ADHD Flashcards
What is the triad of difficulties found in ADHD?
Inattention
Hyperactivity
Impulsivity
From what age do symptoms of ADHD tend to appear?
Age 5 (may not necessarily be diagnosed at this age)
ADHD can occur in one setting and not in others. e.g. can occur at school, but not at home. TRUE/FALSE?
FALSE
must be across ALL settings
How do symptoms of ADHD in adults differ fromt hat ni children?
Adults = less obvious symptoms of hyperactivity/ impulsivity
They possess more inattentive symptoms
Is ADHD thought to be over or under diagnosed in the UK?
Underdiagnosed and undertreated
Children who are brought to clinic by their parents often do not recognise that there is a problem with their behaviour. TRUE/FALSE?
TRUE
How can ADHD impact someones childhood?
- Parenting difficulties => increased level of home stress
- Relationship difficulties with peers
- Reckless behaviour
- Inappropriate decision making due to poor problem solving ability
- Barrier to learning/ potential exclusion from school
- Higher likelihood of antisocial behaviours
How can ADHD impact an adults life if they have not been diagnosed/treated?
- increase in psychiatric comorbidity
- Higher levels of criminality, antisocial behaviour
- Higher level of substance misuse
- Impairments in occupational function that could easily be accommodated
What social factors suffer when ADHD goes undiagnosed and untreated?
- Family => parental divorce/separation, early parenthood
- Society => Substance use, Less likely to quit smoking
- Work => ↓ productivity
- Healthcare => increase in accidents and ER visits
- School => suspended/ drop out
Why do adults present with residual ADHD features but not enough for a diagnosis?
They “grow out of it”
- Improvement in cortical thickness (maturation)
=> allows brain to compensate for cognitive deficits e.g. impulses can be regulated better
Does ADHD have a genetic component?
Yes research found hyperactivity tends to aggregate in families
=> “familial clustering”
increased risk (60%) if patient is offspring of adults with ADHD
What neurotransmitter genes are involved in ADHD?
Dopamine and serotonin transporter genes are involved
Why is the ADHD reviewal clinic badly attended?
Parents of children with ADHD potentially have hyperactive/ inattentive traits
=> forget their child must attend the appointment
What peri-natal factors may increase the risk of a child developing ADHD?
- tobacco/alcohol/ illicit drug use during pregnancy
- prematurity and perinatal hypoxia
What other perinatal complications can cause presentations like ADHD?
- unusually short or long labour
- foetal distress
- low forceps delivery
- eclampsia
- Exposure to viral infection during first trimester?
Do any parenting styles particularly increase the risk of ADHD?
Not any particular one BUT there can be an issue if parents have conflicting parenting styles
i.e. one is very disciplined whilst the other is not
What social situations in childhood can potentially increase the risk of someone developing ADHD?
- parental divorce/separation
- low social class
- large family size
- paternal criminality
- maternal mental disorder
- maltreatment / emotional trauma
What area of the brain is shown to be dysfunctioning in ADHD, and what is this area responsible for?
FRONTAL LOBE
- Reasoning and Planning
- Impulse control
- Judgement
- Initiation of actions
- Social/Sexual behaviour
- Long term memory
Explain the neurochemistry of ADHD and why dopamine is involved?
- excessively efficient dopamine-removal system (higher concentration of dopamine transporters)
=> Less dopamine in reward pathway
=> less rewards found in normal behaviour
=> inattention to one task, need to keep swapping for reward
OR use risky behaviour to get dopamine reward
What other neurotransmitters are decreased in ADHD?
Noradrenaline => can affect attention
Serotonin => can affect mood/ behaviour/sleep/memory
How is a presentation of presumed ADHD in a child usually assessed?
- school observation
- Screening questionnaires
- Background information regarding risk factors, developmental hx and family hx
How is a new presentation of presumed ADHD in an adult usually assessed?
- Historical concerns about behaviour
- Specific adult screening tools used
- Clinical picture consistent with symptoms of ADHD both NOW and BEFORE (not just historical difficulties)
- Cognitive difficulties/ ability to function evaluated for impairment
- Comorbidities?
What is the diagnostic criteria for ADHD in a child?
- 6 or more symptoms of inattentiveness AND/OR
- 6 or more symptoms of hyperactivity/impulsivity
- Present before age 5y
- Reported by parents, school and seen in clinic (across all situations)
What is the usual diagnostic criteria for ADHD in adults?
- 5 or more symptoms of inattentiveness AND/OR
- 5 or more hyperactivity and impulsiveness symptoms
- Historical concerns since early age
Adults must have an impairment of function to be diagnosed with the disorder. WHat tasks may be impaired?
- underachieving at work/ education
- driving dangerously
- difficulty making/keeping friends
- difficulty in relationships with partners
What psychosocial interventions may be used in addition to pharmacological treatment in ADHD?
Parent training
Social skills training
Behavioural classroom management strategies
List the 1st to 4th line pharmacological interventions for ADHD?
1st Line = Stimulants e.g. methylphenidate
2nd Line = SNRI e.g. Atomoxetine
3rd Line = Alpha agonist e.g. Clonidine
4th Line = Antidepressants e.g. imipramine/ Antipsychotics e.g. risperidone
How do stimulant treatments for ADHD work?
- increase dopamine by blocking its transporter
- Dexamphetamine also increases extracellular noradrenaline andpossibly serotonin
What is the number needed to treat for stimulants in ADHD? And is this good or bad?
NNT = 4
=> for every 4 children given stimulant treatment, one will show improvement
=> this is a GOOD NNT
