ADHD Flashcards
ADHD is a neurodevelopmental disorder defined by what things? (3)
- Impairing levels of inattention
- Disorganization
- And/or hyperactivity-impulsivity
What does inattention and disorganization entail in ADHD pt?
Inability to stay on task, seeming not to listen, and losing materials, at levels that are inconsistent with age or devleopmental level
What does hyperactivity-impulsivity entail in ADHD pt?
Overactivity, fidgeting, inability to stay seated, intruding into other people’s activities, and inability to wait - symptoms that are excessive for age or developmental level
True or False? There is no biological marker or imaging study that is diagnostic for ADHD?
True - it is a clinical diagnosis
What is an essential feature to diagnose ADHD?
Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development
Inattention and hyperactivity-impulsivity requires how many symptoms and for how long in order to be diagnosed?
Six or more symptoms that have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities
What are 2 key DSM criteria for the diagnosis of ADHD?
- Present prior to the age of 12
- Present in 2 or more settings
Boys vs Girls - which is ADHD more diagnosed in?
Boys
What are some risk factors for developing ADHD? (9)
- Low birth weight/prematurity
- Exposure to smoking during pregnancy
- Family history of ADHD
- Perinatal stress
- Fetal alcohol syndrome
- Lead poisoning
- Traumatic brain injury
- Severe early oxygenation deprivation
- Adverse parent-child relationships
In terms of pathophysiology of ADHD, what are some potential links to anatomical structures? (2)
- Delay and rate of cortical thickening contributes to difficulty prioritizing tasks
- Lack of connectivity between prefrontal cortex is associated with lapses in attention and poor impulse control
In terms of pathophysiology of ADHD, what are some dopamine and norepinephrine abnormalities? (2)
- Deficit in DA reward pathway impairs brain’s ability to maintain attention to dull or repetitive tasks, postpone indulgence, regulate mood and arousal, resist distractions
- NE dysfunction leads to inability to modulate attention, arousal, and mood
What are some signs and symptoms of ADHD in infancy? (4)
- Difficulty being soothed because irritability, fidgeting, crying and/or colic
- Feeding problems including poor sucking, crying during feedings
- Short periods of sleep or very little sleep
- When crawling in constant motion
What are some signs and symptoms of ADHD in school age? (5)
- Constantly “on the go”, unable to stay seated or play quietly
- Easily distracted, trouble completing tasks
- Impulsive, unable to wait turn, may blurt out answers, needs instant gratification
- May appear accident prone due to hyperactivity and impulsivity
- Disorganized, forgetting or losing homework
What are some signs and symptoms of ADHD in adolescence? (2)
- Dominant features include disorganization, forgetfulness, inattention, overreaction
- Reckless driving and risky behaviour may occur
What are some signs and symptoms of ADHD in adulthood? (3)
- Hyperactive symptoms include inability to sit through class/work meetings, excessive talking, needs to get to places quickly
- Impulsive symptoms include frequent job changes, low frustration tolerance, unstable interpersonal relationships
- Inattentive symptoms include poor time management, poor motivation and concentration, forgetfulness, excessive mistakes
What are 2 important tools that are recommended by CADDRA guidelines for initial information gathering for children/adolescents suspected of ADHD?
- SNAP-IV 26 questionnaire
- CADDRA Teacher Assessment Form
In ADHD, approximately __% diagnosed as children continue to have symptoms that persist into adulthood, resulting in _% of the adult population
60%, 4%
What is the clinical course of ADHD in infancy? (2)
- Delay in motor and language development
- Difficult temperament
What is the clinical course of ADHD in preschool age? (3)
- Usually when initial symptoms start
- Hyperactive/impulsive symptoms dominate with tendency for intense temper tantrums
- Symptoms are less stable and vary between settings
What is the clinical course of ADHD in school age? (5)
- When initial diagnosis usually occurs
- Boys present with hyperactivity/impulsive symptoms that are more noticeable
- Girls present with more inattentive symptoms
- Hyperactive/impulsive symptoms persist whereas inattentive symptoms develop later
- Oppositional and socially aggressive behaviours begin to emerge
What is the clinical course of ADHD in adolescence? (4)
- Hyperactive symptoms begin to decline, impulsive and inattentive symptoms persist
- Inattentive symptoms may be more prominent
- Oppositional and socially aggressive behaviours continue to develop
- Substance use disorders may emerge
What is the clinical course of ADHD in adulthood? (3)
- More prevalent in males than females (1.6:1)
- Inattentive symptoms are most common
- Hyperactive/impulsive symptoms associated with higher bipolar/psychosis
What are some comorbidities seen with ADHD? (11 dont need to memorize all, just keep them in mind)
- Conduct or behavioural problems (52%)
- Anxiety (33%)
- Major depressive disorder
- OCD (1-3%)
- Depression (17%)
- Oppositional defiant disorder (25-50%)
- Tourette’s disorder (1%)
- Autism (14%)
- Epilepsy is 2-3x more likely
- Substance use disorders are 2.5x more likely
- Alcohol use disorder 2x as common
- Cocaine use disorder 2x as common
- Cannabis use disorder 2x as common
- Nicotine dependence 1.5x as common - Learning disorder 33%
What are some consequences of untreated ADHD? (3)
- 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? (6)
- Eliminate or significantly decrease the core ADHD symptoms
- Improve behavioural, academic, and/or occupational performance
- Improve self-esteem
- Improve social functioning
- Minimize adverse drug effects
- Improve quality of life
When might behavioural therapies be the initital treatment of ADHD?
If symptoms are mild, diagnosis is unclear, or medication is not preferred by parents
The most effective treatment of ADHD is a combination of…?
Behavioural therapies + medication
What are the CADDRA tiers of holistic ADHD care? (5)
- Adequate education of parents/caregivers and their families
- Behavioural and/or occupational interventions
- Psychological treatment
- Educational accommodation
- Medical management
What is behavioural parent training?
Behaviour modification principles for parents to implememnt at home to improve compliance with parent’s commands (ex. parent child interaction therapy)
What is behavioural classroom management?
Provides principles for teacher to implement in order to improve attention, work, productivity, compliance to classroom rules
What are behavioural peer interventions?
Focus on peer interactions and relationships
CBT in ADHD, yay or nay?
Reduces core ADHD symptoms in short term, but additional long-term studies needed. Tailors treatment to individual’s behaviours.
Probably a yay
For ADHD, meds should target ________ ____ _____ ___________
symptoms that cause impairment
Atomoxetine vs. Concerta (methylphenidate) - What is the bottom line of the first landmark ADHD study?
In treatment of ADHD without comorbidities (besides ODD), Concerta is 1st line option. ATX is second line for Concerta non-responders. However, if patient’s family is hesitant to start a stimulant, ATX is an option although not as effective as MPH. Also, if pt doesn’t respond to MPH, then ATX could be an option
In the 2nd landmark ADHD study, what were the results when it came to pharm treatment and behavioural treatment for treating ADHD? (3)
At end of 14 months:
1. Combined behavioural + pharm treatment = pharm alone for core ADHD symptoms
2. Pharm treatment > behavioral treatment for core ADHD treatment
3. Combined behavioral + pharm treatment > pharm alone or behavioral alone for reducing oppostional behaviors/anxiety and improving social interactions/self-esteem
What are the 2 classes of ADHD medications?
- Stimulants
- Non-stimulants
What are the 2 stimulant product types for ADHD treatment?
- Methylphenidate products
- Amphetamine products