ADHD Flashcards
ADHD
excessive inattention
hyperactivity
impulsivity
any combo of above
But can have any IQ
Neuropsychological deficits in ADHD
- response inhibition (can focus on things they like, but if not really interested, start switching)
- delay aversion (focus on what’s right in front of them)
- executive functioning
attentional networks
alertness: thalamus, ant/post cortical
orientation: parietal lobes, frontal eye fields
executive control: anterior cingulate, thalamus, frontal lobes
Epidemiology of ADHD
- school aged children: 3-8%
- adults: 4%
- M:F 2:1 to 5:1
- Girls and Women tend to have inattentive symptoms
- Gender bias in recognition of symptoms
- Girls frequently not recognized (less hyperactive)
3 types (DSM V)
- inattentive type
- hyperactive/impulsive
- combined
Inattentive sx
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 sx
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
6 or more sx in either or both categories (this and inattentive), 5 if greater than 17 y
What do you need to rule out in order to dx ADHD?
Depression, anxiety, abuse, poor sleep/nutrition, etc
Developmental risks without treatment
-HS/college graduation
-fewer professionals
-increased risk of incarceration
-increased risk of : antisocial personality disorder
non-alcohol drug abuse
tobacco use
Comorbidities w/ ADHD
major depression enuresis oppositional disorder conduct disorder overanxious separation anxiety social phobia simple phobia multiple anxiety
Other problems for kids w/ ADHD
tutoring, repeat grade, special class, reading, math, or learning disability
Why might these comorbidities occur?
Underlying genetic vulnerability Developmental changes Psychological effects of having ADHD Living with others who are irritated by the ADHD Self-treating the problem
developmental concerns and comorbid risks (age groups)
preadolescent: increased risk of oppositional behaviors and conduct disorder
early adolescent: increased risk of substance use disorders
- *behavioral problems can persist into adulthood (often w/ legal involvement)
- conduct disorder can become antisocial personality disorder
- higher cost to system
development of depression and ODD
- ADHD irritates others
- frequent negative messages
- development of negative sense of self
- anger and devaluation =defense
- frequently develop oppositional defiant disorder or depression
not all w/ ADHD have ODD and vice versa
Treatment of ODD
parent management training
Why treat ADHD?
over 90% of indiv will improve with appropriate medication and tx
Meds for ADHD
stimulants (2 classes) most effective
-amphetamines, methyphenidates
- atomoxetine (Strattera)
- bupropion (Wellbutrin)
alpha agonists (guanfacine, clonidine) mostly for hyperactive sx
tricyclics: rarely used
stimulant info
- effective, well tolerated
- 80-90% reduction in sx burden w/ right dose
- evidence for protective effects developmentally
Amphetamines
d-amphetamine (Adderall)
-short acting (4-6 hr)
long acting: adderall XR (8-12 hr) Vyvanse 10-12h
Methylphenidates
Short acting:
Ritalin 3-4 h
long acting
ritalin LA 8-10 h
concerta 10-12h
ADHD into adulthood
- at least 65% continue to have ADHD symptoms into adulthoold
- hyperactivity decreases with time (rare by late adolescence)
- inattentive sx, restlessness and impulsivity, and attentional problems remain
long term ADHD tx
- focus on quality of life
- many still need stimulant as adults
- tx can decrease burden on partner
- parents can have ADHD (highly genetically linked)
adults w/ ADHD have higher risks of
alcohol abuse
alcohol dependence
drug abuse
drug dependence
ADHD/drug abuse relationship
- early tx may decrease the risk of substance abuse
- early stimulant use decreases later risk of substance use
- tx may decrease relapse in substance abuse problems
- specific substance abuse tx programs are an important part of tx for substance use problems
