ADHD - treatment and controversy

Question 1

methods of treatment involve combinations of?

Answer 1

• medications (mainly Ritalin)
• behaviour modifications
• life-style changes

Question 2

medication for ADHD targets what NTs and what drugs are usually given?

Answer 2

• targets dopamine/noradrenaline
• Ritalin and Atomoxetine

Question 3

is there a cure for ADHD?

Answer 3

• NO
• only attempts at alleviating symptoms

Question 4

how many children in US currently receive ADHD treatment?

Answer 4

3/4

Question 5

R

what is methylphenidate and how does it work?

Answer 5

• Ritalin
• stimulant amphetamine derivative (speed)
• paradoxical action: stimulant drug enhances activity normally but in ADHD reduces activity/improves cognition
• acts to inhibit DAT function = increase in dopamine

Question 6

what are limitations and side effects of Ritalin?

Answer 6

• limitations = decreased appetite, headaches, sleep problems
• side effects = motor tics, irritability, nausea

Question 7

is there a risk of addiction/substance abuse with Ritalin?

Answer 7

YES

Question 8

SNRI,inhibits…, what kind of drug

what is atomoxetine and how does it work?

Answer 8

• Strattera
• selective noradrenaline reuptake inhibitor
• inhibits NET function
• non-stimulant drug
• lower risk of abuse but some side effects

Question 9

what was the first non-stimulant drug approved by FDA?

Answer 9

atomoextine/Strattera

Question 10

what are some non-pharmacological treatments of ADHD?

Answer 10

• parental training
• academic interventions
• peer related interventions

Question 11

what are some limitations of non-pharmacological treatments of ADHD?

Answer 11

• behavioural gains only during period of treatment
• not applicable to all cases
• smaller effect sizes than medication
• difficulties in provision – involved parties, continuity, high cost

Question 12

what is the multimodal approach to treating ADHD?

Answer 12

• use of combined interventions
• pharma + non-pharma

Question 13

what are some criticisms about ADHD?

Answer 13

• modern disorder because of increased demands on children, result of bad parenting/lazy teachers
• bias to a biomedical view as no blood test for it, may be over-prescription of drugs, concern about children using drugs, drugging problematic children

Question 14

is ADHD a modern creation?

Answer 14

• 1798 book described “mental restlessness” similar profile to inattentive ADHD
• use of stimulant medicine (amphetamines) in hyperactivity since 1930s

Question 15

how have modern life demands changed and why are ADHD symptoms complex?

Answer 15

• modern life demands = increased expectations, longer periods of concentration, school demands and busier homes
• ADHD symptoms may reflect different forms/rates of cog. development (learning problems, maturational delay and temperament difference)

Question 16

how does too much poor-quality biological info about ADHD affect thoughts around the disorder?

Answer 16

• the aetiology of ADHD is perceived to be a disease caused by biomedical factors, for which psychostimulant medication is an effective and safe intervention’
• theoretically challenged on the basis that no biological abnormality has ever been specifically or unambiguously linked to the aetiology of ADHD through mechanism of conventional techniques
• also criticise : use of MRI, inconsistency in genetic studies, lack of bio-marker (blood test) or specific psychological test

Question 17

what is the problem with mis/over diagnosis of ADHD?

Answer 17

• convincing evidence was found that ADHD is over-diagnosed in children and adolescents
• for individuals with milder symptoms in particular, the harms associated with an ADHD diagnosis may often outweigh the benefits
• reflection of ongoing controversy about the proper identification of these conditions, and these views negatively impact attitudes towards drug treatment

Question 18

what are the implications of an over-prescription of Ritalin?

Answer 18

• doctors are finally being urged to reduce the use of Ritalin and other ‘chemical coshes’ against children with ADHD
• too many children are being given the drugs, says the UK’s National Institute for Clinical Excellence (Nice)
• the situation is far worse in the USA where prescriptions are written for around 5 million children and adolescents
• Nice says the drugs should be reserved for those children who are severely affected by the problem

Question 19

what are the reasons for the over-prescription of Ritalin?

Answer 19

• improper (over-)diagnosis
• easiest treatment option
• parental/teacher pressure
• pharmaceutical greed

Question 20

what impairments can having ADHD cause in life (adolescents)?

Answer 20

• children diagnosed with ADHD have significant difficulties in adolescence, regardless of treatment
• increased risk of adverse life outcomes when teenage, including car crashes, injury and higher medical expenses, earlier sexual activity, and teen pregnancy
• ADHD persists into adulthood in about 30-50% of cases and those affected are likely to develop coping mechanisms as they mature

Question 21

having ADHD as an adult can affect?

Answer 21

• education
• occupation
• social relationships
• sexual activities, dating and marriage
• parenting and offspring psychological morbidity
• crime and drug abuse
• health and related lifestyles
• financial management, or driving