boys

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4
Q

What are the risk factors associated with ADHD?

A
  • Preterm birth or low birth weight
  • Maternal illicit drug use, alcohol use, or smoking during pregnancy
  • Close family history of ADHD
  • History of traumatic brain injury
  • Exposure to some environmental toxins
  • Psychosocial adversity
  • High levels of family conflict
  • Syndromic associations
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5
Q

What environmental toxin is ADHD particularly associated with?

A

Lead

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6
Q

Give an example of a syndromic association of ADHD?

A

Neurofibromatosis type 1

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7
Q

What illustrates a genetic element of ADHD?

A

Twin studies, adoption studies, and sibling studies have been carried out and there is a strong condorance between close family history of ADHD and risk of developing the disorder

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8
Q

Has a particular gene locus for ADHD been identified?

A

No

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9
Q

What pathophysiological mechanisms have been proposed in ADHD?

A
  • Alterations in neural networks
  • Frontal lobe dysfunction
  • Differences in dopaminergic pathways
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10
Q

What evidence is there that alterations in neural networks lead to symptoms of ADHD?

A

Imaging studies have suggested that a number of regions of the brain may contribute to the clinical manifestations of ADHD

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11
Q

What regions of the brain have imaging studies shown may contribute to the clinical manifestations of ADHD?

A
  • Frontal and parietal cortex
  • Basal ganglia
  • Cerebellum
  • Hippocampus
  • Corpus callosum
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12
Q

What evidence is there that ADHD is due to frontal lobe dysfunction?

A
  • Reduction in brain volume particularly marked in pre-frontal cortex
  • Pathwys connecting pre-frontal cortex and striatum shown to differ in children with ADHD
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13
Q

What evidence is there that there are differences in dopaminergic pathways in the brains of children with ADHD?

A

Stimulant medications used in the management of ADHD increase dopamine levels in the brain and produce symptomatic improvement

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14
Q

What is the limitation of the hypothesis that there are differences in dopaminergic pathways in brains of children with ADHD?

A

Complex interactions of neurotransmitters in the brain and non-specific mechansims of action of stimulant medication make it difficult to conclude that dysfunction of dopaminergic pathways is the sole aetiological factor of ADHD

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15
Q

What are the options for management in ADHD?

A
  • Behavioural management

- Medications

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16
Q

What are the options for behavioural management in ADHD?

A
  • Parenting support groups and courses
  • Extra support in school
  • CBT
  • Social skills training
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17
Q

What needs to be ensured regarding the school in the management of ADHD?

A
  • School is aware of diagnosis

- Appropriate strategies put in place for managing child within school environment

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18
Q

When is medication commenced in ADHD?

A

ADHD causing severe impairment to daily activities and learning

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19
Q

What needs to be done prior to medicating for ADHD?

A
  • Full mental health and social assessment

- Physical examination

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20
Q

What does the physical examination prior to starting on medication for ADHD need to include?

A
  • Assessment of cardiovascular risk factors
  • Height
  • Weight
  • Heart rate
  • Blood pressure
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21
Q

When is an ECG required prior to starting on medication for ADHD?

A

If significant personal or family history of cardiac disease

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22
Q

What are the main drugs of choice for ADHD?

A
  • Methylphenidate
  • Atomoxetine
  • Dexamphetamine
  • Clonidine
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23
Q

What preperations of methylphenidate can be dispended?

A
  • Immediate release
  • Sustained release
  • Extended release
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24
Q

What is the first line drug in ADHD?

A

Methylphenidate

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25
Q

What kind of drug is methylphenidate?

A

Dopamine reuptake inhibitor

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26
Q

What is the mechanism of action of methylphenidate?

A

Blocks dopamine transporter and norepinephrine transporter centrally, which leads to inceased concentrations of dopamine and norepinephrine in the synaptic cleft

27
Q

Is methylphenidate well tolerated?

A

Generally yes

28
Q

What are the main side effects of methylphenidate?

A

Can affect sleep and appetite

29
Q

What route is methylphenidate given?

A

Oral

30
Q

What is the peak action of immediate release methylphenidate?

A

2-4 hours

31
Q

What is the peak action for sustained release methylphenidate?

