Académique Documents
Professionnel Documents
Culture Documents
Disorder
By
Chris Golner
Outcome
History of ADHD
Mid-1800s: Minimal Brain Damage
Mid 1900s: Minimal Brain Dysfunction
1960s: Hyperkinesia
1980: Attention-Deficit Disorder
With or Without Hyperactivity
Scientific American
Http//www.sciam.com/1998/0998issue/0998barkely.html#link1
Genetic Linkages to ADHD
Twin studies by Stevenson, Levy et al, and
Sherman et al indicate an average heritability
factor of .80
Biederman et al reported a 57% risk to offspring if
one parent has ADHD.
Dopamine genes
DA type 2 gene
DA transporter gene (DAT1)
Dopamine receptor (DRD4, “repeater gene”) is
over-represented in ADHD patients
DRD4
DRD4 is most likely contributor
DRD4 affects the post-synaptic sensitivity
in the prefrontal and frontal cortex
This region of cortex affects executive
functions and attention
Executive functions include working
memory, internalization of speech,
emotions, motivation, and learning of
behavior
Treatment
Counseling of individual and family
Stimulants
Tricyclic antidepressants
Bupropion
Clonidine
Stimulants
Exact mechanism unknown
Raise activity level of the CNS by decreasing
fluctuations of activity or lowering threshold
needed for arousal
Similar in structure to NE and DA, and may
mimic their actions
At least 75% have positive response with
single dose
95% respond well to stimulant treatment
Include methylphenidate, dextroamphetamine
and pemoline
Methylphenidate
Is a piperidine Taken orally, 2-3 times
derivative commonly a day as needed
known as Ritalin® Behavioral effects start
Is believed to act as within 1/2 hour to hour
dopamine agonist in after ingestion, peaking
synaptic cleft at 1 and 3 hours
Stimulates frontal- Also comes in
striatal regions Sustained-Release
Dosage (5-20 mg) must form, whose effects last
be adjusted to each approximately twice as
patient long.
Effects of MPH
Elevates mood
Raises arousal of CNS and cerebral blood
flow
Increases productivity
Improves social interactions
Increases heart rate and blood pressure
Has little or no abuse potential
Side Effects
Common: Mild:
decreased appetite anxiety/
insomnia depression
behavioral irritability
rebound Rare:
head and stomach tics (Tourette’s
aches Syndrome)
overfocussing
Also thought to cause liver problems or
temporary height and rash (Pemoline
weight suppression only)
Outcome
ADHD can persist into adulthood, but usually
symptoms gradually diminish
When it persists into adulthood, it usually
requires ongoing treatment and counseling
most will develop another disorder (especially
learning disability, ODD, depression, and/or
conduct disorder)
Without treatment:
antisocial and deviant behavior
increased rates of divorce, moving violations,
incarceration, and institutionalization
References
Barkley, R. Attention-Deficit Hyperactivity Disorder, 2nd Ed. New York: Guilford Press. 1998. 628
pp.
Shaywitz, B. and Shaywitz, S. Attention Deficit Disorder Comes of Age: Toward the 21st Century.
Austin, TX: Hammill Foundation. 1992. 366 pp.
Rie, H.E. and Rie, E.D., Eds. Handbook of Minimal Brain Dysfunctions: A Critical View. New
York: John Wiley & Sons. 1980. 744 pp.
Faigel, H. Attention Deficit Disorder: A Review. J. of Adolesc. Health, Mar 1995 Vol. 16: 174-84.
Cantwell, D.P. Attention Deficit Disorder: A Review of the Past Ten Years. J. of the Am. Acad. Of
Child Adolesc. Psychiatry. 1996, Vol 35: 978-87.
Seideman, L., Biederman, J., and Faraone, S.V. A Pilot Study of Neuropsychological Function in
Girls with ADHD. J. of Am. Acad. of Child Adolesc. Psychiatry, 1997. Vol. 36: 366-73.
Seideman, L., Biederman, J., and Faraone, S.V. A Pilot Study of Neuropsychological Function in
Girls with ADHD. J. of Am. Acad. of Child Adolesc. Psychiatry, 1997. Vol. 36: 366-73.
References
Levy, F., Hay D.A., McStephen, M., Wood, C., and Waldman, I. Attention-Deficit Hyperactivity
Disorder: A Category or Continuum? Genetic Analysis of a Large Scale Twin Study. J. of Am.
Acad. Of Child Adolesc. Psychiatry, 1997, Vol 36: 737-44.
Sherman, D.K., Iacono, W.G., McGue, M.K. Attention-Deficit Hyperactivity Disorder Dimensions:
A Twin Study of Inattention and Impulsivity-Hyperactivity. J. of Am. Acad. Of Child Adolesc.
Psychiatry, 1997, Vol 36: 737-44.
Marx, J. How Stimulant drugs May Clam Hyperactivity. Science, 1999, Vol. 283: 306-08.
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