100b - ADHD

Question 1

Which areas of the brian are affected by ADHD?

Answer 1

• Prefrontal cortex
  
  • Executive function and planning
• Striatum
  
  • Reward, reinforcement
  • Motivation for behavior and activities
• Some cerebellum
• Overall brain volume

Question 2

What is the mechanism of action of atomoxetine in the treatment of ADHD?

In which patients is it indicated?

Answer 2

Selective norepinephrine reuptake inhibitor

Works as an antidepressant to treat ADHD + anxiety

**Black box warning: increased suicidal thoughts in teenagers**

Question 3

What comorbididities should we be aware of in children with ADHD? (4)

Answer 3

• Behavior or conduct problem
• Anxiety
• Depresssion and othe rmood disorders
• Autism spectrum disorder
• Learning and/or speech disorders
• Tourette syndrome
• Substance use disorder
• Obesity

Question 4

What environemtal exposures contribute to risk of ADHD?

Answer 4

• Smoking, alcohol, drugs during pregnancy
• Lead exposure
• Brain injury
• Premature delivery + low birth weight

Question 5

What causes ADHD?

Answer 5

Strong genetic component

(multiple genes + gene-environment interaction)

Environmental risk factors

• Smoking, alcohol, drugs during pregnancy
• Lead exposure
• Brain injury
• Premature delivery + low birth weight
  
  • May confound with other factors

Question 6

What is the role of therapy in the treatment of ADHD?

Answer 6

Therapy alone is less affective than medication alone

However, combination treatment may be good for other areas of functioning

• Anxiety
• Academic performance
• Parent-child relationships
• Social skills

Question 7

What is the mechanism of action of stimulant medications in the treatment of ADHD?

Answer 7

Stimulants = methyphenydate, amphetamine

• Stimulate portions of the brain that are underactive
• Increase available dopamine and norepinephrine by blocking reuptake, facilitating release into the synapse

Amphetamine specifically gets into the presynaptic neuron and increases vesicle release

Question 8

What is the most effective treatment for ADHD?

Answer 8

Medical management

Stimulants are first line

(Atomoxetine, alpha-2 blockers 2nd line)

Question 9

What is the mechanism of action for guanfacine in the treatmnet fo ADHD?

What are the indications and side effects?

Answer 9

Alpha-2 agonist; reduces CNS activation

Helps with sympathetic overdrive, reduction of fight/flight response

Can be used in conjunction of stimulants

May cause sedation, drowsiness, depression, low BP, dizziness, fainting

Question 10

What is the DSM-5 criteria for ADHD?

Answer 10

Persistent patern of inattention and/or hyperactivity-impulsivity that interferes with function or development, persisting for at least 6 months

• Requires 6+ symptoms in either category
• (Or 6+ in each category for mixed)
• In at least 2 settings

Question 11

In how many settings do ADHD symptoms ahve to occur in order to diagnose ADHD?

Answer 11

At least 2

Question 12

What are the contrindications to stimulants for the treatment of ADHD?

Answer 12

Significant cardiac history

Question 13

Before what age must ADHD symptoms present to meet criteria for formal diagnosis?

Answer 13

Before age 12

Question 14

What are the side effects of stimulants to watch out for in the treatment of ADHD?

Answer 14

• Decreased appetite
• Insomnia
• Headache
• Nausea
• Less common
  
  • Irritability
  • Lability
  • Tics
  • Heart racing
  • Emotional blunting
  • Hallucinations

Question 15

What is the prevalence of ADHD?

Answer 15

3-11% of school-aged children

M>F

F more likely to have the inattentive type

Question 16

Which medications are used to treat ADHD?

Answer 16

• Stimulants (first line)
  
  • Methylphenidate
  • Amphetamine
• Non-stimulants (if stimulants are not tolerated, or co-occuring symptoms are present)
  
  • Atomoxetine (ADHD + Anxiety)
  • Alpha-2 agonists (Guanfacine, clonidine)

Question 17

Which medications are first line for ADHD?

Answer 17

Stimulants

• Methylphenidate
• Amphetamine

Question 18

List some possible consequence of untreated ADHD (4)

Answer 18

• Difficulties in interpersonal relationships
• Difficulties at school and work
• Increased likelihood of accidents and injuries
• Higher rates of substance abuse