Medications for ADHD

2. Medications for ADHD • Stimulants • Sharpen concentration and increase the activity of the brain chemicals called dopamine and norepinephrine, which are believed to be imbalanced in adults with ADHD. • The FDA has approved several stimulants for the treatment of adult ADHD. • In some individuals a stimulant is contraindicated because of seizures, worsening depression, etc. • Non-stimulant options also exist.

3. Medications • Problems occur when the medication runs out in the middle of the day or when the medication keeps the individual awake at night • The relatively new ADHD medication Daytrana is composed of the same chemical compound as Ritalin and Concerta (methylphenidate), • Daytrana offers the distinct advantage of existing in the patch form, which is typically worn on the hip. At the present moment, this medication is used exclusively for children with ADHD and related disorders, although it can also be used off-label for adults with the disorder.

4. Methylphenidate • remains the most popular choice of medications for individuals with ADHD. However, the combination of dosing difficulties and negative side effects connected with oral administration left room for an alternate form of delivery: the methylphenidate transdermal delivery system, more commonly known as Daytrana.

5. Vyvanse • A new drug called Vyvanse (Lisdexamfetamine) has entered the world of ADHD stimulant medications relatively recently. • Vyvanse was originally marketed as an ADHD treatment for children, but was approved by the FDA for adult and adolescent use this past April. A cousin of the popular ADHD medications Dexedrineand Adderal, Vyvanse includes some key modifications of these medications.

6. If a student is already hyperactive why are doctors prescribing a stimulant? • ADHD individuals have less energy in the brain which is why they fidget or through paper airplanes. • Functioning for them is like trying to work when you are very tired and uninterested in the work at hand.

7. Pet Scan shows much less energy used by an ADHD individual

8. Confusing ADHD and Auditory Processing Difficulty • Because auditory processing disorders and ADHD have very similar symptoms, many ADHD individuals are not diagnosed with auditory processing disorders because they are never tested for it. • While auditory processing disorders affect the student during class lectures, it is not a diagnosis that will get accommodations for tests (except oral tests) since it does not affect the written aspect of test taking.

9. Auditory Processing Disorders Auditory processing disorders are independent from the mechanical process of hearing (in other words, the peripheral hearing, or ability to pick up background sounds is not affected), but rather have difficulties in the screening, filtering and differentiating "important" sounds from background noise. Difficulties in this result in an impaired ability to utilize important auditory information properly.

10. ADHD and Auditory Processing Disorders • ADHD and Auditory Processing Disorders can share a number of overlapping symptoms and behaviors in children. However, when these two disorders exist alongside each other as comorbid disorders, then the two can feed off of each other and increase the likelihood of onset of a third (or fourth) psychological or developmental disorder.

11. Fighting in School and repeated arguments are common

12. Celiac Disease causes ADHD Symptoms • One of the biggest challenges in diagnosing and treating ADHD is trying to separate it out from other disorders that often present similar-looking symptoms. One such disorder is known as celiac disease. When gluten (a type of plant protein found in corn and wheat and other carbohydrates) is ingested in individuals with celiac disease, an inflammatory response in the upper portion of the small intestine occurs. When repeatedly challenged by gluten exposure, damage can occur to this portion of the digestive system, which leads to painful symptoms and impaired digestive and absorptive function.

13. Sensory Processing Disorders • Sensory processing disorders are often seen in the ADHD population, especially in children. This includes more "physical" dysfunctions including the ability of the child to maintain balance and equilibrium. • To the frustrated parent of coach of an ADHD child, this may introduce another complication with regards to sports or other activities which involve coordination and balance, such as basketball, baseball, tennis, soccer, gymnastics, musical instruments, dance, etc.

14. Cerebral Differences - Pet Scan shows much less energy used by an ADHD individual

15. Pet Scan measuring metabolic rate with ADHD and nonADHD Cortex

16. These positron emission tomography (PET) scans show that patients with ADHD had lower levels of dopamine transporters in the nucleus accumbens, a part of the brain's reward center, than control subjects.

17. The researchers studied brain scans of 24 ADHD children (with hyperactivity) and found that the right parietal lobes in children with ADHD did not function as well as in children without ADHD. The right parietal lobes are associated with the development of coping strategies.

18. Using the fMRI there is evidence that ADHD individuals do not use the right hemisphere to the same extent as non ADHD individuals. This region is involved in self concept.

20. ADHD Individuals Have Less Volume in the Prefrontal Cortex

21. Differences in the Cortex of ADHD and nonADHD individuals • The areas that organize and direct behavior are smaller • The area that is responsible for holding and computing is smaller • The area of the brain responsible for self concept is not utilized as much.

22. Cortical Differences Between ADHD Individuals and Others • There is less energy used by the brain of people diagnosed with ADHD so they sort of feel like they can’t get enough energy • The areas that organize and direct behavior are smaller • The area that is responsible for holding and computing is smaller • The area of the brain responsible for self concept is not utilized as much.

23. Differences in Brain Activity Between ADHD and nonADHD • A number of studies have confirmed the hypothesis that individuals with ADHD have reduced bloodflow levels marking a recuction of activity to multiple key brain regions

24. ODD • Oppositional Defiant Disorder • is a disorder in which a child exhibits disobedience, irritability and hostility towards authority figures beyond the range of normal age-appropriate behaviors. • Of course there is a significant gray area with regards to what is age appropriate, especially when the child's environment is considered.

25. Comorbid Conditions Predominantly Inattentive • Major Depressive Disorder, Oppositional Defiant Disorder, General Anxiety Disorder(Depression sometimes is expressed as angry outbursts especially in children) • 20.8% had MDD. • 20.8% ODD. • 18.6% GAD. • Many undiagnosed individuals are considered under achievers. Parents usually use other words.

26. In predominantly hyperactive-impulsive subtype • Oppositional Defiant Disorder, General Anxiety Disorder • 41.9% had ODD. • 22.2% GAD. • 19.4% MDD.

27. In combined subtype: • 50.7% had ODD. • 22.7% MDD. • 12.4% GAD.

28. This data were reported in Prevalence, Recognition, and Treatment of Attention-Deficit/Hyperactivity Disorder in a National Sample of US Children, (Archives of Pediatrics & Adolescent Medicine, September 2007). • Total Sample:  3082 • AD/HD all types:  222 • Inattentive subtype:  95 • Combined type:  72 • Hyperactive-Impulsive type:  55

29. There are a Number Conditions and Problems Associated with ADHD • Some are emotional • Some are other learning disabilities • Some are behavioral • Some have to do with relationships • Other learning disabilities

30. Comorbid Conditions The percentage of each condition depends on who does the study

31. Another Site with Comorbid Conditions

32. What Tests are Used to Diagnose ADHD? • There is no standard battery of tests. • History is very important. This includes family, social, academic as well as medical history. • On the IQ there are usually indicators that the processing speed is slow and there are difficulties with working memory. • On the fluency tests, there are indicators that the individual has difficulty with timed tasks. • There are instruments given to the parents and teachers to get feedback regarding the students’ performance in class. • There are tests that measure continuous performance and these often indicate difficulty. • Memory is often compromised, especially short term memory.

33. The Stroop Test

34. Often Speeded Tests are used to Help Make the Diagnosis of ADHD

35. Symbol search: This subtest of the IQ test involves identifying whether a particular symbol is present in a row of symbols. It has direct implications on one's ability to pay attention to detail as well as the ability to quickly scan through information to find what is relevant. • The improvements in post-methylphenidate scores were about twice as large for the non-anxiety group of ADHD children for tests like symbol search.

36. Arithmetic: This is a timed test on the IQ in which arithmetic questions are orally presented to the children and the responses are measured, assessing both speed and accuracy. • With this subtest there was little help with medication, no help if there is comorbid anxiety

37. Activities Controlled by Executive Function Include: • Managing frustration • Restraining outbursts • Problem solving • Memory recall • Sustaining effort • Focusing • Organizing • Planning

38. The Five Types of Executive Function • Those that involve planning or decision making. • Those that involve error correction or troubleshooting. • Situations where responses are not well-learned or contain novel sequences of actions. • Dangerous or technically difficult situations. • Situations which require the overcoming of a strong habitual response or resisting temptation.

