ADHD Flashcards
What are the three subtypes of ADHD?
- Inattentive type
- Hyperactive-impulsive type
- Combined type
What are the criteria for diagnosis of ADHD
- 6 symptoms (from the following categories) must be present that cause a fxn’l impairment that occur in at least 2 settings
1. Inattention
2. Hyperactivity
3. Impulsivity
Diagnostic criteria:
Often makes careless mistakes in schoolwork or other activities; Often cannot focus attention on tasks; Often does not seem to listen when addressed directly; Often has difficulty with organization; Often avoids activities that take mental effort for a sustained period; Often loses things
Is easily distracted
Is forgetful
Inattention
Diagnostic criteria:
Often fidgets with hands, cannot sit still; Often leaves the seat in a classroom; Often has difficulty playing or engaging in leisure activities quietly; Often talks constantly
Hyperactivity
Diagnostic Criteria:
Often blurts out answers before the questions have been completed; Often has difficulty awaiting their turn; Often interupts
Impulsivity
What are treatments available for ADHD?
- Support groups
- Specialized educational planning
- Diet
- Focused therapies (behavioral therapies) -First line for mild symptoms or preschool age
- Medication
What medications are used for treatment of ADHD?
- Stimulants
- Antidepressants
- Atomoxetine
- Alpha-2 agonists
What are the types of stimulants?
- Methylphenidate (Ritalin, Concerta, Focalin, Methylin, Metadate, Daytrana))
- D-Amphetamine (Adderall, Dexedrine, Destrostat, Desoxyn, Vyvanse
- Forms of administration: Tablets, chewable tablets, liquid, capsule, skin patch
- Short (2-3x), intermediate (1-2x), and long (1x) acting
ADRs:
- Short term: Reduced appetite, Insomnia, Nervousness, GI disturbances
- Increased aggression
- May precipitate tics or psychotic symptoms
- Some cardiac fatalities
Contraindication: people with borderline or above normal blood pressure
Stimulant drugs
Second line ADHD treatment; Selective norepinephrine reuptake inhibitor; Age 6 and up to adult; Equal to methylphenidate in efficacy; Takes 2-4 weeks to have an effect, and another 2-4 weeks to teach the maximal benefit; Little abuse potential
Atomoxetine
ADRs:
- Adults: Insomnia and hypertension
- Children: abdominal pain, decreased appetite, dizziness, vomiting
- May have growth disturbances
- Some suicidal inclinations
Atomoxetine
- Can be stopped abruptly without withdrawal symptoms
What are benefits and disadvantages of antidepressants in ADHD?
- TCAs have a benefit in ADHD, but are superior to the stimulants
- Benefits: Longer half-life; Reduce comorbid mood disorders; Low abuse potential; Do not exacerbate tic disorders
- Disadvantages: Anticholinergic effects, Cardiac adverse effects
What causes ADHD?
Combination of environmental, genetic and biological factors
- Prenatal and perinatal exposure to cigarettes or alcohol increases risk 2-3 X
- Parent with ADHD – 8X increase in risk
- Twin study – genetics accounts for a 75% contribution
- Boys diagnosed 3X more frequently than girls
What are the changes seen in ADHD?
- Decreased brain volume, particularly in the corpus callosum, caudate, and cerebellum
- Changes in dopamine systems in adults with ADHD (prefrontal cortex, involved in lack of attention and diminished memory)
What are the benefits of stimulants for patients with ADHD?
- reduction of hyperactivity, impulsivity, and inattentiveness (improves behavior)
- reduce restless behavior
- improves memory
- seen best in children w/e comorbid sx (anxiety)
- approx 30% adults and children do not respond to medication or cannot tolerate ADRs (increase of tics)
