ADHD - Meiri

Question 1

What is the prevalence of ADHD?

Answer 1

3-7% of school aged children

Male:Female 4:1 (girls often underdiagnosed)

60% diagnosed in childhood continue into adulthood

Question 2

What are the 3 subtypes of ADHD?

Answer 2

1. Predominantly Inattentive Subtype
2. Predominantly Hyperactive-Impuslive Subtype (rare)
3. Combined Subtype (Hyperactive-Impuslive and Inattentive) - Most common

Question 3

What are the diagnostic criteria of ADHD?

Answer 3

• At least 6/9 listed symptoms for hyperactivity/impulsivity.
• Symptoms caused impairment before age 7
• Some impairment in two or more settings (school, home, work, clinic-just one not enough)
• Clear evidence of clinically significant impairment in social, academic, or occupational functioning
• Symptoms do not occur exclusively during another mental disorder and are not better accounted for by another disorder (like hypomanic bipolar or personality disorder, or anxiety or other potential comorbidity-need to stabilize then assess if comorbidity)

Question 4

What are the theories of the brain mechanisms in ADHD?

Answer 4

1. Decreased NE transmission
   Decreased release of dopamine from presynaptic vessels
   Ritalin acts as increased release in these synapses
2. Transfusion of neurotransmitters

Posterior attention system and anterior executive system may have abnormally signals

Overactive frontostriatal insular network

Decreased PET scan metabolism

Question 5

What is the treatment for ADHD?

Answer 5

Medications:
Ritalin 10 mg
Ritalin SR 20 mg
Ritalin LA 20 mg
Concerta 18mg, 36mg, 54mg
Second line – TCA, Atamoxetine (SNRI-takes weeks for effects)

More effective when combined with CAM

Side effects:
Anxiety, psychosis (problemaatic with comorbidities)

Question 6

What are the comorbidities with ADHD?

Answer 6

Tic (increases with meds)

Oppositional Defiant Disorder (40%)

Conduct Disorder

Anxiety Disorders (34%)

Mood disorders