T8 - ADHD Flashcards
Diagnostic Criteria for ADHD:
- 3 things to look for
- hyperactivity or impulsivity
When diagnosing ADHD we look for:
- Amount of symptoms
- How often they occur
- And the impact on their life
DSM-V defines ADHD as ‘a persistent pattern of inattention and/or hyperactive impulsivity that interferes with functioning or development
- it is classified as a neurodevelopment disorder
Signs of inattention in ADHD:
Inattention:
Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is inconsistent with developmental level and negatively impacts directly on social and academic/occupational activities:
- Difficulty sustaining attention
Inattention
- Often does not follow instructions and fails to finish schoolwork, chores or duties in the workplace
- Often does not seem to listen when spoken to directly
- Often has difficulty organising tasks and activities
- Often loses things needed for tasks and activities
- Often avoids, dislikes or doesn’t want to do things that take a lot of mental effort
- Easily distracted by extraneous stimuli
- Forgetful in daily activities
Signs of Hyperactivity or impulsivity:
Hyperactivity or impulsivity:
Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is inconsistent with developmental level and negatively impacts directly on social and academic/occupational activities:
- Fidgets with hands or feet or squirms in seat
- Gets up from seat when remaining in seat is expected
- Runs about or climbs when and where it is not appropriate o -
- Trouble enjoying or playing leisure activities quietly
- Is often “on the go”
o Blurts out an answer before the question is completed
- Difficulty waiting
- Interrupts
- Often talks excessively
The three presentation types of ADHD:
Trends/prevalence of ADHD
- Combined:
- Children meet the threshold for both inattention and Hyperactive/impulsivity symptoms
- Have met the requirements for at least 6 symptoms in each of these domains - Predominantly inattentive:
- Only meet the threshold for the inattentive symptoms - Predominantly Hyperactive/Impulsive:
- Just meet criteria for the hyperactive and impulsive type
Prevalence:
- ADHD effects about 5% of children worldwide
- Is more common in males than females
- Is more common in children than adolescents
- 2.5% in the general population meet the criteria for ADHD
- Many individuals with ADHD are not being identified (50%)
- Females much less likely to be referred
Neurobiological Factors associated with ADHD:
- Executive functioning deficits
- Reward dysregulation - prefer immediate over delayed rewards and therefore make poor decisions
- Deficit in arousal - sluggish
- Can be very emotional and irritable
Neuroimaging:
- MRIs have shown reduced cortical thickness
- reduced cerebral volume
- Smaller volume of some subcortical structures
- Underdeveloped prefrontal cortex, cingulate gyri, cerebellum and basal ganglia
Factors associated with ADHD:
- 16 genes associated with ADHD
- A number of environmental factors combine with genetics to determine ADHD or not
- Maternal smoking, alcohol and illicit substances during pregnancy
- Low birth weight/prematurity
- Maternal stress during pregnancy, post-natal depression
- Environmental toxins: lead, organic pollutants
- Severe early life psychosocial deprivation
- Harsh and coercive parenting
- Nutritional deficiencies (e.g. polyunsaturated fatty acids)
- Dietary sensitivities (e.g. artificial food colourings and preservatives)
- ADHD is highly heterogenous - no one child is the same.
ADHD Assessment:
- Clinical assessment:
What are the National Institute for Health and Clinical Excellence Guidelines?
Clinical:
- Detailed interview with the parent
- Standardised behaviour rating scales to assess ADHD symptoms
Guidelines:
- ensure that people with ADHD have a comprehensive, holistic shared treatment plan that addresses psychological, behavioural and occupational or education needs. Take into account:
- The severity of ADHD symptoms and impairment, and how these affect or may affect everyday life
- Their goals
o Their resilience and protective factors
o The relative impact of other neuro-developmental or mental health conditions
Managing ADHD - non medicinal
School support:
- Psychoeducation
- minimalising visual clusters and mess
- smaller classes
- reminders to keep on task
- positive reinforcement
- checking the student has understood the instruction
- assistance with pacing their school work
- planned regular breaks
- additional tuition
Medication for ADHD
- About 80% of children with ADHD are taking medication if they are seeing a health
professional - About 70% of children with ADHD will have a positive clinical response (will see
improvements) - Stimulants affect dopamine and noradrenaline neural networks
- dexamphetamine
- methylphenidate
- Lisdexamfetamine
- Specific noradrenaline re-uptake inhibitor
