ADHD Flashcards
what are the cardinal features of ADHD?
Impaired attention, impulsivity and over-activity
Pervasive - occurs in more than one environment
The symptoms are age-inappropriate and result in significant psychological, social and/or educational impairment.
Name some associated symptoms of ADHD
- Social disinhibition
- Recklessness
- Impulsive flouting of social rules e.g. butting in, poor turn-taking
- Increased incidence of learning difficulties and clumsiness
name some risk factors for ADHD
Strong • Family history • Male • Low birth weight • Epilepsy • Maternal nicotine use during pregnancy Weak • Maternal alcohol use during pregnancy • Psychosocial adversity • Lead exposure • Traumatic brain injury • Stress during pregnancy
name some pathophysiological changes seen in ADHD
Brain structure - there is a general reduction in volume in certain brain structures in children with ADHD, with a proportionally greater decrease in volume in the left-sided prefrontal cortex
• Neurotransmitter pathways
o Altered catecholamine metabolism
• Executive function and motivation
o Symptoms arise from deficiency in certain executive functions
Attentional control
Inhibitory control
Working memory
o Individuals do not have impaired long-term memory but have deficits in their long-term recall due to impairments in their working memory
name some of the inattentive symptoms seen in ADHD
o Medical conditions e.g. hearing difficulties, epilepsy Inattentive symptoms (DADMOMLFC) - Difficulty sustaining attention - Avoids sustaining attention - Distracted easily - Misplaces things - Organisation problems - Mistakes made - Listening difficult - Forgetful in daily activities - Completing tasks or jobs
Name some of the hyperactive/impulsive symptoms in ADHD
Hyperactive/Impulsive symptoms – LFROST/WIB
- Loud in quiet situations
- Fidgetiness
- Restless or overactive
- On the go all the time
- Seating difficult
- Talks excessively
- Waiting difficult
- Interrupts or intrudes
- Blurts out prematurely
what are some of the ICD-10 criteria for diagnosing ADHD?
• Hyperkinetic Disorder
• ≥6 Sx of inattention
≥3 Sx of hyperactivity
≥1 Sx of impulsivity
• Started before age 7
• Present ≥ 6/12
• Affecting ≥ 2 settings
• Significant impairment in functioning
• Symptoms not due to another causehow would you manage ADHD in a non-pharmacological manner?
behaviour training programmes, teacher education, positive reinforcement of good behaviour, use of clear and effective commands.
what are the first line drugs for management of ADHD?
1st line are psychostimulants:
• act on D1 receptors in the prefrontal cortex & D2 in the striatum
o Methylphenidate (MPH) (blocks DA & NA re-uptake via transporter)
o Dexamphetamine (DEX) (releases DA stored in presynaptic vacuoles)
• Quick in onset, few days. Well tolerated in young people as side effects are not too bad.
Can be given in an immediate release or a slow release form
name some side effects of methylphenidate
Reduced appetite • Can lead to growth retardation - Negated by giving child big breakfast and then dinner followed by like three snacks/supper. Also track centile growth. Insomnia Headache Irritability Tachycardia Tics Seizure
what drugs would you try when attempting to manage ADHD if methylphenidate and dexamphetamine had not been successful?
2nd line Atomoxetine
• Acts on noradrenaline (NA) transporter in prefrontal cortex
• NA reuptake inhibitor, blocks noradrenaline transporter
• Increase NA and dopamine (DA) in prefrontal cortex
• Builds up in the system but takes 4 weeks to get to treatment effect (difficulty)
• Fine-tuning that is required with the stimulants is not necessary
• Useful when stimulant is not tolerated or there is a risk of diversion
• Side effect profile:
o Similar to stimulants but has less of an effect on appetite and growth
o Reduced appetite, nausea, insomnia, dizziness, constipation, sweating, sexual dysfunction
o Seizures
o Can be hepato-toxic but regular LFTs are not strictly necessary
o Potential for suicidality
2nd line Guanfacine
• Also an alpha-2 adrenergic receptor agonist
• Enhances prefrontal cortical regulation of attention and impulse control by strengthening pre-frontal cortex functions
• Patients can gain weight, get sleepy, and have increased appetite
• Less sedating that clonidine
3rd line – Clonidine
• Alpha-2 adrenergic receptor agonist
• Stimulates all three subtypes of the alpha-2 adrenergic receptors
