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ABCN Clinical Neuropsychology > ADHD > Flashcards

ADHD Flashcards

1
Q

Prevalence rate of ADHD

A

10% of United States children ages 4 to 17 years.

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2
Q

Male to female ratio

A

2 to 1

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3
Q

Incidence rates of ADHD increase with…?

A

Age

ADHD among 10- to 17-year-olds being almost twice as high as rates of ADHD in children 5 to 9 years of age.

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4
Q

ADHD diagnosis is associated with

A
  • children of families whose incomes are closer to the poverty level
  • in single-parent households
  • in those having Medicaid as opposed to private insurance or no insurance.
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5
Q

ADHD symptoms must be present by age…

A

12 years

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6
Q

Older adolescents and adults must have at least ?? of nine symptoms in each symptom category.

A

5 (for ages 17 years and older)

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7
Q

Pathophysiology of ADHD

A
  • under activation in frontocortical and frontosubcortical networks
  • basal ganglia (particularly anterior caudate nucleus) abnormalities are the most consistent finding
  • abnormal cortical maturation (or delayed maturating) within the frontal and temporal lobes

*deficits in a distributed neural network that included frontal cortex and striatal-thalamic-cerebellar connections.

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8
Q

Heritability of ADHD

A

30–35% of first-degree relatives of children with ADHD also have the disorder, for a relative risk of 6 to 8 times that of the general population.

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9
Q

Environmental risk factors for ADHD

A
  • prematurity
  • birth complications
  • maternal smoking
  • lead exposure/toxicity
  • moderate to severe traumatic brain injury.
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10
Q

Medication for ADHD

A
  • Psychostimulant medications are the first-line psychopharmacological treatment (70–90% of patients benefit). They increase dopamine & norepinephrine levels.
  • Non-stimulant medication is second line, not as effective as stimulants. They increase norepinephrine levels.
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11
Q

ADHD in adulthood

A

primary symptoms persist into adulthood for as many as 85% of individuals.

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12
Q

Dyslexia comorbidity with ADHD

A

25-40%

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13
Q

What accounts for the comorbidity of ADHD and dyslexia?

A

processing speed is the cognitive endophenotype that best accounts for the phenotypic covariance among the two disorders.

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14
Q

Treatment of ADHD symptoms with stimulants in children with epilepsy is:

A

effective, but carries increased (small) risk of seizure exacerbation in some children

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15
Q

Describe the results of the multimodal treatment study of children with ADHD

A

There was a large effect seen for medication treatment, for which the addition of behavioral therapy produced no significant added benefit. However, with regard to nonsymptom areas (e.g., social skills), there was added benefit noted with the behavioral therapy intervention.

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16
Q

Describe heritability of ADHD

A

70-80% in twin studies and 5-10x increased risk if 1st degree relative has ADHD

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17
Q

Components of sluggish cognitive tempo (SCT) not included in ADHD inattentive presentation diagnosis:

A

lethargy/excessive sleepiness

underactivity

slowness

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18
Q

Percent of children with ADHD that have comorbid SLDs:

A

40%

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19
Q

Which subtype of ADHD is more heritable?

A

Inattentive > hyperactivity

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20
Q

Describe research on methylphenidate treatment of ADHD in preschools versus older children.

A

There was a larger effect size among older children than preschoolers but both produced improvements in symptoms. Side effects (e.g., slowed growth rate) were observed in younger children, which led to physicians recommending behavior therapy first in preschool children.

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21
Q

True or false: ADHD occurs more often with comorbid conditions than without.

A

True

22
Q

How often are boys diagnosed with ADHD compared to girls?

A

Twice as often
(12% vs. 6% prevalence rates) with this being true for younger ages.

Rates are attributed to differential manifestations of ADHD sxs by gender

23
Q

What are the limitations to the DSM-5 Diagnostic criteria of ADHD?

A

Lower stability than is optimal for ADHD subtypes at the individual level over time (ADHD-C then reverting to ADHD-I).

Continued debate in the literature regarding validity of ADHD-H.

Differences in clinical decision making between professionals (e.g., some relying more on scales while other on interview).

Longitudinal stability of a diagnosis is affected by the cut off (5 or 6) when the underlying symptom dimension is continuous.

Cutoffs are applied equally across gender despite the literature suggesting gender differences in manifestations.

DSM-5 criteria do not reflect recent theories of EF (e.g., response inhibition, self-regulation, motivation).

24
Q

Sluggish Cognitive Tempo and ADHD-I

A

ADHD-I maybe associated with different inattentive behaviors.

SCT characterized by:
- difficult sustained attention
- daydreaming
-lethargy
- mental confusion (“mental fogginess”).
- low motivation/initiation
- physical underactivity
- slowed movement
- decreased responsiveness

25
Q

What do twin studies show regarding the heritability estimates of ADHD?

A

70-80% in both children and adults with little or no evidence that environmental risk factors shared by siblings impact etiology.

26
Q

What do molecular genetic studies show regarding ADHD?

A

Candidate gene approach has targeted the DAT1 transporter – found polymorphisms in functional genes affecting both DA and serotonin pathway.

27
Q

Genome-wide linkage

A

Small effect size on chromosomes 5, 6, 10, 12, and 16.

28
Q

What is the role of comorbidity in ADHD expression?

A

Studies have found comorbidity –> marker for more severe manifestation of the disorder.

29
Q

What is the relationship between dyslexia and ADHD?

A

Functional impairment.

Higher risk of:
- being retained in school
- legal difficulties
- academic, social, and occupational impairment

30
Q

What is the relationship between ODD, CD and ADHD?

