ADHD Flashcards
what are the triad of difficulties in ADHD
inattention
hyperactivity
impulsivity
what is needed for a diagnosis of ADHD
triad of difficulties:
- inattention
- hyperactivity
- impulsivity
frequently occur with a cluster of impairing symptoms relating to self regulation (executive functioning, emotional regulation)
these must be:
- developmentally inappropriate
- impairing functioning
- pervasive across settings (home, school, work, etc)
- longstanding from the age of 5
what if school is a problem but child is fine at home
could be learning difficulty/ bullying etc
what is a child with ADHD typically like
daydreamy
cant keep focus
lots of energy
impuslive
how does adult ADHD differ from child ADHD
less obvious symptoms of hyperactivity/ impulsivity
more symptoms of inattention
what is the impact of childhood ADHD
parenting difficulties
increase home stress, high expressed emotions
emotional dysregulation - difficulties in peer relationships and reckless and dangerous behaviour
poor problem solving ability - inappropriate decision making
barrier to learning and exclusion from education
what is the impact of adult ADHD
increase psychiatric comorbidities
higher levels of criminality, antisocial behaviour
higher substance abuse
occupational impairments
why do most adults with childhood ADHD present with residual symptoms that no longer meet diagnostic criteria
possible improvement in cortical thickness (maturation) that allows for the brain to compensate for cognitive deficits
what causes ADHD
genetic predisposition \+ perinatal precipitants \+ psychosocial adversity
cause neuroanatomical brain changes which lead to the cognitive and behavioural features of ADHD
what genes in ADHD
dopamine and serotonin transporter genes
60% increased in offspring if parents have ADHD
what are the perinatal factors in ADHD aetiology
tobacco and alcohol
foetal alcohol syndrome, illicit substances
significant prematurity ad perinatal hypoxia
unsually short/ long labour, foetal distress, low forceps delivery, eclampsia
what are the psychosocial adversities linked to causing ADHD
inconsistent parenting styles severe martial discord low social class large family paternal criminality maternal mental disorder maltreatment emotional disorder
what is the neurobiology of ADHD
under active function within the frontal lobe
excessive (higher concentration of dopamine transporters) dopamine removal system
reduced noreopinephrine and serotonin
what is the frontal lobe responsible for
reasoning planning impulse control judgement initiation of actions social/ sexual behaviour long term memory
how do you asses child ADHD
usually school observation
screening questionnaires
background info- risk factors, developmental Hx, family Hx
how do you assess adult ADHD
historical concerns from close ones
screening tools
current symptoms consistent with ADHD
cognitive difficulties and ability to function evaluated
what is the diagnostic criteria for childhood ADHD
6 or more symptoms of inattentiveness and/ or
6 or more symptoms of hyperactivity and impulsiveness
present before age of 5
reported by parents, school and seen in clinic
symptoms get in way of daily life
what is the diagnostic criteria for adult ADHD
5 or more symptoms of inattentiveness and/ or
5 or more of hyperactivity and impulsiveness
historical concerns since early age
what is essential for a diagnosis of adult ADHD
that symptoms have a moderate effect of different areas of their life:
- underachieving in work/ education
- driving dangerously
- difficulty making/ keeping friends
- difficulty in relationships with partners
what are the psychosocial interventions for ADHD
for mild-severe in children parent training social skills training sleep and diet (controversial) behavioural classroom management strategies specific educational interventions
what are the pharmacological treatment for ADHD
only for mod- severe 1st Line (stimulants) Methylphenidate Dexamfetamine Lisdexamfetamine
2nd Line (SNRI) Atomoxetine
3rd Line (alpha agonist)
Clonidine
Guanfacine
4th Line
Antidepressants (imipramine)
Antipsychotics (Risperidone)
how does methylphenidate (stimulant work)
increases dopamine by blocking its transporter:
improves alertness, working memory, motivation and clarity
how does dexamphetamine (stimulant) work
increases dopamine by blocking its transporter
also increases norepinephrine and serotonin
what does increasing norepinephrine and serotonin do for ADHD
norepinephrine- concentration
serotonin- satisfaction
together- intuition, balanced mood
how do SNRIs work in ADHD
increase norepinephrine
