Behavioral Science - ADHD - Thomas L. Schwartz Flashcards
What inattention symptoms must a patient have had for 6 months in order to consider a diagnosis of ADHD?
Poor attention to details --> mistakes Does not listen Cannot sustain attention Does not follow through Does not organize Avoids tasks Loses things Is distracted Is forgetful
What impulsive/hyperactive symptoms must a patient have had for 6 months in order to consider a diagnosis of ADHD?
Fidgets Leaves seat Runs/climbs Not quiet Talks a lot Blurts out Cannot wait Interrupts
T/F: Most milder cases of ADHD are not noticed until later in life when the demands (ie academic) are greater.
True
Symptoms of inattentiveness persist longer than impulsive/hyperactive symptoms
How heritable is ADHD?
76%
Chromosome 16
Dopaminergic genes, NE genes
What activation in the brain is missing in ADHD?
anterior cingulate
What environmental factors might be associated with ADHD?
Cigarette smoking in pregnancy Lead poisoning Head injuries High sugar Food color additives Learned behavior Reaction to stress
What other disorders should be in the differential when diagnosing ADHD?
Autism Spectrum Disorder Learning Disability Substance Use Disorder Personality Disorder Bipolar Disorder
What are the non-stimulant treatments for ADHD?
Atomoxetine (Strattera) (Norepi reuptake inhibitor)
BP meds (alpha-2 NE agonists)
Guanfancine ER
Clonodine ER
carry no addiction risk
can be sedating
What are the goals of psychotherapy with ADHD?
Self control Behavioral parent training Relaxation Education support Distraction control Attention Sustaining Cognitive Restructuring
What is first line ADHD therapy for little kids?
Meds first
More aggressive stimulants recommended for younger kids
How do Guanfancine ER and Clonodine ER work for ADHD if they are BP meds?
In the brainstem they may dampen NE release and lower BP as an autoreceptor;
In the frontal cortex, these receptors are located on the glutamate pyramidal neurons and help to improve the signal to noise ratio, allowing the neuron to fire appropriately when faced with multiple environmental stimuli. This fine tunes the frontal cortex and helps with prioritizing, response inhibition and vigilance
ADHD patients tend to have what differences from the general population?
Less schooling Lower self esteem More divorces Greater addiction rates Greater antisocial behavior same rates of medical illness
A 19 yo college student presents and meets criteria for ADHD inattentive type. What other psychiatric disorder will he most likely have outside of his ADHD?
A. Anxiety
B. Bipolar
C. Depression
D. Alcoholism
Anxiety
A 30 yo ADHD patient has failed to respond to methylphenidate, which of the following likely has a stronger effect on dopamine release in the brain?
A. Guanfancine ER
B. Atomoxetine
C. Amphetamine
D. Clonodine ER
Amphetamine
always the strongest on dopamine
A 15 yo with ADHD combined type has a functional MRI scan. What is the most likely finding?
A. Hyperactive amygdala
B. Hypoactive cerebellum
C. Hyperactive orbitofrontal cortex
D. Hypoactive orbitofrontal cortex
Hypoactive orbitofrontal cortex
