ADHD Flashcards
Triad of ADHD?
Inattention
Hyperactivity
Impulsivity
What is the impact of childhood ADHD?
Significant parenting difficulties
Increased levels of home stress and high expressed emotions
Emotional dysregulation leading to difficulties in peer relationships and reckless/ dangerous behaviour
Poor problem solving leading to developmentally inappropriate decision making
Significant barrier to learning and potentially exclusion from education
Higher likelihood of antisocial behaviour
What is the impact of adult ADHD?
Increase in frequency of psychiatric comorbid
Higher levels of criminality and antisocial behaviour
Higher level of substance misuse
What causes ADHD?
Perinatal precipitants Genetic predisposition Psychosocial adversity Neuroanatomical brain changes Cognitive and behavioural features
Genetic link in ADHD?
Increased risk (around 60%) among offspring of adults 15% increased risk of ADHD in siblings
What genes tend to be implicated in ADHD?
Those encoding for dopamine and serotonin transporters
What perinatal factors increase the risk of ADHD in children?
Links to tobacco and alcohol sue during pregnancy with higher likelihood of ADHD Foetal alcohol syndrome Prematurity Perinatal hypoxia Short/ long labour, Foetal distress Low forceps delivery Preeclampsia Viral infection
What psychosocial adversity factors are implicated in the progression of ADHD?
Inconsistent parenting Martial discord Low social class Large family size Paternal criminality Maternal mental disorder Maltreatment Emotional trauma
What is required for a diagnosis of ADHD?
Developmentally inappropriate behaviour
Impairing function
Pervasive across settings (home, school, work)
Longstanding from age 5`
Main functions of frontal lobe
Reasoning Planning Impulse control Judgement Initiation of actions Social/ sexual behaviour Long term memory
Which areas of the brain are underactive in ADHD?
Frontal lobe
What is the neurochemistry of ADHD?
Excessive dopamine removal (higher concentration of dopamine transporter; re-uptake inhibitors)
Reduction in NA and serotonin
What will NA mediate in ADHD?
Attention when acting as stress hormone Exertion Perseverance Recall memory Intuition
What will serotonin mediate in ADHD?
Mood Social behaviour Sleep Learning memory Satisfaction Pleasure/ pain Relaxation
Assessment of children with ADHD?
Driven by parents/ school
Ideally a school observation
Screening questionnaires and structured diagnostic questionnaires are helpful
Background information regarding risk factors, including developmental hx and family history
Exploration of early history and attachment style
Assessment of adults with ADHD
Driven by patient
Historical concerns are presented and should be elicited by parents/ siblings/ relatives
Specific adult screening tools
Cognitive difficulties and ability to function need to be evaluated
Co-morbid common
Diagnostic criteria in children for ADHD
6 or more symptoms of inattentiveness and/or 6 or more symptoms of hyperactivity and impulsiveness
Present before age of 5 (or before 3)
Reported by parents, school and seen in clinic
Symptoms reduce functionality
Diagnostic criteria for adults with ADHD
5 or more symptoms of inattentiveness and/or 5 or more hyperactivity and impulsiveness
Historical concerns since early age
In what areas of life can adult ADHD affect?
Underachieving at work or education
Driving dangerously
Difficulty making/ keeping friends
Difficult relationships with partners
Psychosocial interventional treatments for mild/ moderate and severe ADHD in children
Parent training
Social skills training
Sleep and diet; elimination and supplementation
Behavioural classroom management strategies
Specific educational interventions
Pharmacological management for ADHD
1st line: methylphenidate, dexamfetamine, lisdexamfetamine
2nd line: SNRI (atomoxetine)
3rd line: Alpha agonist (clonidine, guanfacine)
4th line: ADs (impiramine), antipsychotics (risperidone)
Mode of action of methylphenidate (stimulants)?
Increase dopamine by blocking its transporter
Mode of action of dexamphetamine?
Increases dopamine
Increased extracellular NA and 5-HT
Mode of action of SNRI in ADHD?
Increased NA
Role of dopamine in ADHD
Alertness Working memory Motivation Clarity Attention Balanced mood
NNT for stimulants in ADHD
4
What monitoring needs to be done for children on stimulants for ADHD?
Monitor growth and HR
What is the mode of action of methyphenidate?
Dopamine/ NA reuptake inhibitor (NDRI)
1st line for ADHD
What is the mode of action of atomoxetime?
NA reuptake inhibitor (NRI)
2nd line for ADHD
