Behavioral Science: ADHD Flashcards
DSM5 criteria for ADHD
- starts before age 12
- symptoms in multiple settings
- must cause social disability
6 inattention symptoms for 6 months:
poor attention to detail, can’t pay attention, doesn’t listen, doesn’t follow through, doesn’t organize, avoids tasks, loses things, distracted, forgetful
6 hyperactive/impulsive symptoms:
fidgets, leaves seat, runs/climbs, not quiet, talks a lot, blurts out, can’t wait turn, interrupts
Genetics of ADHD
- at least 76% heritable
- chromosome 16 involved
- genes involving DA, norepi, 5HT, neurotransmission and neuronal plasticity
Relationship between neuronal tone and ADHD
Inheriting ADHD genes allows abnormal receptor or enzyme proteins
- low firing –> ADHD sx
Number of synapses with time
Increase in synapses from birth to age 6, synaptic pruning beginning at age 14
What brain regions are abnormal in ADHD?
- hypoactive ACC, other abnormalities in PFC, basal ganglia, cerebellum, temporal and parietal cortex
Environmental factors in ADHD
- cigs/alcohol in pregnancy
- lead poisoning
- head injury
- high sugar? food color additives? learned behavior? reaction to stress? spooky
ADHD meds: stimulants
Great efficacy in adults, teens, and children
- promote DA and NE, increase activity
- most carry risk of addiction
- paranoia in misuse
- stunted growth, weight loss
- potential cardiac issues
ADHD meds: non stimulents
- Atomoxetine (NRI), Guanfecine ER and Clonidine ER (alpha-2 NE agonists) have less activity
- no addiction risk
- sedating, may lower BP
Psychotherapy for ADHD
Behavioral modification and training
- self control therapy
- behavioral parent training
- relaxation
- education support
- distraction control
- attention sustaining
- cognitive restructuring
ADHD pharm for preschoolers
Behavioral therapy –> amphetamines –> methylphenidate
ADHD pharm for children and adolescents
Slow release methylphenidate –> slow release amphetamines –> immediate release stimulants –> atomoxetine, clonidine ER, guanfacine ER
ADHD pharm for adults
Atomoxetine, modafinil, guanfacine ER, clonidine ER –> slow release amphetamines –> slow release methylphenidate –> immediate release stimulants
How are the non-stimulants different?
- Atomoxetine: norepi reuptake inhibitor
- Guanfacine ER and clonidine ER: agonize alpha-2 norepi receptor –> dampens NE release in brain stem, helps neuron fire appropriately in frontal cortex when faced with multiple environmental stimuli
ADHD prognosis
Ranges from poor to excellent
- ADHD patients tend to have less school, less powerful jobs, lower self esteem, greater antisocial behavior, greater addiction rates, greater divorce rates but equal rates of medical illness
- 2/3 showed no psychopathology or mental disorder in adulthood
