Session Eight (ADHD and Hyperactivity) Flashcards
Briefly describe the aetiology of ADHD?
- Affects males more than females (3:1)
- Common in children (about 5%)
- But can also persist into adulthood (2-4%)
What are the 3 TYPES of symptoms you look for in a person with ADHD?
- Inattention
- Hyperactivity
- Impulsivity
Give some examples of ADHD inattention symptoms? (9)
- Lack of attention to details
- Difficulty sustaining attention
- Does not listen when spoken to directly
- Trouble completing tasks
- Problems organising tasks and activities
- Avoids sustained mental effort
- Loses/misplaces things regularly
- Easily distracted
- Forgetful
Give some examples of Hyperactivity symptoms in ADHD? (6)
- Fidgetiness (hand, feet, squirming in chair)
- Leaves set when not supposed to
- Restlessness or over active
- Difficulty in engaging in quiet leisure activities
- Always on the go
- Talks excessively
Give some examples of Impulsivity symptoms in ADHD? (3)
- Blurts out answers before question has been completed
- Difficulty waiting in line or taking turns
- Interrupts or intrudes on others when they are working or busy
What (vaguely) are the 3 traditional subtypes within ADHD?
- Hyperactive-Impulsive type
- Inattentive type
- Combined type
What are the DSM criteria for diagnosing someone as having ADHD?
Symptom count:
- 6 for Inattention
- 6 for HI
- If 6 in each, patient is said to have combined type
Further diagnostic criteria:
- Symptoms maladaptive and inconsistent with developmental level
- Age of onset has to be before the age of 12
- Pervasiveness (symptoms must be present in two or more settings)
- Impairment (significant impairment of function or QoL in social/ academic/ occupational settings
- Symptoms are not better accounted for by another disorder
Define ADHD.
ADHD = A persistent pattern of inattention and/or HI that interferes with functioning and development.
ADHD is NOT a manifestation of defiance, oppositional behaviour, hostility, failure to understand tasks or instructions
What are some associated features of ADHD?
- Developmental delay in language, motor or social skills. Usually mild and non-specific but common co-occurrence.
- Emotional symptoms e.g. low frustration tolerance, irritability, mood lability.
- Educational problems, even in the absence of a specific learning difficulty, academic or work performance are usually impaired.
- Cognitive deficits e.g. attention, executive function, memory.
What are the pros and cons of using the Impulsivity, Hyperactivity, Inattention model for ADHD diagnose?
Pros:
- These symptoms frequently co-occur and are distinct from other conditions
- This cluster is associated with significant impairment
- This method predicts treatment response
Con:
- All three phenomena (HII) are indistinguishable from the normal spectrum.
How does ADHD present in adulthood?
Most commonly carried over symptom = Inattention (+ some Impulsivity)
- Disorganisation (difficulty planning ahead)
- Forgetfulness (misses appointments or loses things
- Procrastination (starts projects but doesn’t complete them)
- Time management problems (always late)
- Premature shifting of activities (start something, get distracted and move on)
- Impulsive decisions (especially around spending)
- Criminal offences (speeding, recreational drug use)
- Unstable jobs and relationships
Why should adult mental health services be interested in ADHD?
- ADHD is associated with significant adult psychopathology
- ADHD symptoms may persists into adult life
- ADHD is a treatable disease
Outline. the evidence for a genetic heritability of ADHD?
Faraone (2000):
- Family studies
- ADHD more common if you have a parent or sibling with the condition
Faraone (2005):
- Meta-analysis of twin studies
- Scores on ADHD symptom tests are highly heritable
McLoughlin (2011):
- Looked at shared genetic effect between the two domains of ADHD
- Inattention Hyperactivity-Impulsivity
- Correlation = 0.5-0.75
GCTA trial looked into SNP heritability for a number of conditions, found ADHD had higher SNP-heritability than BPD, Sz, MDD, ASDs.
What neurochemical factors have been found to be at play in ADHD?
Cortese (2012):
- Dopaminergic and Adrenergic systems involved in ADHD
- Current drug therapies block DA and NA re-uptake and or promote release
- Studies show decreased availability of DA receptor isoforms and increased DAT binding vs controls.
Serotonin and Acetylcholine also implicated
What has Demontis et al (2019), a massive GWAS study for ADHD, shown about the heritability of the condition?
- 20k cases vs 35k controls
- Identified 12 loci of significant clinical relevance.
- Heritability of ADHD due to these common variants = 22%
What are Copy Number Variants (CNVs) and how do they relate to ADHD?
CNVs = Submicroscopic, rare chromosomal deletions and duplications.
Contribute to increased risks of ND disorders including autism, Sz, ADHD and intellectual disability. May go some way to explaining the genetic risk factors for these conditions.
What Dietary risk factors have been studied in relation to ADHD? And how successful have these studies been?
Thapar (2013):
- Nutritional DEFICIENCIES (e.g. Zinc, Magnesium, Fatty acids)
- Nutritional SURPLUSES (e.g. Sugar, Artificial food colourings)
- Low, High IgG foods
All correlate, none proven link.
What Psychosocial risk factors have been studied in relation to ADHD? And how successful have these studies been?
Thapar (2013):
- Family adversity and low income
- Conflict or hostility in the parent-child relationship
(both correlate, neither causal link established)
- Severe, early deprivation
(high risk, likely causal risk factor)
What Pre/Peri-Natal risk factors have been studied in relation to ADHD? And how successful have these studies been?
- Maternal smoking/ alcohol/ substance abuse
- Maternal stress
- Low birth weight
(all risk factors, no proven links)
