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Attention-Deficit/hyperactivity Disorder

Neurodevelopmental Disorder
Problems in:
- controlling impulsivity
- paying attention
- organizing behavior to attain long-term goals


Types of ADHD

3 Subtypes

1. Combined Presentation
2. Predominantly inattentive presentation
3. Predominantly hyperactive/impulsive presentation


DSM-V Criteria

A. persistent inattention and/or hyperactivity, interfering with functioning or development
- Inattention: 6 symptoms for >6 months present
- hyperactivity: 6 symptoms for >6 months present

B. several symptoms of inattention/hyperactivity before age of 12

C. symptoms present in 2+ settings

D. symptoms interfere with/reduce quality of social, academic to occupational functioning

E. symptoms not due to other psychotic disorder


Combined Presentation

6 attention deficit and 6 hyperactivity-impulsivity symptoms present for at least 6 months


Predominantly inattentive presentation

Only symptoms of attention-deficit, not hyperactivity-impulsivity the last 6 months


Predominantly hyperactive/impulsive presentation

only symptoms of Hyperactivity-impulsivity, not attention-deficit the last 6 months


gender differences

boys more than 2x more likely than girls developing ADHD

- girls more inattentive, rather not disruptive


Prefrontal Cortex

control of cognition, motivation and behavior
--> smaller in ADHDs



Working Memory and planning
--> abnormal



motor behaviors
--> abnormal


Biological Hypotheses

1. ADHD develop slow, so PFC underdeveloped --> immature and PFC smaller
- explains why symptoms become less

2. Dopamine and Norepinephrine function unnormal
- important for sustained attention , impulse inhibition, error processing

3. Genetic Factors:
- probably especially genes that influence dopamine and noradrenaline may be unnormal

4. children with ADHD often prenatal and birth complications
- low weight
- oxygen deprivation
- drinking and smoking during pregnancy


Executive Functioning and ADHD

- EF impaired --> self-regulation deficits
- significant impairment in response inhibition and WM
- Visuospatial WM considered most important neuropsychological deficit



- stimulant drugs
- Drugs affecting norepinephrine levels
- Antidepressant medication
- Behavioral Therapies


Stimulant Drugs (Treatment)

- Ritalin, Dexedrine, Adderall
- 70%-80% respond with decreases in Demanding, disruptive and noncompliant behavior
- 70%-80% increase in positive mood, goal-directed behaviour and quality of interactions with others
- most often used
- often misprescribed

Side effects:
- reduced appetite
- insomnia
- edginess ans gastrointestinal upset
- can increase tics
- can decrease growth of children


Drugs affecting norepinephrine levels

- atomoxetine, clonidine, guanfacine
- help reducing tics
- increase in cognitive performance

side effects:
- dry mouth
- fatigue
- dizziness
- constipation
- sedation


Antidepressant Medication

mostly when patients have also depression
- some positive effects on cognitive performances
not effective for ADHD


Self-regulation deficits

core of ADHD
- related to executive functions like WM