ADHD- Patho, Diagnosis, Symptoms Flashcards
Environmental factors of ADHD
FAS, lead poisoning, meningitis, obstetric adversity, maternal smoking, adverse parent-child relationship, ADHD
In ADHD, what areas of the brain have a decreased total volume?
Prefrontal cortex, caudate nucleus, anterior cingulate gyrus, cerebellum
As ADHD symptoms remit with treatment, what happens to the brain volume?
There is increased cortical thickening and greater brain volume in regions controlling attention and behavior
Where is activity reduced in the brain with ADHD, and what reverses this?
There is reduced activity in the prefrontal and anterior cingulate cortex, but this is reversed with stimulants
What causes lapses in attention and impulse control?
Lack of connectivity between the prefrontal cortex and precuneus
When anticipating reward, there is decreased activation where in the brain?
Ventral striatum
What does MPH suppress?
Default mode network overactivity
Symptoms of ADHD: inattention
wandering off task, lacking persistence, having difficulty sustaining focus, being disorganized
Symptoms of ADHD: hyperactivity
excessive motor activity, fidgeting, tapping, talkativeness, extreme restlessness, wearing others out
Symptoms of ADHD: impulsivity
desire for immediate rewards or inability to delay gratification, social intrusiveness, making important decisions without consideration of long-term consequences
Presentation of ADHD in infancy
irritability, fidgeting, crying, difficulty feeding, short periods of sleep/frequently interrupted sleep
Presentation of ADHD: preschool
excessive motor activity, intense temper tantrums
Presentation of ADHD: school age
difficulty academically, combined inattentive and hyperactive/impulsivity, comorbid oppositional defiant disorder, conduct disorder, aggression –> puts the child at greater risk for delinquency and SUD in adolesence
Presentation of ADHD: adolescents 12-18
inattention and impulsivity more than hyperactive, significant functional impairment, higher rates of delinquency, drug and alcohol abuse, speeding and MVA risk increases
Presentation of ADHD: adults
inattention –> hyperactive/impulsive symptoms are associated with higher rates of comorbid BPD and psychosis; cognitive deficits, impatience, greater risk for unemployment, unstable relationships, psychiatric hospitalizations, incarceration
General diagnosis of ADHD: the onset of symptoms must be when?
Before 12 years of age!
Other general aspects of ADHD diagnosis
Significant impairment must be seen in ≥2 settings and symptoms must be documented
Evidence that symptoms interfere with or reduce the quality of social, academic, or occupation functioning
Not due to another psychiatric disorder, aren’t better explained by another mental disorder, and aren’t due to substance use/intoxication
In children and young adolescents, how many symptoms of inattention/hyperactivity must be present?
≥6 and must be present for at least 6 months
In older adolescents and adults, how many symptoms of inattention/hyperactivity must be present?
≥5
Functional consequences of ADHD
Delays in language, motor, or social development common
Low frustration tolerance; irritability and mood lability
Impaired work/school performance (performance, attendance, attainment)
Social rejection in childhood and adolescence
Elevated incidence of interpersonal conflicts with family, peers, spouses, etc.
By early adulthood: increased risk of suicide attempts
Further increased with comorbid mood, conduct, or SUDs
Increased prevalence of SUDs and incarceration rates
