L15 - ADHD pt 2 Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

What are the treatments for ADHD

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Ritalin? (Methylphenidate)

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe Atomoxetine

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are non-pharmacological treatments?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What was the multimodal treatment of children with ADHD?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What were the follow-up studies

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why does ADHD get criticised?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is ADHD a modern disorder?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Is ADHD normal behaviour but public mis-behaviour?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Is there a bias to a biomedical view?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Is ADHD over/mis diagnosed

A
  • Diagnosed too much
  • Over-prescribed in Austraila by 72% for ADHD drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Over-prescription of Ritalin

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Are the criticisms justified?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Prognosis of ADHD?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly