L15 - ADHD pt 2

Question 1

What are the treatments for ADHD

Answer 1

• No cure - only alleivates symptoms
• Medication: RItalin, atomoxetine = targeted at dopamine/noradrenaline
• Behaviour modification
• Life-style changes: very reliant on parents/teachers = harder to implement
• About 3 in 4 children receive medication

Question 2

What is Ritalin? (Methylphenidate)

Answer 2

• First treatment option - used from 1930
• Stimulant: amphetamine, and has longer lasting forms
• Paradoxical action: where stimulant drug enhances activity normally but reduces activity in ADHD patients, improving cognition
• Inhibits DAT function, leading to increase in dopamine
• Limitations: lots of side effects, and issue of addiction
• Short-term gains in academia
• Relationships are generally improved and short term gains and long term effectiveness
• But we do not know exactly how ritalin works to help

Question 3

Describe Atomoxetine

Answer 3

• Selective noradrenaline reuptake inhibitor
• Inhibits net function = shows might not be dopamine deficit disorder
• First non-stimulant drug
• Lower risk of abuse
• Some side effects inc suicidal thoughts and liver function

Question 4

What are non-pharmacological treatments?

Answer 4

• Parental training: improve coping strategies
• Academic interventions: positive reinforcement, restructuring learning, increased praise
• Peer related interventions
  LIMITATIONS:
• Behavioural gains only during period of treatment AND not applicable to all cases
• Smaller effect size than medication
• Difficulties in provision - involved parties, continuities, high cost
• BEST: mixture of pharma and real world situation

Question 5

What was the multimodal treatment of children with ADHD?

Answer 5

• 600 children given various treatment options: just medical, just behavioural, combination, or routine community care
• Treatment sopped at 14mo
• Follow-up studies at 3/8 years
• Conclusions: Combined and stimulant conditions showed higher improvement post-treatment
• Treatment does not influence functioning 8y after = short-term gains
• Early symptomolgy more predictive of later functioning
• Behavioural/sociodemographic advantage improved functioning
• Combined ADHD has worse prognosis = Need for improved treatment options

Question 6

What were the follow-up studies

Answer 6

• 9.1% children showed complete remission
• 11% stable ADHD
• 60% fluctuating symptoms
  IMPLICATION: Persistence of ADHD into adulthood is a stronger predictor of vehicle risk than childhood limited ADHD

Question 7

Why does ADHD get criticised?

Answer 7

• ADHD is a modern disorder: to appease parents for underachieving children
• There is a bias to biomedical view: aetiology/treatment or blood/psychological test
• Concern about children using prescribed psychoactive stimulant drugs = drugging problematic children

Question 8

Is ADHD a modern disorder?

Answer 8

• No, seen in descriptions in medical books in children with restless and other sympyoms of ADHD in 1763
• 1868: children with sustained attention and hard to control etc.
• Usage of stimulants in hyperactivity since 1930s

Question 9

Is ADHD normal behaviour but public mis-behaviour?

Answer 9

• Roles an parental expectations of children in society have changed
• Modern-life demands: increased expectations of longer periods of concentration e.g school demands and busier homes
• Can be coping/maturation delays
• Symptom complex of ADHD may reflect different forms of cog development e.g learning problems, immaturity and temperament difference = interacts with bio vulnerability
• Increased disorders in society = more disorders in children
• Severe cases of ADHD might be true, but the majority of cases may not be

Question 10

Is there a bias to a biomedical view?

Answer 10

• Pushing it in a biological way - hand in hand with pharma companies
• Criticise: Use of MRI, Inconsistently in genetic studies, lack of bio marker or specific psych test

Question 11

Is ADHD over/mis diagnosed

Answer 11

• Diagnosed too much
• Over-prescribed in Austraila by 72% for ADHD drugs

Question 12

Over-prescription of Ritalin

Answer 12

• Too many children are taking Ritalin
• Doctors urged to reduce use of ritalin = 700K children in UK take this
• Drugs should be reserved for children who are severely affected by the problem
• Improper over-diagnosis
• Easiest treatment option
• Non-medical reasons
• Parental/teacher pressure
• Pharma greed

Question 13

Are the criticisms justified?

Answer 13

• Many other disorders are used to identify children who experience various difficulties but not all attract as much debate as ADHD does just because of the stimulant usage
• DOES not mean we should overlook the absence of reliable diagnostic toold or the over-prescription/diagnosis
• Is a real condition that needs to be handled better

Question 14

Prognosis of ADHD?

Answer 14

• ADHD can be found to produce diverse and serious impairments
• Children diagnosed with ADHD have significant difficulties in adolescence, regardless of treatment
• 37% of those with ADHD do not get a high school diploma
• > 50% of those with ADHD do not finish high school
• < 5% of those with ADHD get a college degree (28% in normal pop)
• Increased risk of adverse life outcomes when teenage, including car crashes, injury and higher medical expenses, earlier sexual activity, and teen pregnancy
• The proportion of children meeting the diagnostic criteria for ADHD drops by about 50% over three years after the diagnosis: regardless of treatments used and also occurs in untreated children withADHD
• ADHD persists into adulthood in about 30-50% of cases. Those affected are likely to develop coping mechanisms as they mature
• New diagnosis of ADHD in adulthood is increasing (controversial)
• ADHD as adult affects job, life, everything