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Developmental Neuropsychology > ADHD > Flashcards

ADHD Flashcards

1
Q

What is the mean onset of ADHD?

A

3-7 years. Features usually apparent earlier in life but dx usually made when
comparisons to non-ADHD children are more obvious and normal toddler behavioural variability can be discounted

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2
Q

What conditions are highly comorbid with ADHD?

A

Conduct Disorder, Oppositional Defiant
Disorder, Learning Disorders, Anxiety & Mood Disorders

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3
Q

What is the aetiology of ADHD?

A

Underlying causes are mainly biological, with less influence from the environment. Genetics accounts for about 76% of variance

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4
Q

Which environmental influences have the most evidence as secondary influences on ADHD?

A

Consistent evidence:
- Prenatal tobacco exposure
- Prematurity and low birth weight
- Birth complications

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5
Q

Which environmental influences have inconsistent evidence as secondary influences on ADHD?

A
  • Zinc deficiency
  • Prenatal alcohol exposure
  • Refined sugar
  • Iron deficiency
  • Food additives (artificial colours, flavours, preservatives)
  • Deficiency in essential fatty acids
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6
Q

Which environmental influences have no empirical evidence as secondary influences on ADHD?

A

Food sensitivity (specific intolerance or allergy such as gluten or lactose)

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7
Q

What is the mechanism of action common ADHD drugs work on?

A

Amphetamines and methylphenidate (Ritalin) increase available dopamine and noradrenalin in cortico-striatal pathways that subserve executive function. Other transmitters like serotonin, acetylcholine, opioid and glutamate are also involved

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8
Q

What are the cortical structures involved in ADHD?

A

Dorsolateral prefrontal cortex: working memory

Ventromedial prefrontal cortex: complex decision making and strategic planning

Parietal cortex: orientation of attention

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9
Q

What are the subcortical structures involved in ADHD?

A
  • Ventral anterior cingulate cortex + dorsal anterior cingulate cortex: affective and cognitive components of exec control
  • Together with the basal ganglia (NAc, caudate, and putamen) they form the fronto-striatal circuit
  • Structural and functional abnormalities extend to amygdala and cerebellum in patient with ADHD
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10
Q

What two primary neurotransmitter systems are involved in ADHD?

A
  • Dopaminergic system: planning & initiating motor responses,
    activation, switching, reaction to novelty, processing reward
  • Noradrenergic system: influences arousal modulation,
    selecting goal-appropriate responses & suppressing
    inappropriate responses, selecting relevant from irrelevant stimuli
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11
Q

What two networks are dysregulated in ADHD?

A

Reward network and altering network

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12
Q

Explain oppositional defiant disorder

A

Is highly comorbid with ADHD (30-50%). Characterised by a recurrent pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness

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13
Q

Explain conduct disorder

A

Is highly comorbid with ADHD (25%). Characterised by repetitive and persistent pattern of behaviour in which the basic rights of others or major societal rules are violated. Associated with risk of sociopathic personality tendencies in adulthood.

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14
Q

What is the general prognosis of ADHD?

A

Between 1/3-2/3 of children with ADHD will continue to manifest symptoms in adulthood (consensus is approx 50%)

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15
Q

In terms of processing speed, is ADHD best characterised by:

A

Reaction time variability

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16
Q

What are the main impairments in attention in ADHD?

A
  • Sustained attention (both types)
  • Selective attention (especially inattentive type)
17
Q

What key areas of executive function are impacted in ADHD?

A
  • Reactive time variability
  • Monitoring/vigilance
  • Working memory
  • Response inhibition
18
Q

What might a general neuropsych profile of ADHD look like?

A

There is no ‘standard’ ADHD profile. Performance characterised by:
- High variability due to attention issues
- Difficulty with independent retrieval of information from memory
- Reasonable immediate recall, weaker delayed recall, intact recognition
- Immediate memory usually worse than recall after repeated presentations (e.g. list learning tasks)

19
Q

What is the utility of neuropsych assessments for ADHD?

A
  • Establish cognitive strengths and weaknesses
  • Establish baseline level cognitive functioning (useful to monitor cog development and track efficacy of interventions)
  • Standardised questionnaires aid with dx (less subjective than observation, comparison across settings and time)
  • Guide interventions (provide targeted interventions for school and home based on individual strengths and weaknesses)
20
Q

How might difficulties with working memory present in typical classroom tasks?

A
  • Carrying out multi-step activities (e.g. maths)
  • Following complex instructions
  • Keeping track of work
  • Remembering/following rules & routines
  • Reading comprehension
  • Decoding new words.
    WM is associated with academic performance
21
Q

What are some common social outcomes associated with ADHD?

A

Irrespective of age, gender, and comorbid disorders, people with ADHD are:
- Less well-liked, fewer dyad friendships
- Less than 1% rated as popular
- Social and academic problems contribute to low self-esteem

22
Q

What are some discredited treatments of ADHD?

A
  • Diet supplements with essential fatty acids
  • Chiropractic treatment
  • Behavioural optometry
  • Homeopathy
  • Acupuncture
  • Physical activity
  • Massage
  • Sensory integration therapies
  • EEG diagnosis/treatment
23
Q

Is neurofeedback an evidence-based treatment for ADHD

A

No, meta-analysis has failed to find support for it to be an effective treatment for ADHD. Shortcomings include small sample size, poor or no randomisation, over reliance on parental report (subjective), lack of follow up, and poor attempts at generalisation

24
Q

What are effective ADHD treatments for preschoolers (4-6 years)?

A
  • Parent training in behavioural management is recommended as a first measure
  • Stimulants in more severe cases (but not amphetamines)
25
Q

What are effective ADHD treatments for primary school (6-11 years)?

A
  • Combination of medication (stimulants) and behaviour therapy
  • Treatment must include school environment
26
Q

What are effective ADHD treatments for secondary school (12-18 years)?

A
  • Medication is most indicated, and behaviour therapy (preferably both)
27
Q

What are some interventions that can be implemented at school?

A
  • Small class size
  • Seat child new front/teacher
  • Consistent rules and expectations + rehearsing rules
  • Structure and routine
  • Remove distracting stimuli e.g. cluttered desk
  • Assistance to complete tasks on time (e.g. timer)
  • Novel and stimulating tasks
    These are less effective than stimulants in reducing core symptoms (decision speed, impulse inhibition, hyper motor activity)
28
Q

What are some interventions that can be implemented at home?

A
  • Establish a routine
  • Calm, consistent discipline strategies
  • Teaching parents to notice and praise and reward good behaviours
  • Reward system e.g. token economy, star chart
29
Q

What are some common side effects of stimulant medication?

A
  • Insomnia
  • Reduced appetite
  • Headaches and stomach aches (more transient)
  • Prone to crying
  • Tics (rare: 1-2%)
  • Mild-moderate weight loss associated with reduced appetite
  • Lower seizure threshold
30
Q

What are some common myths about stimulant medication/

A

Developmental Neuropsychology (8 decks)

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