ADHD Flashcards
ADHD symptoms
- Problems with concentration, such as making careless mistakes, difficulty remaining focused, and needing to be more focused.
- Avoid tasks that require sustained mental effort, such as reading a book or completing a long assignment, misplace items, and be messy.
- Children may fidget, run, or climb when not appropriate, interrupt conversations, or talk excessively about a single topic.
It’s important to note that while children may exhibit more physical symptoms like fidgeting, running, or climbing inappropriately, adults may present with more internal restlessness than physical impulsivity.
ADHD Assessment
- The nurse may notice high-level fidgeting activity in the child & behaviors.
- Teachers may notice difficulty paying attention, disruptive behavior, and inconsistent or messy assignments.
- School nurses may see students in their office repeatedly d/t disruptive behaviors and minor injuries for impulsive behaviors.
ADHD Diagnosis
–Teacher & School psychologists may recommend eval for dx.
–PCP may dx & tx uncomplicated ADHD.
- If symptoms worsen, a referral to a Psychiatric Nurse Practitioner or Child Psychiatrist is recommended.
- Questionnaires and the VANDERBILT ASSESSMENT SCALES are used to identify children with ADHD and measure treatment progress.
ADHD: Implementation
Interventions:
1. Behavior Modification therapy
2. Parent training
3. School accommodations
4. Pharmacologic agents that address Inattention & hyperactive & impulsive behaviors.
CNS Stimulants
- ^ The activity of CNS neurons
- Enhance neuronal excitation; a few suppress neuronal inhibition.
- In sufficient doses, all can cause seizures.
- Limited clinical applications.
CNS Stimulants (ADHD tx)
- Amphetamines
- Methylphenidate & Dexmethylphenidate
- Methylxanthines
- Miscellaneous stimulants
Amphetamines-mechanism of action
- Release norepinephrine
- Release dopamine
Amphetamines Pharmacologic effects
-CNS
-Cardiovascular system
Amphetamines Tolerance
With regular use, tolerance develops to elevation of mood, suppression of appetite, and stimulation of heart and blood vessels.
Amphetamines Physical dependence
Abstinence syndrome with abrupt withdrawal.
Amphetamine Abuse
High potential for abuse due to Euphoria.
Amphetamines Adverse effects
- CNS stimulation
- Wt loss
- Cardiovascular effects
- Psychosis
Amphetamines (Acute Toxicity)
-Dizziness
-confusion
- hallucinations
-paranoid delusions
-palpitations-
dysrhythmias
-HTN
-Death is rare
-Fatal overdose: Convulsions, coma, and cerebral hemorrhage
Amphetamine Treatment
Hallucinations: Chlorpromazine
HTN: Alpha adrenergic blocker(Phentolamine); Chlorpromazine helps lower BP
Seizures: Diazepam
Acidifying the urine can accelerate Amphetamine excretion.
Amphetamines (therapeutic uses)
ADHD
Narcolepsy
Methylphenidate (Ritalin, Metadate, Methylin, Concerta, Daytrana, Biphentin) tx for?
ADHD & Narcolepsy
ADHD symptoms arise from?
Symptoms arise in part from abnormalities in various circuits involving the prefrontal cortex.
Dorsolateral prefrontal cortex (ADHD)-matching symptoms to circuits
-Problems with sustained attention are linked to inefficient information processing in DLPFC.
-Inactivation of DLPFC can lead to difficulty following through or finishing tasks, disorganization, and trouble sustaining mental effort.
-Tests like n-back are used to measure sustained attention and problem-solving abilities. Participants look at a number on a screen and press a button to indicate the number. Higher n values are correlated with increased difficulty in the test.
Dorsal Anterior Cingulate Cortex (dACC) ADHD-matching symptoms to circuits
-Problems with selective attention are believed to be linked to inefficient information processing in dACC.
-Inefficient activation of dACC can result in symptoms such as paying little attention to detail, making careless mistakes, not listening, losing, being distracted, and forgetting things.
-Stroop task: An example test requires participants to name the color with which a word is written. If a blue name is written in orange, the color would be orange, not blue.
Prefrontal motor cortex (ADHD) matching symptoms to circuits
-The prefrontal motor cortex may modulate hyperactivity.
-Common symptoms of hyperactivity in children with ADHD include fidgeting, leaving one’s seat, running/climbing, being constantly on the go, and having trouble playing quietly.
The orbitofrontal cortex (ADHD)-matching symptoms to circuit
-Impulsivity may be modulated by the orbitofrontal cortex (OFC).
-Examples of impulsive symptoms in ADHD include talking excessively, blurting things out, not waiting one’s turn, and interrupting.
