MS Pedia > ADHD > Flashcards

ADHD Flashcards

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1
Q

A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development

A

ADHD

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2
Q

Easily distracted, disorganized, difficulty sustaining focus, wandering off task, lacking persistence

A

inattention

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3
Q

Excessive motor activity (running, fidgeting, tapping, talking) in inappropriate situations

A

hyperactivity

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4
Q

Hasty actions without forethought, high risk of harm (e.g., running into the street), social intrusiveness (interrupting), or rash decisions with poor consideration of consequences

A

impulsivity

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5
Q

Often linked to anxiety and depression

A

inattentive type

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6
Q

More often associated with conduct disorder and oppositional defiant disorder

A

hyperactive-impulsive type

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7
Q

Features of both inattention and hyperactivity-impulsivity

A

combined type

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8
Q

term for ADHD in early 1900s

A

“hyperactive syndrome”

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9
Q

impulsive, disinhibited, hyperactive children, including some with neurological damage (e.g., post-encephalitis)

A

hyperactive syndrome

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10
Q

term for ADHD in 1960s

A

minimal brain damage

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11
Q

children with poor coordination, learning disabilities, and emotional lability but no clear neurological disorder

A

minimal brain damage

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12
Q

later theories involved

A

abnormal arousal and poor emotional modulation, supported by stimulant medications improving attention and focus

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13
Q

Most common chronic behavioral disorder in children

A

ADHD

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14
Q

school-aged children and adults affected worlwide

A

Affects 3–5% of school-aged children worldwide and about 2.5% of adults

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15
Q

gender prevalence in ADHD

A

Males > females (≈2:1 in children, 1.6:1 in adults)

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16
Q

family risk of ADHD

A

ADHD rates in parents and siblings are 2–8 times higher than in the general population

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17
Q

ADHD occurs both in the absence of any identifiable risk factors, and in association with other childhood conditions such as

A

motor dyspraxia, tics, learning problems, speech and language disorders, sleep disorders, oppositional behavior, enuresis, and encopresis

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18
Q

Overactive and socially disruptive behavior is common in children who have evidence of

A

injury from infections, head trauma, toxic exposures, and extreme prematurity

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19
Q

genetic basis of ADHD

A

Highly heritable; first-degree relatives have a 4.6–7.6× higher risk

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20
Q

ADHD is linked to …

A

7-repeat polymorphisms of dopamine receptor D4 (DRD4, chromosome 11p15.5) and dopamine transporter (DAT1) genes

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21
Q

Prefrontal cortex implicated due to

A

high dopamine use and role in attention, inhibition, and working memory

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22
Q

other regions affected in ADHD

A
  • locus ceruleus (noradrenergic attention control)
  • superior/temporal cortices (focus)
  • parietal & striatal areas (motor executive function)
  • hippocampus (memory encoding)
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23
Q

imaging findings of ADHD

A
  • smaller right frontal lobe, striatum, cerebellum, temporal gray matter, total cerebral volume, inferior cerebellar vermis, and corpus callosum
  • reduced blood flow to striatum and frontal lobes
  • prefrontal under-activation and lower glucose metabolism
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24
Q

