ADHD Flashcards
What are the triad of difficulties on ADHD?
Inattention, hyperactivity, impulsivity
What do the triad of ADHD symptoms frequently co-occur with?
A cluster of impairing symptoms relating to self regulation
What is the criteria for symptoms to be diagnosed as ADHD?
Developmentally inappropriate symptoms
Impair function and pervasive across setting
Longstanding from age 5
How is ADHD considered to be a spectrum?
Symptoms cluster on a continuum in the general population
What is the cut off for ADHD symptoms based on?
Clinical determination = aided by screening and assessment tools generally based on level of impairment
How does adult ADHD differ from childhood ADHD?
Less obvious symptoms of hyperactivity or impulsivity and more inattentive symptoms
What is the impact of childhood ADHD?
Significant difficulties parenting children with ADHD
Increased level of home stress and high emotions
Higher likelihood of antisocial behaviours
What does emotional dysregulation in ADHD lead to?
Difficulties in peer relationships and reckless or dangerous behaviour
What effect does ADHD have on education?
Poor problem solving ability leading to developmentally inappropriate decision making
Significant barrier to learning and potentially exclusion from education
What are the impacts of adult ADHD?
Increase in frequency of psychiatric comorbidity
Higher level off criminality and antisocial behaviour
Higher level of substance misuse
Significant impairment in occupational function
What are some issues that untreated ADHD can have on school and family?
School = 60% suspended, 32% drop out, lower occupational status family = 3-5x increase in parental divorce/separation, increased risk of early parenthood
What are some issues of untreated ADHD in society and the healthcare system?
Society = 2x increase in substance misuse disorder plus earlier onset, less likely to quit smoking Healthcare = 50% increase in bike accidents, increased A & E visits, 4x more vehicle crashes
Why do adults present with residual symptoms that don’t meet the diagnostic criteria?
Possibly due to improvement in cortical thickness allowing brain to compensate for cognitive deficits
How does ADHD affect families?
Hyperactivity tends to aggregate in families
ADHD shows familial clustering both within and across generations
How does a family member having ADHD increase the risk of developing the condition in other family members?
60% increased risk in offspring of adults with ADHD
15% increased risk in siblings of children with ADHD
What genes are involved in ADHD?
Mainly dopamine and serotonin transporter genes
What are some perinatal factors in the development of ADHD?
Tobacco/alcohol use during pregnancy
Significant prematurity and perinatal hypoxia
Unusually short/long labour
Foetal distress, eclampsia and low forceps delivery
What are some conditions that have ADHD-like symptoms?
Foetal alcohol syndrome and use of other illicit substances
What are some psychosocial factors that increases risk of ADHD?
Severe marital discord, low social class, large family size, parental criminality, maternal mental disorder, maltreatment, emotional trauma
What does the typical brainmap pattern in children with ADHD show?
Underactive function in the frontal lobe
What are the functions of the frontal lobe?
Reasoning, planning, impulse control, judgement, initiation of action, social/sexual behaviour, long term memory
How are neurotransmitters involved in ADHD?
Excessively efficient dopamine removal system = higher concentration of dopamine transporters
Symptoms can be caused by reduction of norepinephrine and serotonin
How are children assessed for ADHD?
Mainly driven by parents or school
Ideally school observation
Screening and structured diagnostic questionnaires
Exploration of early history and attachment style
How are adults assessed for ADHD?
Driven by patient = historical concerns are present
Specific adult screening tools available
Comorbidities common
Current clinical picture should fit with ADHD symptoms
Cognitive difficulties and ability to function need to be evaluated
