medications and behavior: attention and developmental disorders

ADHD prevalence + onset

• prevalence + onset

  • 8% of children 4-17 y/o

• diagnosis

  • usually occurs in elementary

  • input from parents, teachers, other health care providers

  • negatively impacts social + academic/occupational activites

DSM-5 types of ADHD

• inattentive type

• hyperactivity/impulsive type

• mixed

ADHD criteria 

6+ symptoms for 6+ M before 12 y/o 

inattentive type 

• lack of attention for details; makes mistakes 

• trouble maintaining attention

• does not listen

• doesn’t follow instructions 

• organization difficulty 

• avoids/dislikes mental effort tasks 

• loses things

• easily distracted 

• forgetful

hyperactive-impulsive type

• fidgets/squirms 

• gets up from seat 

• runs/climbs when inappropriate 

• trouble playing quietly 

• often “on the go” “driven by a motor”

• talks excessively 

• blurts out answers 

• trouble waiting one’s turn

• interrupts others 

ADHD pathology 

cortical hypoarousal 

• hypoactive RAS 

• decreased projections from thalamus to cortex 

• attentional gate is closed 

  • cortex isn’t aroused by stimuli

• decreased cortical thickness

  • particularly in prefrontal area

    • cause or consequence?

what about hyperactivity?

• self-stimulation to increase arousal

ADHD pathology: dopamine deficit theory

• decreased DA in caudate nucleus + frontal cortex

• increased expression of dopamine transporter (DAT) which decreases availability of DA + receptor activity

measuring ADHD sx

Connor’s Global Index

ADHD pharmacological treatment

• NIMH 1999 study: including stimulants is better than behavioral tx alone

  • also promotes better improvements in academic + social skills

• what about risk of medication abuse or addiction to stimulants?

  • drug abuse risk decreases in those treated w/ stimulants

stimulants for treating ADHD

• amphetamines 

  • dextroamphetamine (Dexedrine)

  • dextro/levoamphetamine (Adderall)

  • lisdexamfetamine (Vyvanse)

• methylphenidates

  • methylphenidate (Ritalin *most common)

  • dexmethylphenidate (Focalin)

*both classes comparable in effectiveness and SE 

other stimulants - modafinil (Provigil)

• increase NE + DA in brainstem + forebrain 

  • regulates sleep + wakefulness

• increase orexin release

  • excitatory neuromodulator that regulates arousal

  • increases histamine in hypothalamus

    • contributes to wakefulness

    • less appetite suppression + less sleep probs than Ritalin

stimulants: side effects 

• arousal

  • insomnia, nervousness, irritability, weight loss, dizziness

• increase NE 

  • hypertension, tachycardia, cardiac arrhythmias

• OD »» psychotic states, seizures, cardiac failure 

non-stimulants for ADHD 

• NE reuptake inhibitors 

  • atomoxetine (Strattera)

  • viloxazine (Qelbree)

• Antihypertensives 

  • guanfacine (Intuniv)

  • clonodine (Catapres)

• Atypical Antidepressant

  • bupropion (Wellbutrin) NDRI

atomoxetine (Strattera)

• catecholamine agonist that blocks reuptake NE + may indirectly increase DA in frontal cortex 

• developed as antidepressant but effective for ADHD 

• effects resemble stimulants 

• side effects 

  • GI discomfort, decreased appetite, insomnia, agitation, increased HR, hypertension

Autism Spectrum Disorder: prevalence, occurrence, gender info

• Autism, Asperger Syndrome, Rett Syndrome 

• prevalence 

  • Autism: 50-70 per 10,000

  • Asperger’s: 20-30 per 10,000

  • 4x greater in males

Rett Syndrome

mostly female infants who are “normal” for 1st 6 M

• rare genetic disorder

• significant language, motor deficits

autism criteria 

• impairment in social interaction

• impairment in communication

• restricted, repetitive, + stereotyped behavior

• delays/abnormal functioning in one of following 

  • social interaction

  • language

  • symbolic play

Asperger’s Criteria

• mild to moderate impairment in social interaction

• mildly restricted, repetitive, + stereotyped behavior

• no clinically significant language delay

ASD pathology CAMAF

• deficits in white matter (myelinated) areas of brain that underlie language comprehension, judgment + social cognition

• anterior cingulate gyrus

  • difficulty filtering + interpreting environment events

• corpus callosum

  • poor hemispheric connections

• frontal cortex

  • executive functions compromised

• amygdala

  • disproportionate social anxiety

*ASD etiology remains elusive but linked to protein growth factor neuregulin (important in cell signaling)

autism symptoms 

• self-stimulating behaviors (eg rocking)

• terse + odd communication patterns 

  • one words answers

  • speaking in 3rd person

• abnormal visual processing (eg avoiding eye contact, difficulty reading facial expressions0

  • FFA malfunction (fusiform face area)

• unresponsive or rigid posture in response to touch or affection

pharmacological treatment for ASD

medication does not treat actual disorder

• typically treating symptoms that co-occur w/ autism

• depression, anxiety, hyperactivity, seizures, behavioral problems