ADHD Lecture Notes Flashcards

Flashcards based on lecture notes about Attention Deficit Hyperactivity Disorder (ADHD).

ADHD

Attention Deficit Hyperactivity Disorder; a heterogeneous psychiatric disorder characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity.

Epidemiology of ADHD

Most common neurobehavioral disorder in children, estimated to occur in 4.3% to 12% of school-aged children. Onset usually by age 3 but must occur before age 12.

Gender Differences in ADHD

Males are 3 to 6 times more likely to have ADHD than females in school-aged children. During adolescence, the incidence is equal between males and females.

Adult ADHD Prevalence

Estimated to be 4%, with 60% of adults having manifested symptoms of ADHD from childhood; associated with social, marital, academic, career, anxiety, depression, smoking, and substance abuse problems.

Genetic Factors in ADHD

A child with a parent with ADHD has a 50% chance of developing ADHD. 10% to 35% of children with ADHD have a first-degree relative with ADHD.

Environmental Contributors to ADHD

Fetal alcohol syndrome (FAS), maternal smoking (2.7-fold increased risk), hypoxia in-utero, and lead poisoning.

Altered Neurotransmission in ADHD

Dysfunction of norepinephrine (alertness and attention) and dopamine (learning, motivation, goal setting, and memory) is thought to be key in the pathology of ADHD.

Clinical Presentation of ADHD

Patients aged 4 to 18 years presenting with inattention, hyperactivity, impulsivity, academic, and/or behavioral problems should be evaluated for ADHD.

Core Problems of ADHD

Inattention, hyperactivity, and impulsivity.

DSM-5 Presentations of ADHD

Predominantly inattentive, predominantly hyperactive-impulsive, and combined.

Diagnostic Criteria for ADHD

Must exhibit 6 of 9 symptoms before 12 years of age that persist for at least 6 months; symptoms must be present in two or more settings and adversely affect functioning.

Adult ADHD Assessment Difficulty

Diagnosis is always suspect in patients failing to display clear symptoms before 12 years of age; requires a minimum of five symptoms of hyperactivity/impulsivity or inattention.

Comorbidities with ADHD

Between 50% and 60% of patients with ADHD will have one or more comorbidities (e.g., learning disabilities, oppositional defiant, anxiety or depressive disorders).

Adult ADHD Self-Report Scale (ASRS-V1.1)

A symptoms checklist developed in conjunction with the World Health Organization (WHO) for evaluating ADHD in adults.

Primary Therapeutic Goals for ADHD

To improve behavior and increase attention.

Secondary Goals of ADHD Treatment

Improve relationships, decrease disruptive behavior, improve academic performance, increase independence, and minimize adverse effects of therapy.

Nonpharmacologic Treatment for ADHD

Behavioral therapy; involves training parents, teachers, and caregivers to change the environment and establish a reward or consequence system.

First Line Pharmacological Treatment for ADHD

Stimulants, such as methylphenidate, dexmethylphenidate, amphetamine salts, dextroamphetamine, and lisdexamfetamine.

Non-Stimulant Medications for ADHD

Atomoxetine, bupropion, TCAs (e.g., imipramine), clonidine, and guanfacine.

Stimulants Mechanism of Action

Exert their primary effect by blocking the reuptake of dopamine and norepinephrine.

Stimulant Effectiveness

Safe and effective, with response rates of 70% to 90% in patients with ADHD.

Stimulant Trial Period

Should be initiated at recommended starting doses and titrated up, with a trial of at least 3 months to assess effectiveness.

Common Stimulant Side Effects

Fidgeting and finger tapping decrease, increase on-task classroom behavior and positive social interactions

ADHD Stimulant Contraindications

Glaucoma, severe hypertension, cardiovascular disease, hyperthyroidism, severe anxiety, previous illicit or stimulant drug abuse, seizure disorders, Tourette syndrome, and motor tics.

Short-Acting Stimulant Formulations

Initial response within 30 minutes, lasts 4 to 6 hours; may require twice-daily dosing, increasing the chance of missed doses and noncompliance. Risk of rebound effect as stimulant wears off.

Extended-Acting Stimulant Formulations

Designed to minimize rebound problems with rapid onsets. Examples: Adderall XR, Focalin XR, Metadate CD, Ritalin LA (pulsed release), Concerta (continuous release).

Extended-Acting Stimulants with Slower Onsets

Daytrana transdermal patches (delayed onset of 2 hours, effects persist for 3 hours after removal) and Vyvanse (prodrug, onset of action reported to be 2 hours).

Stimulant Onset and Duration

Short-acting (30 min, 4-6 hrs), Intermediate-acting (60-90 min, 6-8 hrs), Extended with rapid onset (30 min, 6-12 hrs), Extended with slow onset (120 min, 12 hrs).

Stimulant Side Effects Management

GI upset (giving with food), sleep disturbance (dose earlier in the day), headache (decrease dose), rebound symptoms (long-acting preparations).

Non Stimulants

Less effective than stimulants and requires 4 weeks for response. Ex:Atomoxetine; Bupropion; Clonidine; Guanfacine

Important Notes on Stimulant Use

Serious side effects (e.g., hallucinations and tics) require discontinuation. Give stimulants 30 to 60 minutes before eating to avoid drug-food interactions.

Growth Suppression/Delay with Stimulants

Major concern but appears to be transient and resolves by mid-adolescence.

Atomoxetine (Strattera)

Selective NE reuptake inhibitor, lacks abuse potential, not a controlled substance. Use if patient fails or is intolerant to stimulants. Strong warnings about severe hepatotoxicity and increased association with suicidal thinking.

Bupropion (Wellbutrin)

Antidepressant that weakly inhibits NE and dopamine reuptake. Side effects include insomnia, headache, nausea, and tremor. Contraindicated in patients with seizure and eating disorders.

Clonidine & Guanfacine

Central α2-adrenergic agonists that inhibit NE release in brain stem. Used as adjuncts to stimulants for disruptive behavior and insomnia. Side effects: low blood pressure and sedation.

Outcome Evaluation of ADHD Treatment

Document core ADHD symptoms at baseline. Improve family/social relationships, disruptive behavior, completing tasks, self-motivation, appearance, and self-esteem. Evaluate every 2 to 4 weeks initially, then every 3 months.