mcp 677 attention deficit hyperactivity disorder presentation
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ATTENTION DEFICIT HYPERACTIVITY DISORDER
WHAT IS ATTENTION DEFICIT HYPERACTIVITY DISORDER?
Name changed from ADD to ADHD in 1994 (APA)
Neurobehavioral disorder (NIH)
3-5% American children affected
Affects ability to stay on task – age appropriate inhibitions
DSM-5 Criteria
Six+ symptoms – by age 16Five+ adolescents age 17 & adultsSymptoms present by age 12Symptoms present for at least 6 monthsSymptoms present in two or more settingsInappropriate for developmental level
Three subtypes of ADHD:
Predominantly Inattentive
Predominantly Hyperactive-Impulsive
Combined Presentation
PHYSIOLOGICAL ASPECTS OF ADHD
Most studied condition in child psychiatry Exact causes and the mechanisms
not understood Neurological disorder Two neurotransmitters involved
Norepinephrine Dopamine
Brain imaging:
Brain matures in a normal pattern delayed approximately 3 years
Brain regions – thinking, paying attention and planning
Cortex – overall delayed maturation
Corpus Callosum – abnormal growth patterns
Heritability
Familial studies – risk among parents and siblings of children with ADHD increased 2 to 8 fold
Adoption studies – biological relatives more likely than adoptive relatives
Pooled analysis of 20 twin studies – heritability 76%
Recent study (Burt, 2009) – 60% heritability Plethora genes – small but significant effect
Comorbidity:
Learning disability Oppositional defiant disorder Conduct disorder Anxiety Depression Bipolar disorder Tourette syndrome
Dopamine & ADHD:
What is dopamine?
Neurotransmitter – Chemical messenger carries signals between neurons and other cells in body
Neurohormone - hormone secreted by a specialized
neuron into the bloodstream, cerebral spinal fluid or the intercellular spaces in the nervous system
Dopamine and ADHD
Too little dopamine
Dopamine transporters take up too much dopamine before it can be passed from one brain cell to another
Inhibitory neurotransmitter – calming
Ability to control impulses
Dopamine production
Substantia nigra
Ventral tegmental area
Dopamine Synthesis:
Hypothalamus
Arcuate nucleus
Caudate nucleus
Treatment:
Medications:
Stimulants (Ritalin®, Adderall®)
Non-stimulants (Strattera®, Intuniv®)
Behavioral Therapy: Individual Family
PEER REVIEWED JOURNAL ARTICLES
LINEAR AND NON-LINEAR EEG ANALYSIS OF ADOLESCENTS WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER DURING A COGNITIVE TASK
Empirical study
Adolescent boys
EEG dynamics
Cognitive task
Methods: Approximate entropy
(ApEn) - measure the complexity of the EEG
ApEn likelihood that similar patterns of observations will not be followed by additional similar observations
series 1: (10,20,10,20,10,20,10,20,10,20,10,20...), which alternates 10 and 20.
series 2: (10,10,20,10,20,20,20,10,10,20,10,20,20...
Results:
Mean ApEn – significantly lower in adolescents with ADHD than control group when performing cognitive task (not at rest)
Impaired cortical (cerebral cortex) information
processing
Lower complexity of the EEG
Topographic comparisons of ADHD subjects and healthy subjects using the ApEn calculated from EEGs recorded during an eyes-open resting condition and during an auditory attentional task.
Objective Diagnosis of ADHD Using IMUs
Empirical study Miniature wireless inertial sensors Levels and patterns of movement in children
using inertial measurement units (IMUs) Accelerometers – tool measures acceleration Gyroscopes – tool measures orientation The IMUs were used to analyze and characterize the
subjects' motion
High-tech 3D-accelerometer hidden in a belt
A movement sensor is clipped onto a belt worn around the waist
GyroBelt driver
Results:
IMU’s promising tool for objective ADHD diagnosis Previous studies – Acceleration measurements Gyroscope measurements have a good predictive
capability for discrimination between ADHD and non-ADHD subjects
More than half the selected features came from the sensor at the child's waist - “global” motion is a better indicator of hyperactivity than “local” motions (foot tapping, finger drumming etc.)
Why Attention-Deficit/Hyperactivity Disorder Is Not a True Medical Syndrome
Theoretical study Thesis - Attention-Deficit/Hyperactivity Disorder (ADHD)
cannot be a valid diagnostic category. Critical of DSM criteria
EXAMPLE:Jack - 6 symptoms inattention zero hyperactivity (ADHD)
Allen – 5 symptoms inattention zero hyperactivity (NOT)
Mark – 6 symptoms hyperactivity zero inattention (ADHD)
Steve – 5 symptoms hyperactivity zero inattention (NOT)
Bob – 5 symptoms inattention & 5 symptoms hyperactivity (NOT ADHD)
Lindstrom asks "What are the odds that the postulated syndrome of ADHD will match up with some underlying disorder…These odds seem pretty slim..."
Non pathological reasons for ADHD
Boring teachers Boring lessons Boring books Infrequent rewards
Conclusions:
Symptoms like inattentiveness, hyperactivity or impulsivity - symptoms of real disorders it is not likely that there is one organic or mental dysfunction that accounts for the complex of symptoms labeled ADHD
No reason to think the huge behavioral category of ADHD can be traced back to some unknown type of harmful dysfunction in the individual.
Conclusions continued:
No reason to think that clinical levels of hyperactivity and inattentiveness always must be caused by pathology.
As with nausea, physicians should view hyperactivity and inattentiveness as nothing more than possible symptoms of disorder
ADHD and Community Psychology
Objective methods of diagnosis Provide information on benefits and dangers
of medication Determine if system changes can have an
affect on symptoms