adhd Flashcards
what is ADHD
attention deficit hyperactivity disorder (not a great definition)
NDD
lifelong condition - start in childhood, continue into adulthood
- people can be borderline (often seen in women) - first period and menopause can push it over the edge
becomes a condition when the deficit begins to impact your life
spectrum condition
what traits do people with ADHD show deficits in
- behavioural inhibition
- sustained attention
- resistance to distractions
- regulating attention level depending on the demand of the activity
what are the potential causes of ADHD
genetics
neurology
NOT environmental or social
how are genetics a cause of ADHD
75% of cases
genes that code certain development instructions are different than people without ADHD
- dopamine problems - DAT1 gene
how is neurology a cause of ADHD
20-25% of cases
- when something has caused the frontal lobe to not develop properly
ex: mother substance abuse, lead poisoning, toxin exposure, early TBI
what parts of executive functioning are impaired in ADHD (7)
(all inhibited to some degree in ADHD)
1. self awareness
2. inhibition
3. verbal working memory - voice in head telling you what to remember
4. visual working memory - gps of mind, being able to reactivate instructions and use them to get where you’re going / accomplish a goal
5. emotion regulation
6. self motivation - lack motivation to do things you don’t always like
7. planning - having a goal and being able to map out the path (big and small goals)
what are the three types of ADHD
- combined type
- impulsive / hyperactive type
- inattentive / distractible type
what is the impulsive / hyperactive type of ADHD
fidgeter
not able to control volume
talking excessively
get in face
interuptting
don’t wait their turn
what is the inattentive / distractible type of ADHD
not able to focus / easy to distract
forgetful
sensory sensitivities
careless mistakes when understimulated
trouble with organisation
losing and misplacing things
why are girls more likely to be diagnosed than boys
girls = more inattentive type, don’t cause trouble (fly under radar)
boys = more likely hyperactive and disruptive
what is ADHD paralysis
when they become so overwhelmed by environment / info / task that they freeze
- not because of lack of motivation
- inability of the frontal lobe to take info, process it, and start the task
- task avoidance
what is time blindness
hard to intrinsically tell time
- so entranced by something that the rest of the day falls apart
what are sleep challenges associated with ADHD
- challenges falling asleep but also bad sleep quality
- feeling tired even when you’ve had enough sleep
- insomnia is common
- stimulants (coffee) don’t have the same effect
what is the mortality for people with ADHD (when untreated)
- worse than other conditions (neuro and substance abuse)
- 5x more likely to die before the age of 45
- late diagnoses - increases risk for premature death
what are the relative rates of mental health conditions in people with ADHD
- higher rates of anxiety disorder in kids and adults (higher in adults)
- increased rates of depression in kids with ADHD and peaks in high school and then tapers
(most adults will get diagnosed with all 3 (ADHD, GAD, depression))
ADHD itself doesn’t kill you, what does?
- higher rates of violence, crime, substance use, accidents, risky behaviours
- most common cause of death is accidents due to risky behaviour
- high rates of suicide (impulsive without rational descions, unable to regulate emotions)
when is the median age of diagnosis in kids
~6
(anywhere from 4-13 is common)
(no stats on adults)
what are the DSM V diagnostic criteria
6+ symptoms in kids (parent or teacher reported)
5+ symptoms in adults and adolescents
- need to be dealing with them for at least 6 months and be developmentally inappropriate
- symptoms present in 2 or more settings in the person’s life
what is the ASRS (adult ADHD self report scale)
4 or more greyed out section checked = high chance of ADHD
- higher score = more likely to have ADHD
what do kids ADHD assessments involve
- parent and child interviews (psych)
- patient history
- child behaviour rating scales (parent and teacher)
- screening tools
why is ADHD misdiagnosed
GP not qualified (need psych consult)
can display as other conditions - symptoms can co-occur
what are the 3 lines of pharma treatment available
- Stimulants
- non stimulants - norepi
- both above target NTs - hypertensive drugs - BP medication - targets alpha 2 receptors
what do you need to look for in order to get pharma treatment
persons urgency
- how soon do they need it to work
- comorbid conditions
- symptoms (very unregulated = third line)
does everyone need medication
no
- ADHD is variable
- if someone is able to put practises in place to manage then they don’t need meds
what are stimulants
- works right away (no buildup time)
- floods brain with dopamine to support symptoms
- low potential for addiction
- wears off - degrades throughout the day
vyvanse, adderall, ritalin
what are non stimulants
- takes 6 weeks to work (need to build up slowly to see benefits)
- no addiction
- lasts longer
- mood regulators (don’t let you feel full range of emotions)
- prevent degradation of dopamine in brain
- symptoms if you forget to take them are rough
- take if you can’t take stimulants / anxiety
effexor, strattera
what is the difference between vyvnase and adderall
vyvanse
- not addictive
- lead up time (longer to absorb)
adderall
- can be addictive
- feel it right away
both
- flood brain with dopamine
- can be prescribed to kids
what are the side effects of ADHD meds
- dry mouth (most common)
- decreased appetite - esp with vyvanse
- rapid HR - esp when first starting (careful with exercise) - can also increase anxiety
- sweaty / difficulty regulating temp
- sleep issues - has to do with when you take meds
what are the levels of scientific evidence
best - systematic / meta analysis
RCT
non randomised control trials
observational studies
worst - qual studies
what is CBT (cognitive behavioural therapy)
focus on thought and change the way you think / approach that thought
- best - lots of support that it improves symptoms
RCT and meta analysis level evidence
does mindfulness work for ADHD
has RCT level evidence
has to be continuous throughout the day
does neurofeedback work for ADHD
helps to stimulate parts of the brain that are inactive (frontal lobe mainly in NDDs)
has RCT level evidence
can diet alone improve symptoms
no scientific evidence for this
