ADHD Flashcards
What are hyperkinetic disorders?
A disturbance of activity and attention, including hyperkinetic conduct disorders, other hyperkinetic disorders and hyperkinetic disorder, unspecified
What is the prevalence of hyperkinetic disorders?
1-5% in child to adolescent population of the UK
Is there a gender difference in hyperkinetic disorders?
Yes. A male dominance. Although girls are poorly diagnosed.
Male:female = 3-4:1
What is ADHD?
Attention deficit hyperactivity disorder, a form of hyperkinetic disorder
What are the core features of ADHD?
- Inattention
- Excessive activity
- Impulsivity
What are the clinical features of ADHD?
- inattention, excessive activity and impulsivity apparent before the child is 7
- Excessive for the child’s age and development
- pervasive (evident in more than 1 environment - typically 3)
- symptoms may worsen in the afternoon
What affects does ADHD have on the child/young person
- Impair social, emotional and cognitive functioning
- symptoms are responsibile for considerable morbidity and dysfunction
- Affected children are often exposed to years of negative feedback about their behaviour and suffer educational and social disadvantage
What is the heritability of ADHD?
- Genetic link
Having a sibling, parent or twin with ADHD increases your chances - Genetic-environment interaction
Genes can either increase or reduce the impact of an environment or an environment can activate a genetic effect
Genetic factors contribute to the development of behavioural symptoms on a background of high environmental adversity
What are the organic factors of ADHD?
- smaller brain volume of the frontal and parietal cortex
- smaller basal ganglia
- right dorso-lateral prefrontal lobe reduced
- smaller cerebellar vermis
- Attentional systems involve
What genes are associated with ADHD?
- DRD4
- SLC6A3/DAT1
- DRD5
- SLC6A4/5HTT
- HTR1B
What is the DRD4 gene?
Dopamine receptor 4, a dopamine G protein-coupled receptor
What is the SLC6A3/DAT1 gene?
The dopamine transporter. A membrane-spanning protein that pumps the neurotransmitter dopamine out of the synaptic cleft back into cytosol.
What is the DRD5 gene? Dopamine receptor 5,
Dopamine receptor 5, a dopamine G protein-coupled receptor
What is the SLC6A4/5HTT gene?
The serotonin transporter, a type of monoamine transporter protein that transports serotonin from the synaptic cleft to the presynaptic neuron
What is the HTR1B gene?
a 5-HT receptor, Which may inhibit the release of dopamine or serotonin depending on the location of the receptor in the brain.
What is the consequence of a child with ADHD having a smaller frontal cortex?
The prefrontal cortex is related to executive function, consolidation of memory, short term memory and reacting and responding in the moment, impulse control and regulation are all affected by dopamine
What is the difference in sizes between a child with ADHD and a child without ADHD?
A child without ADHD has on average a 3% smaller brain
Give examples of ADHD-associated executive difficulties
- organisation
- planning
- working memory
- attention
- response inhibition
- impulse control
What are comorbid associations with ADHD?
- sleep disorders (up to 50%, difficulty falling asleep and waking up early)
- Behavioural difficulties (25-50%)
- Developmental co-ordination disorders
and specific learning difficulties (25%) - Social communication difficulties (~25%)
- Anxiety symptoms (~25%)
- Tic disorders (~20%)
- mood difficulties (~20%)
- Increased psychosocial factors
What is the assessment for ADHD?
No specific diagnostic test
Assesment includes:
- direct observation in more than 1 setting
- psychoeducational assessment
- structured questionnaires
- identifying co-morbid (mental) health problems
- developmental history
- develop a formulation based on view of child
What questionnaires can be used for ADHD assessment?
- SNAP-IV
- Conners
What additional assessments should be carried out in children being assessed for ADHD?
- hearing
- vision
- neurological signs and physical anomalies
- weight
- bp
- height
How is ADHD managed?
- psychostimulants
- parenting interventions
- Information for parents and teachers
- MDT with school and health services
What are first-line treatments for ADHD
- behavioural and educational interventions
What environmental management strategies can be put in place for children with ADHD?
- provide a calm environment
- avoid too many distracting stimuli when you want the child to concentrate
- initially, avoid situations that require quiet, still behaviour for long periods of time
- maintain structure and supervision longer than you think should be necessary
What behavioural training strategies can be used with ADHD?
- encourage consistency in managing less desirable behaviour
- do not personalise their behaviour problems
- positive reinforcement for appropriate and acceptable behaviour
- assist parents to be firm and in control without being coercive
>set clear rules with consequences
>use routine, countdowns and reminders
>use quiet time, planned ignoring and timeout (age appropriate) - provide feedback using direct observation of interactions between child and parents
What medications are used in the treatment of ADHD?
- methylphenidate
- dexamphetamine
- Atomoxetine
- Clonidine
- Guanfacine
What are the side effects of psychostimulants?
- Retarded/slowed growth through causing decreased appetite
Why is weight monitoring important for children with ADHD?
Anorexia is a side effect of psychostimulants. Too much weight loss, i.e. centile drops will require medication adjustment
How often should ADHD patients be monitored?
<6 monthly, but more frequently when titrating medications
Monitor response to medication
monitor side effects
monitor height, weight, pulse &BP
What factors are associated with persistence of ADHD into adulthood?
- progressive reduction in cerebellar & hippocampal volumes
- maternal depression
- marital discord
- negative parent-child interaction
- family socio-economic disadvantage
- familial ADHD