A

Extended release

32
Q

What is the peak action for extended release methylphenidate?

A

8-12 hours

33
Q

What is the half life of methylphenidate?

A

2-3 hours (depending on individual)

34
Q

When must dosing of methylphenidate begin?

A

Morning

35
Q

What is the dose of methylphenidate tailored to do?

A

Control symptoms during the day

36
Q

What is the second line drug in ADHD?

A

Atomoxetine

37
Q

How does the effect of atomoxetine compared to methylphenidate?

A

It has a slightly smaller effect size

38
Q

When is atomoxetine useful?

A
  • Risk of stimulant diversion by the family
  • Co-morbid tic disorder/Tourette’s syndrome
  • Anxiety disorder
  • History of stimulant misuse
39
Q

What are the advantages of atomoxetine over methylphenidate in terms of side effects?

A

Doesn’t affect sleep or appetite as much

40
Q

What are the main side effects of atomoxetine?

A
  • Liver problems

- Suicidal thoughts

41
Q

What is the mechansim of action of atomoxetine?

A

Acts primarily on the norepinephrine pathway

42
Q

How does the duration of action of atomoxetine compare to methylphenidate?

A

Atomoxetine is a longer term agent, altering the neuroendocrine environment of the brain over weeks

43
Q

What is the implication of atomoxetine altering the environment of the brain over weeks?

A
  • Takes lonegr to work

- Does not really matter when during the day it is taken

44
Q

When is dexamphetamine used in ADHD?

A

When methylphenidate and atomoxetine have not be tolerated

45
Q

What is dexamphetamine?

A

A stereoisomer of amphetamine

46
Q

What kind of drugs are amphetamines?

A

Sympathomimetic agents

47
Q

What is the mechanism of action of dexamphetamime?

A

Causes release and blocks reuptake of noradrenaline and dopamine from central neurons

48
Q

When is clonidine considered in ADHD?

A
  • Unable to tolerate usual medications

- Tic disorders

49
Q

What is the mechanism of action of clonidine?

A

Centrally acting alpha2 adreneric agonist and imidazoline agonist

50
Q

What new treatments for ADHD are under investigation?

A

Guanfacine hydrochloride

51
Q

What is the mechanism of action of guanfacine hydrochloride?

A

Non-stimulant selective alpha2A adrenergic receptor agonist

52
Q

How should the dose of ADHD medications be determined?

A

Slowly titrated upwards until no further improvement in symptoms, or sooner if side effects troublesome

53
Q

How long should the dose titration take for methylphenidate and atomoxetine in ADHD?

A

4-6 weeks

54
Q

What should happen in all children taking medication for ADHD?

A

Should be reviewed regularly

55
Q

What side effects should be assessed for when reviewing methylphenidate in ADHD?

A
  • Weight loss and poor appetite
  • Raised blood pressure
  • Sleep difficulties
56
Q

What side effects should be assessed for when reviewing atomoxetine in ADHD?

A

Changes in behaviour, including self-harming and suicidal ideation

57
Q

What should be considered regularly for all medications for ADHD?C

A
  • Ongoing effectiveness

- Suitability of the medication

58
Q

What co-morbidities often occur with ADHD?

A
  • Developmental coordination disorder
  • ASD
  • Learning disabilities
  • Tourette’s syndrome and tic disorders
  • Oppositional defiant disorder and conduct disorder
  • Mood disorders
  • Anxiety disorders
  • OCD
  • Substance misuse
  • Restless legs syndrome
  • Sleep disorders
  • Auditory processing disorders
  • Language delay
  • Persistent bed wetting
59
Q

What % of children with ADHD have learning disabilities?

A

20-30%

60
Q

What % of children with ADHD have oppositional defiant disorder?

A

50%

61
Q

What % of children with ADHD have conduct disorder?

A

20%

62
Q

What can oppositioanal defiant disorder (ODD) and conduct disorder (CD) lead onto inadulthood?

A

Antisocial personality disorder

63
Q

What % of children with ADHD and ODD or CD go on to develop antisocial personality disorder?

A

50%

64
Q

Which mood disorders in particular are common in ADHD?

A
  • Bipolar affective disorder

- Major depressive disorders

TAS Development ✅ (21 decks)

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