Stimulant Medication & ADHD Flashcards
What is ADHD?
attention deficit hyperactivity disorder
ADHD as a real and measurable disorder
not just kids who can’t sit still
not due to video games or lack of discipline
both over diagnosed & under diagnosed
inattention
careless mistakes
difficulty focusing
forgetfulness/losing things
difficulty staying on task/following instructions
organization problems
hyperactivity/impulsivity
fidgeting/restlessness/trouble sitting still
trouble stopping themselves from x- calling out an answer, interrupting…
excessive talking/movement
acting without thinking
trouble waiting in line/for your turn
reduced inhibition to risk
3 presentations
primarily inattentive- “daydreamers”
primarily hyperactive- usually diagnosed young boys
combined type
diagnosis
at least 6 symptoms for at least 6 months
not age appropriate
symptoms impair normal functioning
cannot be the result of other problems
some statistics
the most commonly diagnosed neurodevelopmental disorder
predominant rates of ADHD
ages 3-17
6-16%
among those diagnosed with ADHD
~38-81% are taking a stimulant medication
**medication is usually not recommended for children younger than 6
behavioral interventions (for the individual & the family) should accompany medication
Why do we need to treat?
people with ADHD make up a large proportion of the population
can also be highly functional members of society (strengths)
people with ADHD are more likely to have problems with
accidents & injuries
job loss & divorce
higher risk of addiction/substance use disorders
emotional regulation
sense of time/timing
excessive risk taking behavior poop
comorbidity
any mental, emotional, or behavioral disorder
behavior or conduct disorder
anxiety
depression
autism spectrum disorder
tourette syndrome
current treatment model
multimodal treatment
multimodal treatment
medication helps to manage symptoms
behavioral therapy help manage- day to day tasks, skills & strategies to minimize impairment, social skills training
ADHD in the brain
there are measurable and distinct differences between the brains of those with ADHD & “neurotypical” people
chemical differences of ADHD in the brain
lower levels of dopamine & norepinephrine
distinct structural differences of ADHD in the brain
prefrontal cortex
basal ganglia
cerebellum
prefrontal cortex
inhibition, self-regulation, planning
basal ganglia
learning ideas & motivated responding
cerebellum
timing, coordination
network between prefrontal cortex and cerebellum
regulates other systems- network of networks
structural differences
prefrontal lobe function
PFC is critical to working memory
prefrontal lobe function
matures at a slower pace in ADHD
7.5 years in neurotypical=10.5 in ADHD
MRI shows decreased prefrontal-limbic blood flow
pattern of disrupted activity and connectivity
PFC is critical to working memory
manipulating information in your mind
regulating attention, organization, planning
self-monitor & changing behavior
structural deficits ADHD
delayed brain growth
abnormalities in basal ganglia
overall delayed brain growth relative to neurotypical
smaller right prefrontal cortex & cerebellum
abnormalities in basal ganglia related to reward and learning
BG-> high density of dopamine receptors
smaller caudate & globus pallidus
the frontostriatal circuit
the ventral and dorsal anterior cingulate
also includes portions of the BG
the ventral and dorsal anterior cingulate
control affective & cognitive components of executive control
in ADHD there are abnormalities in the frontostriatal circuits
these extend to the amygdala and cerebellum
PFC, BG & cerebellum are closely connected
cognition & learning
in ADHD
reduced connectivity between cerebellum & PFC
cerebellum dysfunction likely associated w/ difficulty with predicting events & timing
fronto-cerebellar circuit abnormalities might represent a distinct subtype of ADHD
ADHD & dopamine
several symptoms of ADHD are linked with dopamine & norepinephrine in PFC & BG
reward & pleasure
the power of “maybe”
delayed reinforcement of gradient
reinforcement is most effective when it is immediate
delays=much slower learning
in the brains of someone with ADHD
immediate reinforcement= VERY rewarding
delayed reinforcement= VERY weak
problematically in our society- we reward those who can delay gratification
neurotransmitter imbalance
psycho stimulants
upregulate dopamine & norepinephrine activity
psychostimulants
firstline treatment for ADHD
inhibit dopamine reuptake
methylphenidate (ritalin) & amphetamine (adderall)
upregulate dopamine & norepinephrine activity
increase prefrontal activity & down regulate some* BG activity
optimal response curve
ritalin
quick- reaches peak ~2hrs after administration
increase norepinephrine & dopamine in CNS- blocks reuptake
adderall
longer effects- peak 3-7 hrs after taking
increase norepinephrine & dopamine in CNS- blocks reuptake, inhibits auto receptors, increase NT release, increase # of post synaptic receptors
cocaine/methamphetamine
typically taken in increasing doses over time
used recreationally
via injection, intranasally, inhalation
ADHD medications
typically taken in measured & precise doses *(which are monitored & updated as needed)
use is instrumental and specific (1 tablet in the AM and after lunch)
via transdermal patch, oral administration, extended release
strong base of evidence in treating symptoms
increased academic achievement
decreased absenteeism at school
reduced risk of emergency administration t the hospital for injury/trauma
lower risk of depression and anxiety
decreased substance abuse
measurable and significant benefits in children, adolescence & adults
kindergarten teacher
Mrs. Samera
adverse effects of stimulant medication
decreased appetite
sleep disturbances
stomach aches
drowsiness
increased emotionality
increased blood pressure & pulse
sleep disturbances
ADHD already prone to circadian disregulation, can be helped with careful dosing schedule
decreased appetite
slower physical growth in children
risk-benefit analysis
children & adolescence are monitored carefully while on medication
monitored for
height & weight compared to peers
blood pressure & heart rate monitored regularly
prescreen children for other risk factors prior to medication
treatment interruptions/medication holidays
cardiovascular problems in kids
no significant association between these drugs and cardiovascular events
this has been evaluated independently in several different populations & events
a review of 1,200,438 people with ADHD (ages 6-24)
found no increased risk of serious cardiovascular events
FDA conducted a review of sudden death in patients using ADHD medication
14 pediatric & 4 adult cases of sudden death
none were solely or directly related to use of ADHD medication
6 deaths were due to structural cardiovascular abnormalities
there is a significantly reduced risk of SUD when ppl w/ ADHD are given proper medical treatment
reduction in risk taking behavior & inhibition problems
reduction in self-regulating behaviors
ADHD, depression, anxiety
