ADHD revision

ADHD

A neurodevelopmental condition characterised by inattention, hyperactivity, impulsivity and/or inattention

Presentations of ADHD

1. Inattention

2. Hyperactivity/impulsivity

3. Combined

Most people have combined presentation, but adults and girls more likely to have singular presentation of inattention

Diagnosis in CYP

No objective markers. Psychiatric interviews conducted with parent if client is child, or client if adolescent, and rating scales (Connor’s Rating Scale for ADHD) and neurological tests (QB-Test) support clinician’s judgement

Liability threshold model

Neither genetic or environmental risk factors are sufficient to cause ADHD, but they interact and accumulate and when a certain threshold is overcome, ADHD symptoms manifest

Genetic risk factors

• Dopamine system genes

• Inherited from family

Environmental risk factors

• Toxins, alcohol, cigarettes during pregnancy

• Premature birth

• Low birth weight

Executive function theory

Says people with ADHD have deficits in vigilance, response inhibition, working memory and planning as the brain hasn’t developed as it should

Shaw et al. (2007)

People with ADHD had delayed cortical maturation

Evaluation of executive function theory

• Good theory as explains inattention part of ADHD

• But doesn’t mention hyperactivity or impulsivity

State regulation theory

Says people with ADHD struggle to regulate their levels of attention in certain conditions. Inattention is due to cortical and autonomic hypoarousal. Hyperactivity is a strategy to up-regulate arousal by things like stimming

Evaluation of state regulation theory

• Partly valid as we know the things above

• But doesn’t explain the whole picture of ADHD

Delay aversion theory

Says people with ADHD have altered processing of rewards and become impulsive when waiting for a delayed reward

Support for delay aversion theory

People with ADHD have altered functioning and structure of brain systems involved in reward processing, and lower dopamine, making reward processing more difficult

NICE-recommended management in preschoolers

ADHD focused group parent training, consider medication if symptoms still impairing

NICE-recommended management in children/adolescents

• Group based ADHD support

• Medication if symptoms still impairing

• CBT if still impairing with medication (adolescents only)

NICE-recommended management in adults

• Medication

• Psychological intervention if doesn’t work - NHS isn’t currently providing this

Best management of ADHD is…

Via combined pharmalogical and psychological interventions, e.g. CBT/mindfulness

Co-occurring conditions

• 10x more likely to have CD/ODD

• 5x more likely to have depression

• 3x more likely to have anxiety

• More likely to have other neurodevelopmental disorders, substance use disorders and emotional dysregulation

Importance of individualised support and transdiagnostic focus

Acknowledges the condition’s varied presentation and high rate of co-occurring conditions, leading to more effective, holistic and person-centred care that goes beyond a single diagnostic label