Attention-deficit Hyperactivity Disorder – ADHD Jan Buitelaar Radboud University Nijmegen Medical Center Donders Institute for Brain, Cognition and Behavior Department of Cognitive Neuroscience, and Karakter Child and Adolescent Psychiatry University Center Nijmegen, The Netherlands Symposium 19 mei 2018 Amsterdam
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Attention-deficit Hyperactivity Disorder – ADHD · Attention-deficit Hyperactivity Disorder – ADHD Jan Buitelaar Radboud University Nijmegen Medical Center Donders Institute for
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Attention-deficit Hyperactivity Disorder – ADHD
Jan Buitelaar Radboud University Nijmegen Medical Center Donders Institute for Brain, Cognition and Behavior Department of Cognitive Neuroscience, and Karakter Child and Adolescent Psychiatry University Center Nijmegen, The Netherlands
Symposium 19 mei 2018 Amsterdam
Conflict of interest
Speaker Advisory Board Research Support Involved in clinical trials
Lilly X X X X
Janssen Cilag X X X
UCB X
Organon X
Medice X
Shire X X
Medice X
Novartis X
Roche X
Servier X
Declaration of Interest Jan Buitelaar
Take home message
• ADHD is a disorder of brain development with a strong genetic loading
• Environmental and GxE factors play additional roles • ADHD is a very persistent disorder, 24 hours/day • It is important to identify and treat ADHD as a disorder
on itself and as a risk factor for other disorders • A comprehensive treatment approach includes a
combination of medical and psychological interventions • Treatment should be
– Systematic – 24 hours / day – Long-term
Inattention
Impulsivity/Hyperactivity
ADHD - Core Symptom Areas
Case description Aetiology Classification Emergence of a concept Comorbidity Cost Core symtoms Epidemiology Implications
CORE SYMPTOMS of ADHD
§ must be more severe than those seen in other
children of the same age § must be more severe than those seen in other
children with the same developmental level § must be present in several settings
(eg family, school) § must create serious problems in everyday life § will change with age and can be life-long
Core symtoms
Figure 1 The history of attention-deficit/hyperactivity disorder
Faraone, S. V. et al. (2015) Attention-deficit/hyperactivity disorder Nat. Rev. Dis. Primers doi:10.1038/nrdp.2015.20
Faraone, S. V. et al. (2015) Attention-deficit/hyperactivity disorder Nat. Rev. Dis. Primers doi:10.1038/nrdp.2015.20
Mortality in ADHD versus non-ADHD
Dalsgaard et al. Lancet 2015, , http://dx.doi.org/10.1016/ S0140-6736(14)61684-6
Mortality in ADHD versus non-ADHD -mechanisms
Faraone. Commentary in Lancet 2015, http://dx.doi.org/10.1016/ S0140-6736(14)61822-5
Thapar et al. Lancet Psychiatry, 2016
ADHD – the broader clinical picture
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Neurodevelopmental disorders
This is different from a cerebral lesion in a mature brain
Wide spread ramifications of neural dysfunction towards a variety of clinical symptoms
The developmental “snowball” rolls downhill over time……
“Outcome”?
…….gathering speed and mass (loadings for psychopathology and atypicality).
“Outcome”?
…….gathering speed and mass (loadings for psychopathology and atypicality).
Environmental Influences
Genetic Predispositions
Maturation
Time
Birth
“Outcome”
Child’s Own Behavior
The developmental pathway of an individual child reflects not only genetic endowment and environmental effects, but also the interactions among these and the child’s own activity over time.
Time
Protective and Supportive Conditions and Adverse Events Risks and
Protective Factors
Behavior Birth
“Outcome”
Maturation and Maturational Vulnerabilities
Genetic Predispositions
Environmental Influences
Adaptive and Maladaptive Behaviors
Influences on development are both positive and adverse. Likewise, the individual’s behaviors over time are both adaptive and maladaptive.
Impairment through the lifespan
Childhood ⇒ Adolescence
Difficulties at school Becomes Underachievement, no high school graduation
Enhancing Neuro Imaging Genetics through Meta-Analysis
http://ENIGMA.ini.usc.edu
Cross-disorder analysis of ADHD and ASD Based on mega-analysis results of 3242 people from ADHD sample (1713 cases) and 2090 people from ASD sample (1036 cases)
• ADHD is a disorder of brain development with a strong genetic loading
• Environmental and GxE factors play additional roles • ADHD is a very persistent disorder, 24 hours/day • It is important to identify and treat ADHD as a disorder
on itself and as a risk factor for other disorders • A comprehensive treatment approach includes a
combination of medical and psychological interventions • Treatment should be