39. Colleges Have an Office of Disabilities • Students with a documented disability can get various services. • Services are usually supplied at a fee. • Students who qualify can get the reasonable and necessary accommodation of extended time and a low distraction environment. • Students should check the college web site which will explain what documentation is necessary in order to receive accommodations.

40. Can a Teen or Adult Develop ADHD? • ADHD is related to brain physiology and does not develop spontaneously. • Adults diagnosed with ADHD had symptoms as a child, but sometimes their teachers made informal accommodations for them. • Some individuals do poorly in school, because they had ADHD but were not diagnosed • The ratio of males to females seems to even out by adulthood.

41. The connection between ADHD and circadian rhythms: • scientific explanation behind reasons why ADHD children stay up until three in the morning on a consistent basis.while impulsivity is often more associated as a "morning" behavior, the inattentive subcomponent of ADHD appears to be more affiliated with the evening. Omega-3 deficiencies may disrupt circadian rhythms possibly due to an impairment in melatonin production (melatonin, a hormone, is associated with the sleep-wake cycle and has implications on the circadian rhythm patterns).

42. What is Oppositional Defiant Disorder? • Always seen with another diagnosis • Most likely this will be ADHD • It is a willful pattern of disobedience

43. ODD • Oppositional Defiant Disorder • is a disorder in which a child exhibits disobedience, irritability and hostility towards authority figures beyond the range of normal age-appropriate behaviors. • Of course there is a significant gray area with regards to what is age appropriate, especially when the child's environment is considered.

44. ADHD and Anxiety • By and large, it appears that memory-based tasks are the hardest hit by an accompanying anxiety disorder when methylphenidate is administered as an ADHD treatment.

45. What Happens if the Classroom Behavior Improves with Medication, but Academics Don’t • For the teacher, however, an improvement in classroom behavior due to medication, but a lack of improvement in academic work (especially in memory-related tasks) may be a tip-off that an undiagnosed accompanying anxiety disorder may be in place in this ADHD child.

46. What are the similarities and Differences between Cocaine and Ritalin? • SIMILARITY: Uptake patterns into the brain: Both methylphenidate and cocaine enter the brain at similar rates and target similar specific regions of the brain. • Brain Regions Targeted by each drug: In addition to similar uptake patterns in the brain between the two drugs, there is a relatively large degree of overlap for particular brain regions targeted.

47. Differences Between Ritalin and Cocaine • the method of delivery not only affects the speed of uptake of a drug (injected is almost always faster than snorted, which is almost always faster than ingested), but also the actual brain regions targeted by the drug. • the Nucleus Accumbens is targeted by cocaine and injected methylphenidate. However, when methylphenidate, such as Ritalin, Concerta or Metadate is taken orally, this nucleus accumbens region is not targeted (at least not anywhere near the level of injection).

48. Addiction and ADHD DRUGS • The nucleus accumbens is believed to play an important role in the addiction potential of a number of drugs, including many stimulant medications. • Thus, proper use of the methylphenidate medication actually bypasses a key brain region believed to be critically involved in the "high" or addiction process of a stimulant drug.

49. Low Birth Weight (Less than 5.5lbs) Low birth weight, which has a number of implications for other disorders, was found to be a good indicator of childhood conduct problems appearing alongside of ADHD in its own right. It is believed that low birth weight is a good indicator of a poor prenatal environment, which is why so many disorders and developmental issues are often associated with low birth weights.

50. Ear Infections and ADHDAre they Related? • The main culprit for attentional deficits is often believed to be the result of hearing loss (even mild), early in a child's life due to complications with the middle ear, including infections, allergy-related causes or build-up of fluids in the canal. • As a result, the child begins to miss out on verbal cues, and does not develop the same level of response to an adult voice.