1: ADHD Flashcards Preview

ICM > 1: ADHD > Flashcards

Flashcards in 1: ADHD Deck (31)
1

prevalence and impact of ADHD

-prevalence rate: 6-10%
-male more than females

2

diagnostic criteria for inattention symptoms of ADHD

need at least 6 of the following:
-fails to give close attention to details/ makes careless mistakes
-difficulty sustaining attention
-doesn't seem to listen when spoken to directly
-doesn't follow through on instructions/fails to finish work
-difficulty organizing tasks and activities
-avoids tasks requiring sustained mental effort
-loses things necessary for tasks/activities
-easily distracted by extraneous stimuli
-forgetful in daily activities

3

diagnostic criteria for hyperactivity-impulsivity symptoms of ADHD

need at least 6 of the following:
-difficulty playing/engaging in activities quietly
-always on the go or acts as if driven by a motor
-talks excessively
-blurts out answers
-difficulty waiting in lines or awaiting turn
-interrupts or intrudes on others
-runs about or climbs inappropriately
-fidgets with hands or feet or squirms in seat
-leaves seat in class/situations when expected to sit

4

general diagnostic criteria for ADHD

-symptoms present before age 12
-clinically significant impairment in social or academic/occupational functioning
-symptoms that cause impairment in 2 or more settings
-not due to another disorder

5

three subtypes of ADHD

-combined type
-predominantly inattentive subtype
-predominantly hyperactive/impulsive subtype

6

describe the combined type of ADHD

-clinical levels of both inattention and hyperactivity/impulsivity
-most common subtype

7

describe the predominantly inattentive type of ADHD

-clinical levels of inattention only
-often not identified until middle school
-sluggish cognitive tempo

8

describe the predominantly hyperactive/impulsive type of ADHD

-clinical levels of hyperactivity/impulsivity only
-more common among very young children prior to school entry

9

associated peer problems

-inattentive sx -> ignored
-hyperactive/impulsive sx -> actively rejected
-not deficient in social reasoning/understanding, but rather the execution of appropriate social behavior

10

associated family dysfunction/parental issues

-no clear causal relationship b/w family problems and ADHD
-family probs can impact the severity and developmental course/outcomes of ADHD

11

associated problems with self-esteem

-inflated: positive illusory bias (Hoza)
-low self esteem associated with co-morbid depression

12

developmental course of ADHD

-persistent across lifespan in most cases
-inattention remains stable
-hyperactivity declines with age
-adult outcomes including psychiatric comorbidity (conduct disorder or depression or anxiety)

13

etiological factors of ADHD: heritability

.80-.85 (extremely high)
-environmental factors are not the cause, but may contribute to the expression, severity, course, and comorbid conditions

14

etiological factors of ADHD: prefrontal lobe dysfunction

-involved in inhibition, executive functions
-abnormal brain activation during attention and inhibition tasks

15

etiological factors of ADHD: genes involved in dopamine regulation

-dopamine transporter DAT1 gene implicated
-7 repeat of dopamine receptor gene DRD4 implicated
-gene x environment interactions

16

etiological factors of ADHD: possible differences in size of brain structures

-prefrontal cortex
-corpus callosum
-caudate nucleus

17

ADHD differences in brain structure and function

-diffs in brain maturation, structure, fxn - particularly in frontostriatal circuitry (prefrontal cortex, basal ganglia, cerebellum)
-these areas are associated with executive fxn abilities:
-attention, spatial working memory, short term memory
-response inhibition and set shifting

18

what neurotransmitters are different in ADHD?

**dopamine
*norepi (mostly a dopamine prob, but dopa makes norepi)
-epi
-serotonin

dopamine associated with approach and pleasure-seeking
norepi role in emotional/behavioral regulation

19

executive functioning deficits

deficits in cognitive processes which activate, integrate, and manage other brain functions (sx overlap with ADHD, but not all kids with ADHD have EF deficits)
-cognitive: working memory, planning, organizing strategies
-language: verbal fluency, communication
-motor: response inhibition, motor coordination
-emotional: self-regulation of emotion, frustration tolerance

20

what is the basis of executive functioning deficits in ADHD?

behavioral disinhibition - a performance, rather than knowledge, deficit

21

evidence-based assessment of ADHD

*teacher and parent-completed questionnaires (Connor scales)
-structured clinical interview with parent(s)
-IQ/achievement testing to screen for learning disabilities (50% comorbidity)
-behavioral observations at home and school
-no medical screen, cognitive test, or brain imaging technique can detect ADHD
-kids with ADHD can focus long enough to watch TV, play video games or sit still at doc's office

22

well-established ADHD treatments

-stimulant meds
-behavioral interventions
-behavioral parent training
-behavioral classroom management
-intensive summer treatment programs

23

what are the best known stimulant meds for ADHD?

methylphenidate
-Ritalin
-Concerta
-metadate

dextroamphetamine
-Adderall

24

how do these stimulant meds reduce ADHD symptoms (mechanism of action)?

-block reuptake of norepi, dopamine and facilitate their release
-enhances norepi, dopamine availability in certain brain regions: prefrontal cortex, basal ganglia

25

how do these stimulant meds reduce ADHD symptoms (visible behavior changes)?

-extremely effective short term
-decrease disruption in class
-increase academic productivity and on-task behavior
-improve teacher ratings of behavior

26

common side effects of ADHD stimulant meds

-insomnia
-decreased appetite

27

what is an alternative non-stimulant medication for ADHD?

strattera/atomoxetine
-non-stimulant alternative
-could need 4-6 weeks to work
-hasn't been studied as long as the stimulants
-smaller effect size relative to stimulants

28

limitations of stimulant treatment

-individual differences in response (80% respond)
-limited impact on domains of fxnal impairment
-does not normalize behavior (managed, but not cured)
-family problems beyond scope of medication
-no long-term effects established
-long-term use rare
-limited parent/teacher satisfaction
-some families not willing to try meds

29

ADHD behavioral treatment components

-psychoeducation about ADHD
-structure/routines
-clear rules/expectations
-attending/rewards
-planned ignoring
-effective commands
-time out/loss of privileges
-point/token systems
-daily school-home report card
-intensive summer treatment programs

30

multi-modal treatment study for ADHD (MTA) - describe the set up/parameters

-6 sites
-579 kids, 7-9 y/o
-ADHD, combined type
-assigned to 14 months of:
-med management
-intensive behavior therapy
-combined treatment
-treatment as usual in the community (TAU)

31

MTA results

-all groups showed reduced ADHD over time
-meds alone + combined therapy did better than behavior therapy alone and TAU
-combined tx was often not better than meds alone
-higher med doses were needed in meds alone group relative to combined tx group