ADHD Flashcards
Cardinal features of ADHD
Hyperactivity
Impulsivity
Inattention
Age at which symptoms should be present for a diagnosis of ADHD in DSM V
12
Age at which symptoms should be present for a diagnosis of ADHD in DSM V
12
Change for DSM V regarding ADHD and ASD in combination
Comorbid diagnosis now allowed
Questionnaire used to get information for teachers to investigate ADHD symptoms
Connor’s questionnaire
Number of settings symptoms must be present in for a diagnosis of ADHD
2 or more
Length of time ADHD symptoms should persist before a diagnosis
6 months
Prevalence of ADHD in UK school aged children by DSM IV criteria
3-4%
Prevalence of ADHD in school aged children by ICD 10 criteria
1-2%
Rate of ADHD in boys compared to girls
3:1
Increased risk of ADHD with an affected sibling
2-3x higher
Heritability of ADHD
80%
Concordance of ADHD in monozygotic twins
79%
Concordance of ADHD in dizygotic twins
32%
Genes associated with ADHD
Dopamine transporter gene (DAT1)
Dopamine D4 receptor gene
SNAP-25
Functional imaging findings in children with ADHD
Lower cerebral blood flow to frontal areas
In teenage girls - globally lower glucose metabolism
Neurotransmitters involved in ADHD
Dopamine and noradrenaline dysregulation in the prefrontal cortex
Potential environmental factors involved in ADHD
Obstetric complications
Low birth weight
Prematurity
Prenatal exposure to alcohol, nicotine, and benzodiazepines
Poor attachment
Early deprivation
Living in an institution
Percentage of children with ADHD who have comorbid conduct disorder
14%
Percentage of children with ADHD who have comorbid oppositional defiant disorder
40%
Percentage of children with ADHD who have comorbid anxiety disorder
34%
Percentage of children with ADHD who have comorbid tics
11%
Percentage of children with ADHD who have comorbid mood disorder
6%
Percentage of children with ADHD who meet diagnostic criteria in adulthood
50%
Percentage of children with ADHD who develop substance misuse problems as adults
15-20%
Mechanism of action of stimulant treatments of ADHD
Release noradrenaline, dopamine and serotonin
Increase extracellular dopamine which inhibits impulses
Reason for withdrawal of pimoline for ADHD treatment
Abnormal LFTs
Occasionally liver failure
Most rapid stimulant ADHD treatment
Methylphenidate
Daily dose range of methylphenidate
5-60mg daily
Mechanism of action of atomoxetine
Noradrenaline reuptake inhibitor
Increases noradrenaline in the synaptic cleft
Monitoring required for methylphenidate and atomoxetine
Height
Weight
BP
HR
3 monthly then 6 monthly
For atomoxetine - LFT monitoring recommended
Relationship between ADHD medications and tics
Methylphenidate can cause tics; atomoxetine does not
Adverse effects of methylphenidate
Decreased appetite and weight loss
Growth slowing for first 2 years
Sleep disturbance
Cramps
Headaches
BP and pulse increase
Emotional blunting
Tics
Depression
Hallucinations
Adverse effects of atomoxetine
Decreased appetite and weight loss
Mild growth slowing
GI symptoms
Fatigue
Dizziness
Medications which may improve ADHD symptoms other than stimulants or atomoxetine
TCA
Alpha 2 agonists
Antipsychotics
Benefits of using TCAs for ADHD
Treats comorbid depression and anxiety
May be useful for stimulant non-responders
Monitoring required for TCA treatment of ADHD
ECG
Adverse effects of TCAs used to treat ADHD
Sedation
Changes in BP (up or down)
Dizziness
Dry mouth
Heart block
Benefits of alpha 2 agonists to treat ADHD
Treat comorbid tic disorder or aggression
Useful for those who are over-aroused
Can be useful for stimulant non-responders
Adverse effects of alpha 2 agonists used to treat ADHD
Delayed response
Sedation
Postural hypotension
Dry mouth
Hallucinations
Hypertensive rebound if doses missed
Male:female ratio of ADHD
4:1
Environmental risk factors for ADHD
Prematurity
Maternal alcohol use during pregnancy
Maternal smoking during pregnancy
Head injury
First line medication for a child with ADHD and a congenital heart condition
Atomoxetine
Symptoms most likely to resolve first in childhood ADHD
Hyperactivity
Percentage of children with ADHD who have comorbid ASD
59%
Percentage of children with ADHD who have specific learning disorders
70%
Class of medication which can be used for ADHD with comorbid depression/anxiety
TCA
Length of time a trial of methylphenidate or lisdexamphetamine should last
6 weeks
Percentage of children who have ADHD
5-7%
Percentage of adults who have ADHD
2.5-3.5%
ADHD medication which should be avoided if there is hepatic impairment
Atomoxetine
Medication suggested for ADHD with comorbid tics
Alpha 2 adrenergic agonist e.g. clonidine
First line medication for adult ADHD
Methylphenidate
Neural pathway implicated in ADHD
Frontostriatal
First line treatment for ADHD if there are substance misuse concerns
Atomoxetine
Second line treatment for ADHD if there are substance misuse concerns and atomoxetine is not suitable
Modified release methylphenidate e.g. Medikinet XL