ADHD Flashcards
3 domains of ADHD
Inattentivity Hyperactivity Impulsivity
ADHD prevalence
- 6-10%
- 3:1 or 9:1 male: female
Inattention Sx
fails at
- details
- sustaining attention
- doesn’t listen
- difficult organizing tasks
- avoid tasks requiring sustained effort
- loses things
- easily distracted
- forgetful
Hyperactivity Sx
- always on the go
- talks too much
- difficult waiting in lines
- fidgety
- leaves seat
What are some diagnostic criteria?
- Sx present before 12 years
- Significant impairment present in 2 or more settings
- Not due to underlying disorder
Subtypes:
- Combined type- most common
- inattentive- diagnosed later
- hyperactivity/impulsivity- more commonly diagnosed in young children
Associated problems
- ignored by peers, rejection
- difficulty with execution rather than understanding rules
- no relationship b/w family problems and ADHD
- self-esteem
Self-esteem of ADHD kids
- inflated- positive illusory bias
- low- associated with comorbid depression
In most cases, ADHD is present
THE ENTIRE LIFE
some might learn to compensate better as adults
hyperactivity declines with age, inattentiveness remains the same
Comorbidity of ADHD with
- conduct disorder
- depression
- increased risk of substance abuse and chronic criminality
- increased risk of suicide
Etiology of ADHD
- environmental or genetic
- brain synapse differences
- gene differenes
- structural differences
- .8-.85 heritability
- dysfunction in prefrontal lobe (inhibition, executive function)
-
dopamine genes implicated-
- dopamine transporter DAT1
- 7 repeats of DRD4 dopamine receptor gene
- prefrontal cortex, corpus collosum, caudate nucleus
Abnormalities in
frontostriatal circuitry: prefrontal cortex, basal ganglia, cerebellum
Dopamine and epinephrine related hwo?
dopamine made from epinephrine
(except not really, DOPA==> dopamine==> epi==> norepi)
4 areas of “executive functions”
- cognitive- working memory, planning
- language- fluency, communication
- motor- response inhibition, coordination
- emotional- self-regulation of emotion
executive function defecits
- not always found in ADHD
- can overlap with ADHD
- also found in different disorders
Behavioral disinhibition
- basis of executive functioning deficits in ADHD
- ie: performance problem not knowledge
- Risks for ADHD increase with….
- leading to….
- genetics; prenatal tobacco/alcohol exposure
- basal ganglia and frontal lob abnormalities, dopamine
Assessment of ADHD
- Connor scale (completed by teacher/parent)
- IQ test (screen for dev issues)
- behavioral observations at home/school
- no medical screen can detect ADHD
ADHD treatment
- medication
- behavioral intervention (parent training, classroom management, summer treatment programs)
Medications for ADHD
- methyphenidate (ritalin, concerta, metadate)
- dextroamphetamine (adderall, vyvance= prodrug)
benefits of vyvance?
prodrug= decreased chance of OD/ getting high
MOA for meds
- block reuptake of NE and dopamine, facilitate release
- enhance NE and dopamine in PFC and basal ganglia
Strattera
atomoxetine- non stimulant that works for some kids…can take 4-6 weeks for it to work. Small effect size.
ADHD med limitations
- does not normalize behavior (always will be a bit weird)
- side effects (insomnia, decreased appetitie, tick development)
- educate parent (so they don’t blame it all on ADHD)
*
Overall results of studies
(regardng behavioral treatment/drugs)
- treatment is better than no treatment
- med + behavior treatment > behavioral treatment alone
- behavioral treatment + med not better than meds alone (with regards to ADHD sx)
- behavioral treatment + med DOES help with comorbid sx
- combined treatment may reduce med dose
Combined drug/behav treatment
- made parents/teachers feel better
- improved functional outcomes (relationships, functioning)
- normalized kid
What happens to combined ADHD kids when they enter teens/adult
- still have “significant impairment”!
- life-long/long term treatment needed
environmental factors can
- NOT CAUSE ADHD
- might contribute to expression/make it worse
