Diagnosis and Treatment of ADHD Flashcards
WIth the new DNS 5, what age to symptoms need to appear before to get the ADHD diagnosis?
12 years (used to be 7)
FOr the ADHD diagnosis, the symptoms have to NOT be from what three other conditions?
psychosis, depression, and anxiety
What are the three general subtypes of ADHD?
- inattentive
- hyper/impulsive
- mixed
Which subtype is most common in boys? Which is most common in grisl?
mixed - boys
inattentive - girls
(hyper/impulsive is least common)
What early medical history possibilities are contributors to ADHD
in utero exposures to substances
birth traumas
other frfontal lobe trauma (TBI, lead, mercury, etc)
What should be in the differential diagnosis for ADHD
learning disorders behavioral disorders (ODD< conduct, etc) anxiety disorders mood disorders (depression, bipolar) psychotic (rare
What is formal testing for ADHD?
cognitive psychological testing with tests like the TOVA, trails, working memory, wisconsin card sort, etc.
What are the cloninger dimensions of ADHD personality?
increased risk taking
decresaed harm avoidance
potentially increased reward dependence
What is the gold standard for pharmacotherapy in ADHD?
psychostimulants - methylphenidate and amphetamines
What are the risks associated with stimulants?
cardiovastular (so be careful if FAS)
tics, tourettes (maybe)
anxiety/dep
psychosis/mania
What is the best adminstration system for stimulants in ADHD?
the daytrana patch - it’s continuous for a long period of time
If ADHD is comorbid with depression, how do you treat it?
treat whatever is most severe and then add a 2nd treatment is the first doesn’t fix it
What drug should you give th comorbid ADHD and anxiety?
atomoxetine to treat both
What are some of the signs of ADHD in infancy?
unduly sensitive to noise, light, temp or change in general very active sleep little cry often explosively irritable emotionally labile difficulty delaying gratifications
Can you diagnose a kid with ADHD in preschool?
you maybe could, but it’s controversial because they wont look overly abnormal. just watch closely for a couple more years
What are th eneurological “soft signs” of ADHD?
clumsiness, L/R confusion, perceptual-motor dyscoordination
do kids with ADHD tend to have low or hihg self esteem? How well are they socialized?
low self esteem
poor socialization
What is the prevalence of ADHD?
probably 5% in school age children and 3-4% in adults
What are females with ADHD often diagnosed with first?
depression because females tend to exhibit less hyperactivity and internalize more
ADHD wins the prize for what in terms of childhood disorders?
it’s the most commonly treated childhood disorder
what percentage of kids on stimulants get get them a primary care doc?
60%
What are the three major parts of the brain involved in ADHD?
prefrontal cortex (development delayed), basal ganglia (volume reduced), cerebellum (volume reduced)
What two main NTs are involved with ADHD?
NE and DA (lower concentration or, lower firing rate, possibly fewer receptors)
What role does the basal ganglia play in ADHD?
it’s normally inolved with th eselection of appropriate behaviors and voluntary motor control. aslo emotional function. Without it, you get dysfuntion as in ADHD
What does the dorsal anterior cingulate cortex fail to mediate in ADHD?
it normally regulates selective attention, so they have little attention to detail and make careless mistakes/lose things
What does the dorsolateral preforntal cortex fail to mediate in ADHD?
it normally regulates SUSTAINED attention, problem solving and executive functioning
so they lack follow torugh and organization
What part of the brain regulates the motor hyperactivity seen in ADHD?
premotor cortex
fidgeting, leaving seat, est
What part of the brain mediates the impulsivity and social/emotional responses of ADHD?
orbital frontal cortex
Cerebellar volume is decreased with ADHD< so what motor symptoms might they have?
bad handwriting, clumsiness, delays in achieving motor milestones
Why does a lack of dopamine result in ADHD
DA usually enhances signal to improve attention - keeps you focused on task behavior and cognition
Why does a lack of NE result in ADHD?
NE usually dampens noise, increases inhibition and helps executive operations
For the ADHD criteria, it is 6 signs before 12 years old, but once you’re older than 17, how many are needed?
only 5
Does the gender difference in ADHD persist into adulthood?
nope - 1:1
Comorbidites are the absolute norm with adulte ADHD. WHat are some?
mood disorders (dep anx, bipolar), dementia, sleep apnea, insomnia, hyperthymid personality
Which tends to persist more into adulthood - inattentiveness or hyperactivity?
inattentiveness
