ADHD Flashcards
what is Attention Deficit Hyperactivity Disorder
“persistent pattern of inattention or hyperactivity—impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development”
Starts in early childhood (<7 years old)
Prevalence: 2-10% of children
Higher incidence in boys than girls
what is the diagnosis of adhd
Diagnosis is done through assessment of information collected from parent and school and the young person themselves if old enough (e.g. Conner’s Comprehensive Behavior Rating Scalesassesment)
Computerised testing of core symptoms is also possible hyperactivity, impulsivity and inattention/distractibility (e.g. QbTest)
what is the Pathophysiology of adhd
INHIBITION
Inhibition of prepotent or dominant response
Interrupt ongoing behaviour
Interference control
Frontoparietal circuits
Dorsal frontal parietal circuits
Mesocorticolimbic circuits
what are the genetic and environmental factors effecting adhd
Genetic dysfunction in ADHD: dopamine transporter, D4 receptor, dopamine beta-hydroxylase, MAOA, catecholamine-methyl transferase, SLC6A4, 5-HT2A, 5HT1B, DAT1 gene, DRD4 gene
Environmental/Social factors
E.g. Lead exposure, smoking/alcohol in pregnancy
what is the treatment of adhd
Stimulant drugs - ADHD children require more stimulation to maintain attention.
Methylphenidate (Ritalin)
Dexamfetamine (Dexedrine)
Atomoxetine (Strattera)
Different formats
Where there may be concern about the potential for drug misuse and diversion (for example, in prison services), atomoxetine may be considered as the first‑line drug treatment for ADHD in adults
For adults with ADHD and drug or alcohol addiction disorders there should be close liaison between the professional treating the person’s ADHD and an addiction specialist
Antipsychotics are not recommended for the treatment of ADHD in adults. [2008]
what are not recommended for treatment for adhd in adults
Antipsychotics are not recommended for the treatment of ADHD in adults. [2008]
what is the moa of Methylphenidate
class: CNS stimulant
Mechanism of action: Norepinephrine–dopamine reuptake inhibitor
SUMMARY TREATMENT
treatment in children
1.5.2.1Drug treatment is not indicated as the first‑line treatment for all school‑age children and young people with ADHD. It should be reserved for those with severe symptoms and impairment or for those with moderate levels of impairment who have refused non‑drug interventions, or whose symptoms have not responded sufficiently to parent‑training/education programs or group psychological treatment.
Moderate levels of impairment: psychological interventions
SUMMARY TREATMENT
treatment in adults
Drug treatment is the first‑line treatment for adults with ADHD with either moderate or severe levels of impairment.
Methylphenidate is the first‑line drug. Psychological interventions without medication may be effective for some adults with moderate impairment, but there are insufficient data to support this recommendation. If methylphenidate is ineffective or unacceptable, atomoxetine or dexamfetamine can be tried.
If there is residual impairment despite some benefit from drug treatment, or there is no response to drug treatment, CBT may be considered. There is the potential for drug misuse and diversion in adults with ADHD, especially in some settings, such as prison, although there is no strong evidence that this is a significant problem.
summary
Is it a legitimate disorder or a manifestation of the way in which children are brought up is/has changed?
Dietary interventions (additives etc.); mostly disregarded now
UK studies of offenders have indicated around 45% of youths and 24% of male adults screen positive for a childhood history of ADHD, 14% of whom have persisting symptoms in adulthood
8% of professional baseball players in the US have ADHD
It requires a clinical diagnosis for which
there is not overall objective test
Diagnostic criteria frequently change
There is no curative treatment
Therapy often includes stimulant drugs with abuse potential
Rates of diagnosis and of treatment substantially differ across countries
what are the symptoms
inattention - attention time span
hyperactivity and impulsity - figet, talk a lot , trouble waiting
