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Flashcards in ADHD Deck (97)
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1

3 Types of ADHD

Hyperactive
Impulsive
Inattention

2

What do ADHD symptoms affect?

Cognitive functioning
Academic functioning
Behavioral functioning
Emotional functioning
Social functioning

3

What other psychiatric disorders is ADHD frequently associated with?

Oppositional defiant disorder (ODD)
Conduct disorder (CD)
Depression
Anxiety disorder
Learning disabilities

4

Major Transmitters in ADHD

Dopamine
Norepinephrine

5

Where are dopamine sensitive neurons?

Frontal lobe

6

What is the dopamine system associated with?

Reward
Attention
Short term memory
Planning
Motivation

7

Functions of the Frontal Lobe

Ability to project future consequences
Choice between good & bad actions
Override & suppression of socially unacceptable responses
Determination of similarities & differences

8

Differences in the Brain of a Person with ADHD

Decreased activation in the basal ganglion & anterior frontal lobe
Increase in dopamine transporter activity
Dopamine imbalance allows inappropriate increase in norepinephrine activity

9

Methylphenidate

Increases extracellular dopamine in the brain
Changes areas of function in the frontal lobe

10

DSM V Symptoms of Inattention or Hyperactivity/Impulsivity

Symptoms inappropriate for given age
Negatively impacts social & academic or occupational activities
Symptoms prior to age 12
Symptoms present in 2+ settings
Symptoms present for at least 6 months
Symptoms not better explained by other psychiatric

11

ADHD Inattentive Symptoms

Failure to give close attention to detail
Difficulty sustaining
attention in task
Failure to listen when spoken to directly
Failure to follow instructions
Difficulty organizing tasks & activities
Reluctance to engage in tasks that require sustained mental effort
Loses things necessary for tasks or activities
Easy distractibility
Forgetfulness in daily activities

12

ADHD Impulsive-Hyperactivity Symptoms

Fidgetiness with hands & feet or squirms in seat
Difficulty remaining seated in class
Excessive running or climbing in inappropriate situations
Difficulty in engaging in quiet activities
Is often "on-the-go" or acts as if "driven by a motor"
Often talks excessively
Excessive talking & blurting out answers before questions have been completed
Difficulty awaiting turns
Interrupting & intruding on others

13

Medical Evaluation of ADHD

Vanderbilt forms
Refer for vision & hearing tests
Complete H&P
Blood lead level (maybe)
TSH (maybe)
Sleep study (maybe)
Neurology consult (seizure/neuro disorder)

14

Treatment of ADHD

Ritalin
Adderall
Concerta
Behavioral therapy

15

Criteria for Initiation of Pharmacotherapy for ADHD

Complete diagnostic assessment that confirms ADHD
>6 years old
Parental consent
School is cooperative
No previous sensitivity to the medication
Normal HR & BP
No Hx of seizure disorder
Doesn't have Tourettes, autism spectrum disorder, anxiety disorder, substance abuse among household members

16

Things to Note Prior to Therapy for ADHD

Comprehensive medical eval + EKG
Pretreatment height, weight, BP, HR
Pretreatment appetite, sleep patterns, headaches, & abdominal pain
Assess for substance use/abuse

17

Education for ADHD Pharmacology

Meds prescribed to help with self control & ability to focus
Benefits vs. risks
Risks: CV issues, anorexia, insomnia, tics, priapism
Follow up protocol expectations
Patient specific goals

18

Potential Goals for ADHD Treatment

Less interruption in class
Turning in homework on time
Keeping their butt in their seat

19

Medications for ADHD

1st: methylphenidate (Ritalin) or dextroamphetamine (Adderall)
2nd: atomoxetine (Straterra)

20

Considerations for Medication Choice in ADHD

Duration of coverage
Ability to swallow pills
Time of day when symptoms occur
Desire to avoid administration at school
Coexisting tic disorder
Coexisting emotional or behavioral condition
Potential SE
Hx of substance abuse
Expense

21

Pros of Pharmacotherapy for ADHD

Long record of safety & efficacy
Improves: core symptoms, parent-child interactions, aggressive behavior, academic productivity & accuracy, improved self-esteem

22

Cons of Pharmacotherapy for ADHD

Insufficient data to judge long term academic performance
Symptoms tend to improve over time
Does not significantly affect learning problems, reduced social skills, oppositional behavior, emotional problems

23

How to choose which stimulant for ADHD?

Providers preference & comfort level
Patient & parent preference

24

Drugs Classes of ADHD Medications

Stimulants
Atomoxetine
Alpha-2-adrenergic agonists
Antidepressants

25

Stimulant Medications for ADHD

Methylphenidate
Detroamphetamine
Detroamphetamine-amphetamine

26

Antidepressant Medications for ADHD

TCAs
Bupropion

27

Short Acting Methylphenidate's for ADHD

Ritalin
Methylin

28

Time Frames for Ritalin & Methylin

Onset: 20-60 minutes
Duration: 3-5 hours
Half-life: 2-3 hours

29

Extended Release Long Acting Methylphenidate's for ADHD

Metadate ER
Methylin ER
Ritalin SR

30

Time Frames for Extended Release Long Acting Methylphenidate's for ADHD

Onset: 20-60 minutes
Duration: 8 hours