ADHD Flashcards
what is ADHD
excessive inattention, hyperactivity, impulsivity, any combo of above
Neuropsych deficits in ADHD
response inhibition, delay aversion, executive functioning
areas in brain dealing with alertness
thalamus, anterior/posterior cortical network?
areas in brain dealing with orientation
parietal lobes, frontal eye fields
areas in brain dealing with exec control
anterior cingulate, thalamus, frontal lobes
Prevelance of ADHD
3-8% in school children
Male: Female from 2:1 to 5:1
Male or female more likely to have inattentive symptoms
Women (girls frequently not recognized –less hyperactive)
3 types of ADHD
Inattentive type, hyperactive/impulsive type, combined Type
Inattentive Symptoms
careless mistakes, difficulty sustaining attention, poor follow through, often doesn’t seem to listen when spoken to directly, often avoids/dislikes/reluctant to do takes requiring sustained mental effort, often forgetful in daily activities
Hyperactive/impulsive symptoms
fidgeting, difficulty sitting still, often unable to play or take part in leisure activities, driven by motor, often talks excessively, often trouble waiting for turn
DSM 5 criteria
6+ symptoms in either (or both) category; 5 symptoms if >17 y.0; several symptoms before age 12
- several symptoms present in 2+ setting (home, school, work, with friends or relatives, in other activities)
- clear evidence symptoms interfere with, or reduce quality of social, school, or work functioning
developmental risks
(study of 15 year old men with hyperactivity as boy, compared to those without ADHD)
- increased risk of being incarcerated
- fewer achieving professional degrees/bachelors or above,
- more non high school grads
- more antisocial personality disorder
- increased risk of non-alcohol drug abuse
increased risk of tobacco use (2x compared to those without ADHD)
Comorbidities
Increased risk of…
- major depression
- enuresis
- oppositional disorder
- conduct disorder
- overanxious
- separation anxiety
- social phobia
- multiple anxiety
Developmental concerns/comorbid risks
preadolescent– increased risk of oppositional and conduct disorder
Early adolescent: increased risk of substance use disorders (PSUDs)
behavior problems can persist into adulthood, often with legal involvement
conduct disorder can become antisocial personality disorder
ADHD can predispose to…
ODD due to social factors that are internalized
frequent negative mesages, develop negative sense of self, anger and devaluation = defense
Treatment of ODD
parent management training
efficacy of ADHD treatment
over 90% will improve on appropriate meds
Medications for ADHD
Stimulants, Atomoxetine, Bupropion, Alpha agonists (mostly affect hyperactive symptoms), Tricyclics (rarely)
Stimulants for ADHD
Adderall– d-amphetamine
Ritalin –> Methylphenidate
Proportion that continue to have ADHD symptoms into adulthood
65%– hyperactivity tends to decrease with time generally, rare by late adolescence
which symptoms remain
inattentive, restlessness, impulsivity, attention problems
Adults with ADHD have increased risk for
Alcohol abuse/dependence, drug abuse/dependence
Treatment decreases risk of…
substance abuse
