ADHD Flashcards
What is ADHD?
Excessive Inattention
Hyperactivity
Impulsivity
Any combination of the above
ADHD is not…
Oppositional Behaviors
Intellectual Disability (can have at any IQ)
Specific Learning Disorder
Only reason for poor focus or hyperactivity
Neuropsychological Deficits in ADHD
Response Inhibition
Delay Aversion
Executive Functioning
Types of ADHD
Inattentive type
-Frequently undiagnosed
-More common in girls
Hyperactive type
-Diagnosed earlier (bothersome to others)
-Frequently confused with oppositionality
Combined type
-Meets criteria for both (i.e. 6 or more
symptoms in each category)
ADHD
_______ are the standard of care
due to high efficacy and generally
good tolerability
Stimulants
ADHD Medication options:
-Stimulants (2 classes) – Most effective
- Atomoxetine (Strattera)
- Bupropion (Wellbutrin)
- Alpha agonists (guanfacine, clonidine)
- ->Mostly affect hyperactive symptoms
-Tricyclics (Rarely used; “old school”)
Inattentive Symptoms
Careless mistakes
Difficulty sustaining attention
Often does not seem to listen when spoken to directly
Poor follow through
Often avoids, dislikes, or is reluctant to do tasks that require sustained mental effort (e.g. homework, notes, taxes, etc)
Is often forgetful in daily activities
Hyperactive/Impulsive Symptoms
Fidgeting; Difficulty sitting still Often unable to play or take part in leisure activities quietly. “Driven by a motor” (high energy level) Often talks excessively. Often has trouble waiting for turn
DSM 5 Criteria
6 or more symptoms in either (or both) category; 5 symptoms for >17 y.o.
Several symptoms present before age 12
Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities).
There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
Making the diagnosis
Good diagnostic interview and exam (Gold Standard)
Rule out other common diagnoses and problems that impact attention
Depression, anxiety, abuse, poor sleep/nutrition, etc
Explore and treat comorbid diagnoses if present
May use available rating scales to support diagnosis and track symptom burden over time
Vanderbilts, Conner’s, etc
Common
Comorbidities:
- Substance Abuse
- Anxiety Disorders
- Depression
- Learning Disorders
- Oppositional Behavior
Gold Standard for Diagnosis = Good History and Exam
Screens can be supportive but are not sufficient!
Differential Diagnosis of ADHD:
Anxiety
- Depression
- Sleep Problems
- Abuse
- PTSD
- Lack of food
- Sleep Apnea
- Psychosis
- Relational Problems
- Mania
- Learning Disorders
- Many others
ADHD is the most ______ psychology disorder
GENETIC
What doesnt work
Trying harder
Diet changes
Teaching how to pay attention, control yourself, etc. (Stop and Think Programs)
Behavioral programs
Rewards and Punishments
Many of these things can help in conjunction with medication but do not help alone
Medications
Stimulants (2 classes) – Most effective Atomoxetine (Strattera) Bupropion (Wellbutrin) Alpha agonists (guanfacine, clonidine) Mostly affect hyperactive symptoms Tricyclics Rarely used (old school)
Amphetamines (duration)
Short acting: Adderall (4-6 h) Long Acting Adderall XR (8-12 h) Vyvanse (10-12 h)
Methylphenidates (duration)
Short Acting Ritalin (3-4 h) Long Acting: Ritalin LA (8-10 h) Concerta (10-12 h)
ADHD into Adulthood
At least 65% continue to have ADHD symptoms into adulthood.
Hyperactivity tends to decrease with time
Rare by late adolescence
Inattentive symptoms, restlessness and impulsivity, and attentional problems remain
ling term rx
Focus on quality of life
Many still need stimulant as adults
Treatment can decrease burden on partner
Parents can have ADHD (highly genetically linked)
ADHD—Drug abuse relationship suggests
Early treatment may decrease the risk of substance abuse
Early stimulant use decreases later risk of substance use
Treatment may decrease relapse in substance abuse problems
Specific substance abuse treatment programs are an important part of treatment for substance use problems
ADHD Take Away Points
Differential of attention problems is broad
Many co-morbidities with ADHD
Comprehensive evals are necessary
Life-long disorder that frequently requires chronic treatment
Stimulants are most effective treatment
Obstructive sleep apnea may cause?
ADHD
