ADHD

Question 1

A general definition of ADHD,
What are the two main domains?
What do symptoms have to be?
Gender?

Answer 1

o ‘A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development’
o Two domains
 Inattention
 Hyperactivity & Impulsivity
o Several symptoms present before age 12
o Several symptoms present in two or more settings (e.g. home and school)
o Symptoms interfere with social, academic, or occupational functioning.
o Not better explained by another mental disorder.
o Gender differences
 ADHD 3x more common in boys

Question 2

What are the three main psychostimulants?

Answer 2

• Catecholaminergic agonists – affects dopamine, noradrenaline, and adrenaline
• Methylphenidate
• Dexamphetamines
• Amphetamines slightly outperform MPH

Question 3

Three main nonstimulants?

Answer 3

• Atomoxetine (Strattera) – norepinephrine reuptake inhibitor
• Guanfacine – adrenergic agonist

Question 4

Side effects of medications for ADHD?

Answer 4

• changes in appetite and sleep, mood swings, stomach aches.

* Atomoxetine also linked to liver damage and suicidal thoughts.

Question 5

Psychological interventions for ADHD?

Answer 5

 Psychoeducation for children and parents
 Behavioural interventions and other parental training
 Cognitive behavioural interventions - unhelpful thoughts

Question 6

Klein et al., (2012) found that adverse outcomes more likely in ADHD…

Answer 6

 Low educational attainment
 Lower SES, salary
 Higher divorce rates
 Substance problems
 Diagnoses of antisocial personality disorder
o some outcomes are better in those treated with psychostimulants

Question 7

What is the prognosis of Adults ADHD ?

Answer 7

 Adult AHD associated with unemployment
• Stimulant treatment in childhood is protective.
 Associated with substance misuse
• Childhood psychostimulant treatment protective
 Responds to psychostimulant medication,
• Atomoxetine has lower abuse potential
• 90% of adults with symptoms lacked history of childhood ADHD
• Polygenic risk scores for childhood ADHD didn’t predict adult ADHD

Question 8

Heritability of ADHD in children and adults?

Answer 8

 Childhood inattention and hyperactivity domains were 71% and 73% heritable.
 Adult ADHD less heritable – 30%

Question 9

There are no specific SNPs involved in ADHD but…

Answer 9

 Higher rate of rare copy number variants in ADHD than controls
 ADHD patients with rare large CNVs show lower polygenic risk than those without
 Contributes to overall risk with a threshold
 Multiplex families more at risk

Question 10

Name five environmental risk factors for ADHD

Answer 10

o lead, mercury, manganese, and PCB exposure
o pre-natal exposure to alcohol and cigarettes and pregnancy complications
o ADHD remains stable though these have reduced
o Fewer cases of ADHD in sunnier places
o Higher altitude had fewer cases

Question 11

Sleep problems more common in children with ADHD as is…

Answer 11

• Sleep medication use common (22%)
• melatonin effective for treating sleep problems
• used off label
• ~1% of children use melatonin, most commonly to treat ADHD

Question 12

Other endophenotypes than sleep?

Answer 12

o High levels of comorbidity with other disorders
o Delay aversion (marshmallow test)
 Different but related to impulsivity
 Related to dopaminergic pathways (treatments change this)

o Reaction time variability
 Increased in ADHD
 Responds to medication
 Due to brain activity not lapses in attention