ADHD Flashcards
what is ADHD
attention deficit hyperactivity disorder
what is the triad of difficulties seen in ADHD
Inattention
Hyperactivity
Impulsivity
what other symptoms are seen in ADHD
impairing symptoms relating to self regulation with are:
- developmentally inappropriate
- impairing function
- pervasive across settings
- longstanding from age 5
what is a spectrum disorder
a disorder which the general population feature on with a clinically determined cut off based on level of impairment
what is the impact of childhood ADHD
Difficulties parenting
Increased level of home stress
High expressed emotions
Difficulties in peer relationships and reckless and dangerous behaviour
Poor problem solving ability
Inappropriate decision making
Significant barrier to learning and potentially exclusion from eduction
Higher likelihood of antisocial behaviour
what is the impact of adult ADHD
increase in psychiatric comorbidity
higher levels of criminality and antisocial behaviour
higher level of substance misuse
significant impairments in occupational function
why does ADHD get better with age
due to improvement in cortical thickness (maturation) that allows for the brain to compensate for cognitive deficits
what are the causes of ADHD
genetic predisposition
perinatal precipitants
psychological adversity
what genes are involved in ADHD
dopamine and serotonin transported genes
what perinatal factors can impact ADHD
tobacco and alcohol use during pregnancy
other illicit substance use
short or long labour, foetal distress, low forceps delivery and eclampsia
exposure to viral infection in first trimester
what psychological adversity factors can impact ADHD
Inconsistent parenting Severe marital discord low social class large family size paternal criminality maternal mental disorder maltreatment and emotional
what neurobiological changes are seen in aDHD
Under-active function of the frontal lobe
what is the frontal lobe responsible for
Reasoning Planning Impulse control Judgement Initiation of actions Social/sexual behaviour Long term memory
What neurochemical changes are seen in ADHD
excessively efficient dopamine removal system
reduction of norepinephrine and serotonin
how are children assessed for ADHD
a school observation
screening questionnaires
full history
exploration of attachment stye
how are adults assessed for ADHD
Historical concerns from family
Adult screening tools
Need to currently fit criteria, not historically
Assessment of cognitive difficulties and ability
Look at co-morbidities
what is the diagnostic criteria for children to be diagnosed with ADHD
6 or more symptoms of inattentiveness and/or
6 or more symptoms of hyperactivity and impulsiveness
present before age 5
happens at home, in school and at clinic
symptoms get in the way of daily living
what is the diagnostic criteria for adults to be diagnosed with ADHD
5 or more of the symptoms of inattentiveness and/or
5 or more of hyperactivity and impulsiveness
historical concerns since early age
symptoms must have moderate effect on daily life eg. (work, education, dangerous driving, difficulty making/keeping friends etc)
what are the psychological treatments for mild, moderate and severe ADHD in children
Parent Training Social Skills Training Sleep and Diet Behavioural Classroom management strategies Specific educational interventions
what are the pharmacological interventions for moderate and severe ADHD
1st line - Stimulants
2nd line - SNRI
3rd line- Alpha agonist
4th line - antidepressants/antipsychotics
what stimulants can be given in ADHD
Methylphenidate
Dexamfetamine
Lisdexamfetamine
what SNRI is given in ADHD
Atomoxetine
what alpha agonists are given in ADHD
Clonidine
Guanfacine
how does methylphenidate work
stimulant - increases dopamine by blocking its transporter
how does dexamphetamine work
stimulant
increases dopamine by blocking its transmitter, also increases extracellular norepinephrine and possibly serotonin
how do SNRI’s work in ADHD
increase norepinephrine by blocking its transporter
how do alpha agonists work
increase norepinephrine by reducing sympathetic stimulation