temperamental risk factors of ADHD

A
  • high novelty seeking
  • reduced behavioral inhibition
  • poor effortful control
  • negative emotionality
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25
environmental risk factors of ADHD
Very low birth weight, maternal smoking/alcohol use, child abuse or neglect, multiple foster placements, lead/neurotoxin exposure, infections (e.g., encephalitis)
26
course modifiers of ADHD
Family interaction patterns in early childhood can affect progression and increase risk of secondary conduct problems
27
ADHD signs begin before
age 7 and persist for at least 6 months in two or more settings (home, school, play)
28
earlies detection and peak onset of ADHD
Earliest detection is 2 years; peak onset 3–5 years
29
primary manifestations
cognitive disorganization, distractibility, inattention, impulsivity, hyperactivity
30
secondary manifestations
disruptive behaviors, poor social skills, emotional immaturity, fidgeting, poor academic performance, excessive talking
31
common precursors
Feeding difficulty and sleep disturbances in infancy/preschool
32
Hyperactive children seen as
quarrelsome, irritable, defiant, untruthful, destructive
33
Non-hyperactive inattentive children may be misperceived as
undermotivated or lazy, delaying diagnosis
34
ADHD Diagnostic Criteria for Inattention
Six (or more) symptoms for at least 6 months (at least 5 if age 17+), inconsistent with developmental level, negatively impacting social/academic/occupational activities:
35
Diagnostic Criterias of ADHD
- Often fails to give close attention/makes careless mistakes - Difficulty sustaining attention in tasks or play - Does not seem to listen when spoken to directly - Does not follow through on instructions/fails to finish tasks - Difficulty organizing tasks/activities - Avoids or dislikes tasks requiring sustained mental effort - Loses things necessary for tasks - Easily distracted by extraneous stimuli - Often forgetful in daily activities
36
ADHD Diagnostic Criteria for Hyperactivity/Impulsivity
Six (or more) symptoms for at least 6 months (at least 5 if age 17+):
37
Diagnostic Criterias of ADHD
- Fidgets, taps hands/feet, squirms in seat - Leaves seat when remaining seated is expected - Runs or climbs in inappropriate situations (feeling restless in adolescents/adults) - Unable to play/engage quietly “On the go” or acts as if “driven by a motor” - Talks excessively - Blurts out answers before question completed - Difficulty waiting turn - Interrupts or intrudes on others
38
criterion B, C, D, and E for ADHD
B. Several symptoms present before age 12. C. Several symptoms present in two or more settings (home, school, work, with friends/relatives). D. Clear evidence symptoms interfere with or reduce quality of functioning. E. Not better explained by another mental disorder.
39
combined presentation
both criteria 1 & 2 met
39
Predominantly Hyperactive/Impulsive Presentation
criterion A2 is met but criterion A1 is not met for the past 6 months
40
predominantly inattentive presentation
criterion A1 is met but criterion A2 is not met for the past 6 months
41
full criteria were previously met, fewer than full criteria have been met for the past 6 months, and symptoms still result in impairment in social, academic, or occupational functioning.
partial remission
41
Co-occurs in ~50% of children with the combined type and ~25% with the inattentive type
ODD
41
DDx of ADHD
- Oppositional defiant disorder - Intermittent explosive disorder - Other neurodevelopmental disorders - Specific learning disorder - Intellectual disability - Autism spectrum disorder - Anxiety disorder - Mood disorder - Disruptive mood dysregulation disorder - Reactive attachment disorder - Substance use disorders - Psychotic disorders - Medication induced symptoms of ADHD - Disordered sleep - Sydenham’s chorea
42
Present in ~25% of children/adolescents with the combined type (varies by age and setting)
Conduct Disorder
42
Few symptoms beyond minimum required; minor impairment.
mild
43
Comorbidity of ADHD
- ODD - CD - DMDD - Specific Learning Disorder - Anxiety Disorders and Major Depression - IED - Substance Use Disorders - Personality Disorders - Other possible comorbidities
43
Symptoms/impairment between mild and severe.
moderate
43
Most affected children also meet ADHD criteria; a smaller share of ADHD cases meets this criteria.
Disruptive Mood Dysregulation Disorder
44
Many symptoms in excess of minimum or marked impairment.
severe
45
Common in ADHD.
Specific Learning Disorder
46
Occur more often than in the general population but still in a minority of ADHD cases
Anxiety Disorders & Major Depression
47
Seen in a minority of adults, higher than population rates.
Intermittent Explosive Disorders
48
More frequent in adults with ADHD but still only a minority.
Substance Use Disorders
49
May co-occur in adults.
Personality Disorders
50
other possible comorbidities
obsessive-compulsive disorder, tic disorders, and autism spectrum disorder
51
Improve behavioral control, and permit a more adaptive disposition of attention in relation to the demands of the moment
stimulant medications
52
stimulant medications
- methylphenidate - pemoline - modafinil
53
alternatives for stimulant medications
- Despiramine or risperidone - Dexedrine - Clonidine and guanfacine - Tricyclic antidepressants or Selective serotonin reuptake inhibitors - Norepinephrine reuptake inhibitor - Barbiturates - Methylxanthines
54
Inhibits receptor uptake of dopamine by blocking the dopamine transporter (DAT1)
methylphenidate
55
optimal dose of methylphenidate
10 and 50 mg per day
56
long-acting methylphenidate preparation (Ritalin sustained release) is effective for approximately
6 hours
57
Other recently introduced long-acting methylphenidate preparations are trademarked as
Concerta, Ritalin-LA, and Metadate CD and their duration of action is in the 8-to-12-hour range
58
Reduce ADHD symptoms and aggression
Clonidine & Guanfacine (α2-agonists)
59
Risk of cardiovascular complications, especially with methylphenidate.
clonidine
60
Less sedating, less hypotension, longer half-life.
guanfacine
61
Useful for stimulant nonresponders; side effects include anorexia, weight loss, rare acute liver failure.
Atomoxetine (NE reuptake inhibitor)
62
May help hyperactivity with depressed mood
Tricyclics/SSRIs (fluoxetine, sertraline, paroxetine)
63
Sedative but can worsen hyperactivity—switch to nonbarbiturate antiepileptics if needed
Barbiturates
64
Generally safe; may mildly improve externalizing behaviors
Methylxanthines (caffeine, theophylline)
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