ADHD Flashcards
Diagnostic requirements
- Present >6months
& 2. impacting
& 3.symptoms present prior to 12 years of age
&4.signs not present only during psychotic episode
& 5. signs not more readily explained by other illness
& 6. six or more signs of attention deficit (5 for adult)
&/or 7. 6 or more signs of hyperactivity (5 for adult)
severity levels
mild/moderate/severe based on symptoms and life impact
May also have remission, where still mildly impacting life but insufficient symptoms now for dx.
minimal brain dysfunction
term describing conditions such as ADHD where there is dysfunction but not obvious brain damage.
methylphenidate (ritalin)
Stimulant medication used to treat ADHD. Dopaminergic. Common side effects are nausea, nervousness, agitation,stomach pain,insomnia, weight loss. Can be euphoric in large doses and also addictive at high doses. Helpful for 70% in symptom reduction but no long term study says better occupational outcome etc.
benzadrine
first formulation containing amphetamine. was used for headaches, decongestant, ADHD
Adderall
contains amphetamine and dextramphetamine. Second line tx for ADHD or narcolepsy. Side effects nausea, weight loss, insomnia, anxiety,headache, v+/d+
epidemiology of ADHD
Stable world-wide 5% prevalence in childhood. 2/3rds of childhood cases persist into adulthood.
neuroimaging and pathophysiological findings in ADHD
decreased cortical thickness, decreased cerebral volume, underdeveloped prefrontal cortex, cingulate gyrus, cerebellum and basal ganglia. Atypical functional activation of left inferior prefrontal cortex and left parietal lobe. Dysregulation of synaptic plasticity and neural networking. Abnormalities in dopamine and nor-adrenaline systems.
Common comorbidities
Most ADHD have at least 1 comorbidity.
ODD (Oppositional Defiant Disorder), Conduct Disorder, DMDD (Disruptive Mood Dysregulation Disorder), Anxiety, Depression, Language Disorder, Tourette’s, Learning Disorder, Sleep Disorder.
Causes of ADHD
Many individual small effects combine to form risk. Multiple genes especially involved in catecholamine, dopamine and serotonin regulation, and synaptic development.
pre-natal risks such as maternal stress, smoking, drug use,alcohol. Low birth weight and premature birth. And Post natal factors such as organophosphates, lead, psychosocial deprivation, coercive parenting etc.
multifinality
term describing how people may have very similar experiences yet very different final outcomes.
Polygenic Liability Threshold Model
Polygenic= multiple genes influence outcome, is not 1 dominant gene.
Liability or risk + sum of all genetic and environmental risk factors.
Polygenic Liability Threshold Model;
imagine normal bell curve, this expressing liability for a disease in the population. Somewhere eg at 75% along x axis (may vary), is the threshold of liability , ie all individuals graphed to right of this have disease and those to left, do not.
scaffolding behaviour
supported learning with much initial support and gradually requiring less support. Thought some maternal scaffolding in regards self control etc may be somewhat protective of ADHD.
Some ADHD standardized scales.
- Vanderbilt ADHD DiagnosticRating Scales. Parents fill in, regarding child 6-12 years of age. Provides scale of how severely affected, as well as some info on comorbidities.
- Swanson, Nolan & Pelham (SNAP)-IV Rating Scale. Teachers and Parents complete. For children and yound adults with ADHD and or ODD.
- Adult ADHD Self-Report Scale.
Management strategies for ADHD
- Interventions targeting social functioning, academic achievement, occupational functioning.
- School support
- Medications.
- Behavioural training programs.
- Address comorbidities as required.
