ADHD Flashcards
What is ADHD?
neurodevelopmental disorder defined by impairing levels of inattention, disorganization, and hyperactivity-impulsivity
What does the inattention and disorganization of ADHD entail?
inability to stay on task
seeming not to listen
losing materials
at levels that are inconsistent with age or developmental level
What does the hyperactivity-impulsivity of ADHD entail?
overactivity
fidgeting
inability to stay seated
intruding into other peoples activities
inability to wait
symptoms that are excessive for age or developmental level
Is ADHD only a disorder of children?
can persist into adulthood
-with resultant impairments of social, academic, and occupational functioning
What is the biomarker or imaging study that is diagnostic of ADHD?
there is no biological marker or imaging study that is diagnostic for ADHD
-a clinical diagnosis
What is the essential feature of ADHD?
persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development
Describe the diagnostic criteria for the inattention side of ADHD.
6+ sx persist for 6+ mo and inconsistent with development and impact social and occupational/academic activities
1. fails to pay attention to details or makes careless mistakes
2. difficulty sustaining attention
3. does not seem to listen when spoken to
4. does not follow through on instructions or tasks
5. difficulty organizing
6. dislikes/reluctant to tasks requiring mental effort
7. loses things
8. easily distracted by extraneous stimuli
9. often forgetful in daily activities
Describe the diagnostic criteria for the hyperactivity-impulsivity side of ADHD.
6+ sx persist for 6+ mo and inconsistent with development and impact social and occupational/academic activities
1. fidgety
2. leaves seat when seating expected
3. runs around when inappropriate
4. unable to engage in activities quietly
5. often “on the go”
6. often talks excessively
7. blurting answer before question is done
8. difficulty waiting for turn
9. interrupts or intrudes on others
What is key regarding the diagnosis of ADHD in regards to age and setting?
several inattentive or hyperactive-impulsive symptoms were present prior to age of 12 and are present in two or more settings
Describe the etiology of ADHD.
not entirely known
multifactorial:
-genetics (heritability, NT dysfunction - mainly DA & NE)
-non genetic factors (20-25%)
What are the risk factors for ADHD?
low birth weight/prematurity
exposure to smoking during pregnancy
family history of ADHD
perinatal stress
FAS
lead poisoning
traumatic brain injury
severe early oxygenation deprivation
adverse parent-child relationships
Describe the pathophysiology of ADHD.
anatomical structures
-delay and rate of cortical thickening contributes to difficulty prioritizing tasks
-lack of connectivity between prefrontal cortex is associated with lapses in attention & poor impulse control
EEG abnormalities
-90% with ADHD (not diagnostic)
DA and NE abnormalities
-DA: impairs brains ability to maintain attention to dull or repetitive tasks, postpone indulgence, regulate mood and arousal, resist distractions
-NE: inability to modulate attention, arousal, and mood
Describe the ability of the PFC when catecholamine levels fluctuate between low to high.
low: fatigued
moderate: alert
high: stressed
Which assessment forms are recommended for initial information gathering for children/adolescents suspected of ADHD?
SNAP-IV 26
CADDRA Teacher Assessment Form
What are some comorbidities often seen with ADHD?
conduct or behavioral problems
anxiety
MDD
OCD
SUD 2.5x more likely
learning disorders
epilepsy 2-3x more likely
autism
Tourettes
oppositional defiant disorder
What are the consequences of untreated ADHD?
decreased social, educational, vocational, and self-care functioning
increased rates of accidental injury
increased time and energy to cope with ADHD related challenges
What are the goals of therapy for ADHD?
eliminate or significantly decrease the core ADHD sx
improve behavioral, academic, and/or occupational performance
improve self-esteem
improve social functioning
minimize drug AEs
improve QoL
What should the treatment of ADHD be based on?
current evidence, family, and clinician preference
When can behavioral therapies be considered as the initial treatment of ADHD?
if symptoms are mild, diagnosis is unclear, or medication is not preferred by parents
What is the most effective treatment for ADHD?
behavioral therapies + medication
What are the non-pharm treatment options for ADHD?
family-focused interventions
-behavioral parent training
school-focused interventions
-behavioral classroom management
child-focused interventions
-behavior peer interventions
CBT
What should the meds target in ADHD?
the symptoms that cause impairment
What did the landmark study of atomoxetine vs Concerta find regarding adverse events?
similar in between groups
What is the bottom line of the landmark study of atomoxetine vs Concerta?
in treatment of ADHD without comorbidities (besides ODD), Concerta is 1st line option
-ATX is 2nd line option for Concerta non-responders
-however, if pts family is hesitant to start a stimulant then ATX is an option although not as effective as MPH
-also if pt doesnt respond to MPH than ATX could be an option
What was the MTA study?
second landmark ADHD study
RCT comparing behavioral therapy, intensive medication management, combination behavioral therapy + intensive med management
What were the results of the MTA study?
combined behavioral + pharm tx = pharm alone for core ADHD sx
pharm tx > behavioral tx for core ADHD tx
combined behavioral + pharm tx > pharm alone or behavioral alone for reducing oppositional behaviors/anxiety and improving social interactions/self-esteem
What are examples of ADHD medications?
stimulants:
-methylphenidate products
-amphetamine products
non-stimulants:
-atomoxetine
-guanfacine
-clonidine
-bupropion
What is the MOA of methylphenidate?
inhibits presynaptic reuptake of DA and NE by blocking transport proteins
-DA appears to have a larger role than NE
-leads to increased sympathomimetic activity in CNS
-limited peripheral activity
