Attention Deficit Hyperactivity Disorder Flashcards
Name the triad of difficulties seen in ADHD
inattention
hyperactivity
impulsivity
ADHD co-occurs with impairing symptoms relating to self regulation. Name them.
Developmentally inappropriate
• Impairing functioning
• Pervasive across settings (i.e. Home, school, work, etc) • Longstanding from age 5
Impact of childhood ADHD
Difficulties raising children with ADHD
High levels of home stress - high expressed emotions
Emotional disregulation - difficulties in peer relationships, dangerous behaviour
Poor problem solving abilities - developmentally inappropriate decision making
Barrier to learning - exclusion from education
Increased likelihood of antisocial behaviour
Impact of adult ADHD
increase in the frequency of psychiatric comorbidity as compared to children
Higher levels of criminality, antisocial behaviour
Higher level of substance misuse
Significant impairments in occupational function
Causes of ADHD
Genetic predisposition - familial clustering, serotonin and dopamine transporter genes
Perinatal precipitants - tobacco, alcohol, foetal alcohol syndrome, prematurity and perinatal hypoxia, complications during delivery (long labour, fetal distress, forceps)
Psychosocial adversity - inconsistent parenting, large family size, low social class, maltreatment, emotional trauma
Formula of ADHD (understanding cause and effect)
Genetic risk + pyschosocial risk factor (1 or more) = structural and functional differences across neurologic pathways = ADHD, emotional, cognitive and behavioural deficits
Neurobiology of ADHD
Underactive function within the frontal lobe Frontal lobe is responsible for: • Reasoning • Planning • Impulse control • Judgement • Initiation of actions • Social/Sexual beahviour • Long term memory
Neurochemistry of ADHD
Efficient dopamine-removal system - higher concentration of dopamine transporters - called re-uptake inhibitors
Symptoms may also be caused by the reduction of norepinephrine (can affect attention when acting as stress hormone); and serotonin, (which influences mood, social behaviour, sleep, and memory)
Childhood ADHD Assessment
Mainly driven by parents/school
• Ideally, a school observation
• Screening questionnaires and Structured diagnostic questionnaires are helpful
• Background information regarding risk factors, including developmental hx and family history
• Exploration of early history and attachment style
Adult ADHD Assessment
- Driven by the patient
- Historical concerns are presents and should be elicited by parents/siblings/relatives
- Specific adult screening tools are available
- Current clinical picture should be consistent with symptoms of ADHD (not just historical difficulties)
- Cognitive difficulties and ability to function need to be evaluated
- Comorbidities are much more common
Diagnostic criteria for childhood ADHD
• 6 or more symptoms of inattentiveness; and/or
• 6 or more symptoms of hyperactivity and
impulsiveness
• Present before age 5 years (or 3 for some clinicians)
• Reported by parents, school and seen in clinic
• Symptoms get on the way of daily life
Diagnostic criteria for Adult ADHD
In general, 5 or more of the symptoms of inattentiveness;
and/or
5 or more of hyperactivity and impulsiveness
Historical concerns since early age
NOTE: For adults, it is essential for the diagnosis that symptoms should have a moderate effect on different areas of their life
Psychosocial treatments for ADHD (mild, moderate and severe)
- Parenttraining(i.eNew Forest parenting programme)
- Socialskillstraining
- SleepandDiet: eliminations and supplements (controversial)
- Behaviouralclassroom management strategies
- Specificeducational interventions
Pharmacologic treatment for ADHD (only moderate and severe)
• 1st Line (stimulants) – Methylphenidate – Dexamfetamine – Lisdexamfetamine • 2nd Line (SNRI) – Atomoxetine • 3rd Line (alpha agonist) – Clonidine – Guanfacine • 4th Line • Antidepressants (imipramine) • Antipsychotics (Risperidone)
MOA of Meythlphenidate in symptomatic treatment of ADHD
Increase dopamine by blocking its transporter
