Attention Deficit Attention Deficit Hyperactivity Hyperactivity Disorder Disorder Larry Gray, MD Larry Gray, MD Developmental and Behavioral Developmental and Behavioral Pediatrics Pediatrics Department of Pediatrics Department of Pediatrics University of Chicago University of Chicago Pritzker School of Medicine Pritzker School of Medicine
38
Embed
Attention Deficit Hyperactivity Disorder Larry Gray, MD Developmental and Behavioral Pediatrics Department of Pediatrics University of Chicago Pritzker.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Larry Gray, MDLarry Gray, MDDevelopmental and Behavioral PediatricsDevelopmental and Behavioral Pediatrics
Department of PediatricsDepartment of Pediatrics
University of Chicago University of Chicago
Pritzker School of MedicinePritzker School of Medicine
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
22
IntroductionIntroduction
740 % 740 % production production
25 fold 25 fold in Adderall in Adderall
USA = 80 % of RitalinUSA = 80 % of Ritalin
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
33
Lecture AimsLecture Aims
Epidemiology + courseEpidemiology + course DiagnosisDiagnosis EtiologyEtiology TreatmentTreatment Relationship to substance useRelationship to substance use
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
44
Key PointsKey Points
Very common: 10 % of boysVery common: 10 % of boys
National US survey: 2003National US survey: 2003– 4.4 million school age children ( ~ 6% )4.4 million school age children ( ~ 6% )– Boys 2.5 X’s > girls Boys 2.5 X’s > girls
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
77
Natural HistoryNatural History
Symptoms identified in schoolSymptoms identified in school
Peak prevalence: 9-12 yrs of agePeak prevalence: 9-12 yrs of age
Symptoms lessen with ageSymptoms lessen with age
Symptoms persist > 25 yrs in 2/3Symptoms persist > 25 yrs in 2/3
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
88
Lecture AimsLecture Aims
Epidemiology + courseEpidemiology + course DiagnosisDiagnosis EtiologyEtiology TreatmentTreatment Relationship to substance useRelationship to substance use
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
99
DSM-IV Diagnosis 1DSM-IV Diagnosis 1 Impairing inattentive symptoms with 6+ of: Impairing inattentive symptoms with 6+ of:
- Not listeningNot listening
- Fails to finish tasksFails to finish tasks
- Difficulty organizingDifficulty organizing
- Loses thingsLoses things
- Easily distractedEasily distracted
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
– At school and homeAt school and home– In social, academic, or occupational functioning In social, academic, or occupational functioning
Not due to:Not due to:– Conduct disorderConduct disorder– DepressionDepression
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
1212
ADHD DifferentialADHD Differential Normal high activityNormal high activity Thyroid disordersThyroid disorders Hearing lossHearing loss Sleep disorderSleep disorder Trauma / severe neglect Trauma / severe neglect Learning disabilities Learning disabilities
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
1313
ADHD ComorbidtyADHD Comorbidty
ODD / CDODD / CD
ADHDADHD
66%66%
Anxiety/ Mood D/OAnxiety/ Mood D/O
33% 33%
24%24%
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
1818
Lecture AimsLecture Aims
Epidemiology + courseEpidemiology + courseDiagnosisDiagnosis EtiologyEtiology TreatmentTreatment Relationship to substance useRelationship to substance use
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
1919
PathophysiologyPathophysiology
Different etiologies at workDifferent etiologies at work No one brain mechanismNo one brain mechanism → → BBehavioral syndrome of: ehavioral syndrome of:
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
2222
Dopamine SynapseDopamine Synapse
DopamineDopamine
Dopamine Dopamine TransporterTransporter
Dopamine Dopamine ReceptorReceptor
from: www.drugabuse.govfrom: www.drugabuse.gov
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
2323
Lecture AimsLecture Aims
Epidemiology + courseEpidemiology + courseDiagnosisDiagnosisEtiologyEtiology TreatmentTreatment Relationship to substance useRelationship to substance use
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
Less addictive potentialLess addictive potential– Same structure and action as cocaineSame structure and action as cocaine– Enters brain more slowly (less reinforcing)Enters brain more slowly (less reinforcing)
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
2828
% dx on meds
% dx but no meds
Male AgeMale Age
%%
44 171700
2020
1010
Success or Undertreatment ?Success or Undertreatment ?
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
2929
Lecture AimsLecture Aims
Epidemiology + courseEpidemiology + courseDiagnosisDiagnosisEtiologyEtiologyTreatmentTreatment Relationship to substance useRelationship to substance use
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
3030
Adolescents and SubstancesAdolescents and Substances
High School seniors reportHigh School seniors report– 50% used alcohol50% used alcohol– 25 % used tobacco 25 % used tobacco – 25% “some” illicit drug use25% “some” illicit drug use
ADHD is ADHD is ↑↑ in those with SUD in those with SUD– 50% of adolescents 50% of adolescents – 25% of adults 25% of adults
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
3131
ADHD, CD and SUDADHD, CD and SUD
ODD / CDODD / CD
ADHDADHD
66%66%33% 33%
CD SUDCD SUD
40%40%
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
3232
ADHD, CD and SUDADHD, CD and SUD
Exp. of antisocial behaviorExp. of antisocial behavior
ADHD w/o CD ADHD w/o CD ≠ ↑ risk ≠ ↑ risk
ADHD’s role in SUDADHD’s role in SUD– Earlier onset (1 year vs 3 years)Earlier onset (1 year vs 3 years)
– Persistence of symptoms across developmentPersistence of symptoms across development
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
3333
Alcohol Use DisordersAlcohol Use Disorders
F/U 165 sons of alcoholicsF/U 165 sons of alcoholics–6% with ADHD: no SUD 20 yrs later6% with ADHD: no SUD 20 yrs later
–CD in childhood 18 X the risk of SUDCD in childhood 18 X the risk of SUD
CD CD ↑ ↑ risk of alcohol use D/Os↑ ↑ risk of alcohol use D/Os ADHD sx assoc. much weakerADHD sx assoc. much weaker
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
3434
Predictors of Problems with Predictors of Problems with Alcohol in ADHDAlcohol in ADHD
129 with ADHD vs. 96 no ADHD129 with ADHD vs. 96 no ADHD
ADHD persisters with CD—5 X’sADHD persisters with CD—5 X’s
Persistence / quality of symptomsPersistence / quality of symptoms
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
3535
Treatment EffectsTreatment Effects
Unmedicated = ↑ risk for SUDUnmedicated = ↑ risk for SUD
Use substances to ↑ self- control Use substances to ↑ self- control
Meta-analysis → Tx ≠↑ SUDMeta-analysis → Tx ≠↑ SUD
Emerging evidence → early Tx Emerging evidence → early Tx
protectsprotects
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
3636
Prospective Study of ADHDProspective Study of ADHD
Rate of SUD during adolescenceRate of SUD during adolescence
75 % unmedicated developed SUD75 % unmedicated developed SUD
25 % medicated developed SUD25 % medicated developed SUD
SUD in treated ADHD = non-ADHD SUD in treated ADHD = non-ADHD
Treating ADHD may Treating ADHD may ↓ risk for SUD↓ risk for SUD
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
3737
Lecture AimsLecture Aims
Epidemiology + courseEpidemiology + courseDiagnosisDiagnosisEtiologyEtiologyTreatmentTreatmentRelationship to substance useRelationship to substance use
Copyright Alcohol Medical ScholaCopyright Alcohol Medical Scholars Programrs Program
3838
SummarySummary
Very common: boys > girlsVery common: boys > girls