DSM 5–> Attention Deficit Hyperactivity Disorder is Now called
Neurodevelopmental Disorder ADHD combined ADHD inattentive ADHD hyperactive/impulsive Other specified, or unspecified
(ADHD) How different from DSM-IVTR?
Starts before age 12, not 8
Symptoms must be in multiple settings
Must cause Social disability
key symptoms of ADHD
6 inattention symptoms for 6 months
- Poor attention to details –> mistakes
- Cannot sustain attention
- Does not listen
- Does not follow through
- Does not organize
- Avoids tasks
- Loses things
- Is distracted
- Is forgetful
6 key ADHD hyperactive/impulsive symptoms
- Fidgets
- Leaves seat
- Runs/climbs
- Not quiet
- Talks a lot
- Blurts out
- Cannot wait turn
- interrupts
Course of ADHD
- Most often apparent at young age where age appropriate norms for paying attention and delaying gratification are not met
- Milder and more inattentive cases may not be notices until later in life when demands are greater
- Inattentiveness tends to persist greater then hyperactivity/impulsivity
ADHD characteristics
DSM 5 Attention Deficit Hyperactivity Disorder is Now called Neurodevelopmental Disorder ADHD combined ADHD inattentive ADHD hyperactive/impulsive Other specified, or unspecified
course of ADHD
- Most often apparent at young age where age appropriate norms for paying attention and delaying gratification are not met
- Milder and more inattentive cases may not be notices until later in life when demands are greater
- Inattentiveness tends to persist greater then hyperactivity/impulsivity
Inattentiveness tends to persist greater then
hyperactivity/impulsivity as you get older
the stimulant class
has great efficacy in adults, teens, children –> promote DA and NE increase activity
side effects of stimulant?
- stunt growth (short)
2. weight loss for stims
The stimulant class has great efficacy in adults, teens, children
Promote DA and NE increase activity All carry risk of addiction Paranoia in misuse Stunt growth, weight loss ?Cardiac issues
The non-stimulants (atomoxetine (NRI)) and (Guanfacine ER and Clonidine ER (alpha-2 NE agonists) have
less efficacy
But carry no addiction risk
Interestingly are often sedating…
May lower blood pressure..
Atomoxetine is a NET inhibitor only
(norepi reuptake inhibitor)
Guanfacine ER and clonidine ER Agonize or stimulate the
alpha-2 norepinephrine receptor
In the brainstem this may dampen NE release and lower blood pressure as an autoreceptor
In the frontal cortex, these receptors are located on glutamate pyramidal neurons (heteroreceptors) and help to improve signal to noise ratio, allowing the neuron to fire appropriately when face with multiple environmental stimuli. This ‘fine tunes’ operation of the frontal cortex which is responsible for prioritizing, response inhibition, and vigilance
for mild ADHD
Behavioral modification and training Self control therapy Behavioral Parent Training Relaxation Education Support Distraction Control Attention Sustaining Cognitive Restructuring
what are the ADHD pharmacy for preschoolers
- methylphenidate (approved for older child)
- amphetamines (approved for very young child)
- behavioral therapy –> this is always the first choice of drug for ADHD
slow release amphetamine drug is favored for children
b/c it’s less addictive
in case of adults ADHD
they also get non-addictive drugs such as guafacin and clonidine then you would use slow releasing amphetamines…
alpha 2 agonist makes
glutamate receptor better (you are not using NE to fix the problem)
what is the no.1 occurring illness with ADHD?
anxiety?
ADHD and nuerotransmitters?
decreased tonic of both NE and DA firing in PFC
medication management for ADHD?
The stimulant class has great efficacy in adults, teens, children - Promote DA and NE increase activity - All carry risk of addiction - Paranoia in misuse - Stunt growth, weight loss ?Cardiac issues
diagnosis of ADHD is usually the
last diagnosis after excluding anxiety, depression, etc
drug of choices for ADHD that are not addictive are
- atomoxetine (NRI)
- guanfacine
- clonidine (alpha 2 agonist)