A

More impaired psychosocial outcomes, including higher risk of legal difficulties and antisocial behavior.

31
Q

Associated Medical Conditions with ADHD

A

thyroid dysfunction
bipolar disorder
ASD
Klinefelter syndrome and its variants
neurofibromatosis and other genetic conditions
moderate to severe brain injury
stroke
epilepsy
sleep disorders
lead toxicity

32
Q

Psychiatric and development conditions co-occuring with ADHD

A

OCD
Tourette syndrome
developmental coordination dx
developmental dyspraxia
dyslexia
speech-sound dx
language disorder
ODD
CD
Depression
Anxiety

33
Q

What discrete executive functions were associated with outcomes?

A

Working memory predicted math

Cognitive inhibition predicted attention ratings.

34
Q

Common assessment methods for ADHD

A

Clinical interview
Behavior rating scales (e.g., Child Behavior Checklist, Conners Comprehensive Behavior Rating Scales, ADHD Rating Scale).

NOTE: Concerns about the sensitivity, specificity, positive and negative predictive power of specific NP tests.

35
Q

Expected Neuropsychological Assessment Results

A

Intelligence:
1. FSIQ tends to be about 1/2 SD below the mean
2. Differences are observed in verbal and nonverbal reasoning, PS, and WM

Attention/concentration:
1. Hallmark = Impaired attention with higher rates of omission and commission errors.
2. Response time and variability = slower

Language:
1. Average
2. Fine motor difficulties may affect task copying

Memory:
1. Struggle with consistent encoding of new information.
2. retrieval may be impaired due to attentional issues, recognition memory is normal.
3. Story memory may be weak due to poor coherence and organization.

Executive Functions:
1. Response inhibition, execution, and vigilance deficits are common.
2. Mixed results on tasks like stroop and set-shifting.

Sensorimotor:
1. subgroup show motor impairments, affecting fine motor dexterity, motor planning, and visual-motor precision.
2. handwriting difficulties are common.

Emotion/Personality:
1. struggle with state regulation (e.g., arousal, activation, and reward motivation)
2. higher risk for externalizing and internalizing disorders.

PVT/SVT:
1. may exaggerate symptoms for medications or accommodations.
2. Important to use SVT/PVTs

36
Q

What is the first line of treatment in children of preschool age?

A

Behavioral therapy

36
Q

Psychostimulants for ADHD

A

Methylphenidate and salts of amphetamine (e.g., Ritalin, Adderall, and Concerta)

70-90% benefit, with additional benefits from switching stimulants or titrating.

37
Q

Atomoxetine (Strattera)

A

Noradrenergic reuptake inhibitor that may reduce tics.

Often used in children with ADHD + comorbid anxiety.

Smaller effect size

38
Q

alpha 2a adrenergic receptor agonists

A

Guanfacine (Tenex, Intuniv)
clonidine

*Second line of treatment

39
Q

Modafinil (Provigil)

A

FDA declined to approve it for clinical use.

40
Q

Behavior & CBT

A

Behavioral Parent Training
Behavioral classroom interventions
Academic interventions
Peer-related interventions

41
Q

What is the first line behavioral treatment administered in adjectively with medication?

A

Behavioral Parent Training (BPT) –> based on social learning theory focusing on teaching the child more socially acceptable behavior by training the primary caregivers in contingency management strategies.

42
Q

Alternative treatments for ADHD

A

EEG biofeedback (neurofeedback) – increase the ratio of high frequency beta EEG to low frequency theta EEG activity.

Maybe effective in treating inattentive symptoms.

Limited evidence for cognitive training programs.

Dietary interventions have been investigated –> supplements (e.g., free fatty acids) and dietary exclusions (e.g., avoiding artificial additives).

43
Q

Adult considerations

A

Symptoms persist into adulthood for about 85% of individual.

44
Q

Assortative mating

A

A nonrandom mating pattern in which individuals with similar genotypes and/ or phenotypes mate with one another more frequently than would be expected under a random mating pattern. If a person with one disorder marries a spouse with another disorder, this will increase the probability that their children could manifest symptoms of both disorders. This is a potential explanation for increased rates of comorbidity between two disorders in the population.

45
Q

Pleiotropy

A

The situation in which one gene influences multiple phenotypic traits. A gene locus on chromosome 6p affects both inattentive symptoms and dyslexia.

46
Q
A
47
Q

Relative risk

A

Relative risk is a ratio of the probability of the event occurring in the exposed group versus a nonexposed group. As used in this chapter, it refers to the ratio of the probability of a family member of an ADHD proband also having ADHD compared to the probability of a family member of a control proband having ADHD.

48
Q

Extended time

A

Adults with ADHD (w/o comorbid LD) do not sig. benefit from extended time on standardized exams.

Extended time on reading comprehension tests has been found to improve performance of adults with LD, but resulted in far less improvement for those with ADHD alone. One possible explanation for this is that adolescents and adults with ADHD tend to rush through tests as a result of impulsivity, so having difficulty completing the test on time is not as much of an issue

49
Q

Rule of thumb for treatment

A

When treating patients with psychiatric comorbid conditions, the rule of thumb is to treating the most serious disorder first. For example, treating an active mood disorder and/or significant substance abuse first then assessing the need to treat secondary ADHD symptoms. There would be significant concerns in recommending stimulant medication in an individual with history of substance abuse, especially if this individual has not been effectively treated for this behaviors.

50
Q

What is the cognitive endophenotype that best accounts for etiology between ADHD and dyslexia?

A

Processing Speed

ABCN Clinical Neuropsychology (34 decks)

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