Class 8: ADHD Flashcards
Define ADHD
A complex chronic neurodevelopmental disorder
Define NDD
Neurodevelopmental disorder is a disorder that comes about as a result of disturbances/alterations to development of the nervous system
Name 5 NDDs
ASD, ADHD, Motor and Tic Disorders, Language Communication Disorders and Intellectual Disability
Name 4 behaviours that NDDs may affect.
Emotion, Learning Ability, Self-Control, and Memory
What are the 5 Major Behavioural Domains affected by NDDs?
Language, Social Interest, Repetitive Behaviour, Cognitive Function and Locomotor Activity.
What 3 Major Behavioural Domains does Intellectual Disability Affect? And is it a decrease or increase?
Language - Decreased
Social Interest - Decreased
Cognitive Function - Decreased
What 3 Major Behavioural Domains does ASD Affect? And is it a decrease or increase?
Language - Decreased
Social Interest - Decreased
Repetitive Behaviour - Increased
What 3 Major Behavioural Domains does ADHD Affect? And is it a decrease or increase?
Repetitive Behaviour - Increased
Cognitive Function - Decreased
Locomotor Activity - Increased
What Major Behavioural Domain does a Communication Disorder Affect? And is it a decrease or increase?
Language - Decreased
What Major Behavioural Domain does a Motor/Tic Disorder Affect? And is it a decrease or increase?
Repetitive Behaviour - Increased
When does aberrant neural development typically start?
Embryogenesis
What is the functional consequence of ADHD for preschool age people?
Behavioural Disturbances
What are 4 functional consequences of ADHD for school aged people?
- Behavioural Disturbances
- Academic Problems
- Difficulty with social interaction
- Self esteem issues
What are 6 functional consequences of ADHD for Adolescents?
- Academic problems
- Difficulty with social interactions
- Self esteem issues
- Legal issues, smoking, drugs
- Injury/Accidents
- Risky sexual behaviour
What are 7 functional consequences of ADHD for College Age People?
- Academic problems
- Occupational difficulties
- Relationship problems
- Self esteem issues
- Substance abuse
- Injury/Accidents
- Risky sexual behaviour
What are 6 functional consequences of ADHD for Adults?
- Occupational failure
- Self esteem issues
- Injury/Accidents
- Relationship problems
- Substance abuse
- Risky sexual behaviour
What is the prevalence of ADHD?
7.2% in children and as high as 2.5% in adults
What is the ratio of males to females with ADHD diagnoses?
3:1 male to female
What percentage of ADHD cases have persistent symptoms throughout lifespan?
30%-50%
Which type of ADHD symptoms decrease over time?
Hyperactive/Impulsive over inattentive
What are the three types of ADHD?
- Inattentive type
- Hyperactive/Impulsive type
- Combined type
How long does the ADHD diagnosis take symptoms into account and before what age?
Over 6 months before the age of 12
What are the 9 symptoms of the inattentive type?
LIME LO FFS
- S Often distracted by extraneous stimuli (can be thoughts)
- F Has problems staying focused
- L Does not seem to listen when spoken to directly
- I Does not follow though on instructions
- O Has problems organizing tasks and work
- E Avoid or dislikes tasks that require sustained mental effort
- L Often loses things needed for tasks or daily life
- M Makes careless mistakes
- F Forgets daily task (chores, errands, appts, etc)
What are the 9 symptoms of the hyperactive/impulsive type of ADHD?
- Fidgets with or taps hands/feet or squirms
- Not able to stay seated
- Runs about or climbs where it is inappropriate
- Unable to play or do leisure activities quietly
- Always “on the go”
- Talks too much
- Blurts out an answer before question has finished
- Interrupts or intrudes on others
- Has difficulty waiting their turn
How many symptoms are required for each type?
6 of 9 symptoms from particular type (or 6+ of both types for combined)
What sex has the bias for ADHD diagnosis?
Males
Which sex’s hyperactivity occur first?
Females
What part of the brain is larger in girls with ADHD compared with typical girls?
Cingulate Gyrus
White matter volume of brain grows at a faster rate for which sex? When does full volume typically occur for each?
Girls are faster at 10.5 days vs Boys 14.5 days
What are the 4 male ADHD symptom patterns?
- More Externalizing Symptoms
- Greater Severity of Hyperactivity-Impulsivity
- Less Difficulty with tasks involved in mental planning
- No significant hormonal impact
What are the 4 female ADHD symptom patterns?
- Symptoms may be more internalized
- Greater compensatory behaviour
- Often accompanies by low mood (lower severity of hyperactivity and impulsivity)
- Symptoms may be exacerbated by hormonal changes
What are the 3 further separations of the PFC?
Dorsal, Lateral and Medial
What part of the PFC regulates attention and motor responses?
Dorsal and Lateral
What part of the PFC regulates emotion?
Medial
What are 3 ways the PFC can assist in regulating attention.
- Allow us to concentrate & sustain attention
- Suppress the processing of irrelevant stimuli
- Control the shifting of attention & multi-tasking
Name 2 things the PFC can do by regulating behaviour and emotions.
- Inhibit inappropriate behaviour
2. Weaken reactions to impulses
Dopamine and Norepinephrine drive what in the PFC?
Optimal regulation of attention and emotion
What is the expressed receptor for dopamine in the PFC?
DA1 receptor
What is the expressed receptor for norepinephrine in the PFC?
⍺2A
In ADHD what is happening with the DA and NE receptors?
There are too few receptors expressed in PFC
In ADHD where there is the correct amount of expressed receptors what happened?
Individual is less responsive to the ligand resulting in a need for more DA or NE
How genetic is ADHD?
80%
What is DAT1?
The Dopamine reuptake transporter
ADHD can happen follow alterations to what?
DAT1 (such as mother smoking during pregnancy)
What are risk factors for ADHD?
- Mother smoking during pregnancy
2. Perinatal hypoxia (less oxygen) during birth
What cell type provides lactate to create ATP (energy) for neurons?
Astrocytes
What is the neuroenergetics theory?
ADHD astrocytes release less lactate in the PFC resulting in less ATP (less energy) leading to mental fatigue
What is the main treatment of ADHD?
Psychostimulant (effective in 70%-90% of cases)
How does ‘Methylphenidate’ treat ADHD?
Ritalin inhibits the reuptake of DA (and to some extent NE) mostly in the PFC resulting in more remaining in the synaptic cleft to be taken in by the functioning receptors.
What are three examples of Non-Drug nutrition treatments of ADHD?
Dietary Exposure (Artificial Food Colour Exclusion, Restriction Elimination, Supplementation with Free Fatty Acids)
What are three ethical considerations for ADHD in Children?
- Long term Psychostimulant use side effect may exist
- Could most case resolve themselves
- Is it over diagnosed/over medicated?
