Chapter 8: ADHD Flashcards
Incidence of ADHD
diagnosis increased dramatically from 6% of children in 1997 to 10% of children in 2017
Reasons for increased diagnosis:
* increased awareness
* more expansive definition of ADHD
* increased environmental exposures & societal stressors
* misdiagnosis d/t inadequate evaluation
Comorbid OCD or conduct disorder (CD) in 50% of cases or hyperactive / combined type
Comorbid anxiety/ depression in 45% of cases of inattentive/ combined type
diagnostic criteria of ADHD (DSM-V)
Inattention type: At least 6 of following (5 if 17yrs+) for 6 months that interferes with social, academic, occupation:
* fails to pay attention to details, makes mistakes
* difficulty sustaining attention in tasks or play
* doesnt seem to listen when spoken to directly
* doesnt follow through, doesnt finish work
* difficulty organizing tasks/ activities (includes messy)
* dislikes tasks requiring sustained mental effort
* loses necessary things
Hyperactive/ Impulsive type: (same # and timeline)
* fidgets, taps, squirms
* leaves seat at inappropriate times
* runs/ climbs when inappropriate
* unable to play quietly
* “on the go” - uncomfortable being still, restless
* talks a lot
* blurts answer before question is done
* difficulty waiting turn
* interrupts/ intrudes on others
Features present before age 12
Features present in two or more settings
Symptoms interfere with function
Not better explained wit hother mental disorder
Symptoms not due to deliberate disobedience or lack of understanding instructions
There is also a combined type (with inattention and hyperactivity)
Persists into adulthood 35-65% of the time!
People with ADHD often have significant strengths and successes - creativity, empathy, innovation
Behavioral scales are used to diagnose but should be taken in context of thorough eval otherwise they likely misdiagnose (scales alone have poor specificity and are very subject to bias).
Pathophysiology and risk factors for ADHD
- MRI differences in brain volume, cortical thickness, white matter
- Mostly in basal ganglia, prefrontal cortex, corpus callosum
- differences in neural activity hemodynamics in studies
- catecholamine metabolism plays key role
- genetic predisposition is present/ inheritability
- Risks: male sex, IUGR, excess screen time, early tobacco/smoke, phthalates/ phenols, pesticides, food additives
Stimulants for ADHD
- Methylphenidate and dextroamphetamine
- good in the short term, but studies show no effect after longer durations of treatment (good at 14 months, no change between treated in untreated kids at 3 yrs and 6 yrs)
- 70% of kids will respond. Kids often respond much better to one agent than the other
- SIDE EFFECTS: appetite loss, insombia, GI upset, palpitations, headache, dizziness, anxiety, aggression. Also subtle changes - “Kids are just not themselves, lost their joy”
Non-stimulant pharmaceuticals for ADHD
Atomoxetine (Strattera)
* similar to an SSRI
* Also effective in short term, usually second-line
Guanfacine
* clonidine derivative
* effective as an adjunct to psychostimulants
AAP recommendations for screen time
(ADHD chapter)
- 6 yrs and older: 2 hrs max per day of digital media
- 3-5 yrs: 1 hour max per day
- 2 and under: no screens (exception FaceTime)
Types of screen time may be better (ie family movie time) or worse (video game alone in room)
Some data that kids with developmental delays spend more time exposed to television.
Sleep disorders in kids with ADHD
- longer sleep latency
- more sleep cycles
- circadian rhythm abnormalities
ADHD symptoms can be improved by increasing quantity and quality of sleep! Avoid screen 1 hour before bed, avoid caffeine 6 hours before bed
Consider melatonin! Can be safe in kids for up to 52 weeks continuously.
What is the ideal room temp for sleep
Cool, between 65 - 70 degrees.
What types of exercise are good for kids with ADHD
- moderate-to-intense exercise
- martial arts
- yoga
- swimming
- 30-60 min per day. Even in bursts (like during school)
school accomodations for ADHD
- 504 plan (section 504 of rehabilitation act of 1973) or individualized education plan (IEP)
- ADHD falls under definition of “disability” for both of them
- kids sit at front and away from windows
- nonverbal cues from teachers to stay on track so as to not felt called out
- extra time to complete tasks
- rewards systems
Teachers that are the best fit: has inherent structure (with some flexibility) with at endency towards giving generous amount of positive feedback
Note - not all adults with ADHD qualify as having a disability under the Americans with Disabilites Act (ADA)
what is an ADHD coach
An ADHD coach helps individuals improve executive functioning with skills and strategies to combat the core impairments of ADHD, such as planning, time management, goals setting, organization, and problem solving. Although further research is needed, several small studies done in college students have shown improvements in measures of time management, anxiety, self-efficacy, and study skills through ADHD coaching.38
true or false: studies have shown significant improvements in driving in adolescents with treatment of ADHD
True!
Kids with ADHD are at greater risk for injury
Teens with ADHD are more likely to get into MVCs
does the type of environment outdoors matter for symptom improvement in ADHD
Yes. Greenspaces are more beneficial for ADHD symptoms as opposed to nongreen spaces (either indoors or built outdoor settings)
What is the role of sugar consumption and ADHD
- Many studies show NO association between consuption and hyperactivity, and no association between consuption over time and risk of ADHD
- One study showed sugar-sweetened beverages increased risk of ADHD
- Another showed eating low-glycemic breakfast can improve cognitive function –> for the authors this is very important!
Role of food additives in ADHD
- links between artificial colors, artificial flavors, and preservatives on hyperactivity
