ADHD Flashcards
What are the hyperactive Sx of ADHD?
- fidgetiness
- intrusiveness
- restlessness
- noisiness
- talkativeness
- inappropriate activity
What are the inattentive Sx of ADHD?
- distractability
- forgetfulness
- poor organization
- impersistance
- mistake-prone
- work avoidance
What is the course of ADHD?
- onset by 12…concern for school
- 12-20…20% remit, 60% partial remission
- hyperkinesis first, followed by inattention
Roughly _____ of children with ADHD continue to manifest significant symptoms into adulthood.
50%
- symptoms will move away from hyperactive and inattentive will dominate
What is the etiology of ADHD?
- genetics
- right-sided hypofrontality
- locus ceruleus under-performs (alarm center)
- virus in utero
- worsened by stressors
- more evident in routined settings (school)
What is the neuropathology of ADHD?
- small increase in cerebrum growth (age 1-3)
- reduced number of cerebellar purkinje neurons (~30%)
- reduced cell size, increased cell density in limbic areas
- modified genes/proteins impairing the balance of excitatory vs. inhibitory synaptic signals
If you have a first degree relative with ADHD, you have _______x the risk of developing ADHD.
4-8
What toxic exposures increase the risk of developing ADHD?
- FAS
- meningitis
- lead poisoning
- obstetric adversity (pregnancy healthcare)
- maternal smoking
- adverse or absent parent-child relationship
What are the controversial triggers of ADHD?
- artificial flavors, colors, additives
- refined sugars, sodas, caffeine
- food allergy or intolerance
- essential fatty acid deficiency
- iron and zinc deficiency
What is the multimodal approach to ADHD?
- behavioral…“rewards and privileges” with structure, checklists and attainable goals
- avoiding triggers, if known
- chiropractic approach
- when meds needed = combo Tx (need support)
What are the treatment goals of ADHD?
- collaborate with school and support system
- realistic, achievable, measurable goals (change over time)
- may include relationship factors, academic performance, rule following
- clarity, immediacy, predictability, consistency, responsibility are vital
What are the deficits of ADHD?
- Inhibition of the ability to control behavior, resist distractions, develop an awareness of space and time
- arousal dysregulation (insufficient alertness alternating with over-arousal)
- under-performing NTs
What are the neurochemical targets of ADHD?
- Tx involving stimulants (first line)
- stimulants help with the under-performing of the dopaminergic and noradrenergic tracts
How do psychostimulants help ADHD?
- all block NE and DA reuptake
- increased NE/DA activity in the locus ceruleus improves attention, ability to focus or “select”
- amphetamines also promote NE and DA release from presynaptic neurons
What are the adverse effects of stimulants?
- may decrease appetite
- may increase BP, anxiety, irritability, difficulty falling asleep, stomach complaints, headache
- may worsen tics
- RARELY causes personality to “flatten” or increases the risk of sudden cardiac death
