Adhd brain-development-and-function-space-stockport-19-10-2018
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Presentation from The World of ADHD According to S.P.A.C.E. 2018 by Dr Peter Mason.
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Adhd brain-development-and-function-space-stockport-19-10-2018
- 1. ADHD BRAIN DEVELOPMENT & FUNCTION Peter Mason Consultant Psychiatrist Adult ADHD Service Cheshire & Wirral Partnership NHS Foundation Trust
- 2. Core symptoms of ADHD • Inattention • Hyperactivity • Impulsivity
- 3. Inattention • Distractible • Difficulty maintaining attention / concentrating • Not listening when spoken to • Difficulty organising / following instructions • Avoiding activities involving mental effort • Forgetful
- 4. Hyperactivity symptoms • Fidgety • Getting up from seat when should be seated • Running about when should be still • Noisy doing leisure activities • Often ‘on the go’ or acts as if ‘driven by a motor’ • Talking excessively
- 5. Impulsivity • Interrupting or intruding on others • Blurting out answers to questions • Trouble waiting in turn • Risk taking • Spending • Fighting
- 6. Prevalence of ADHD • 40% of children exhibit parent-reported problems with attention or hyperactivity corresponding to ADHD diagnostic criteria at age 4.1 • 5.29%2 and 7.1%3 in children and adolescents.2,3 • 3.4% (range 1.2–7.3%) in adults.4 1. Jacobsen et al (2018), 2.Polanczyk G (2007), 3. Willcutt (2012), 4. Fayyad (2007)
- 7. Aetiology of ADHD Genetic • Parents & siblings of ADHD children are 4 to 5 times more likely to have ADHD than general population. • Twin studies give a heritability estimate of 70 - 90%. • Over 50 different genes implicated in ADHD
- 8. Aetiology of ADHD Others • Neonatal hypoxia • Lead exposure • Extreme prematurity & low birth weight • Intrauterine exposure to alcohol (FAS) and nicotine • Acquired brain disorder (encephalitis or trauma) • Diet
- 9. Prevalence of ADHD • 40% of children exhibit parent-reported problems with attention or hyperactivity corresponding to ADHD diagnostic criteria at age 4.1 • 5.29%2 and 7.1%3 in children and adolescents.2,3 • 3.4% (range 1.2–7.3%) in adults.4 1. Jacobsen et al (2018), 2.Polanczyk G (2007), 3. Willcutt (2012), 4. Fayyad (2007)
- 10. Brain Plasticity • Brain plasticity (neuroplasticity) refers to the extraordinary ability of the brain to modify its own structure and function following changes within the body or in the external environment.
- 11. Brain structures • Working memory • Decision making • Insight • Judgement • Inhibition of distractions Thinner in ADHD Prefrontal Cortex
- 12. Brain structures • Sustaining attention • Shifting attention • Integrating reinforcements Thinner in ADHD Cingulate Cortex
- 13. Delayed brain maturation Shaw et al, 2007
- 14. Brain structures • Decision making • Purposeful activity • Classification learning Smaller volume in ADHD Caudate nucleus
- 15. Brain structures • Mood • Motivation • Pleasure Smaller volume in ADHD Nucleus accumbens
- 16. Brain structures • Learning • Responding to stimuli • Memory • Regulating movement • Smaller volume in ADHD Putamen
- 17. Brain structures • Emotional control • Prioritising action • Smaller in ADHD Amygdala
- 18. Brain structures • Long-term memory • Working memory Smaller volume in ADHD Hippocampus
- 20. Brain networks Dorsal anterior cingulate cortex • Selective attention
- 21. Stroop Test CARD Correct answer BLUE RED RED GREEN GREEN GREEN GREEN BLUE RED RED ORANGE GREEN
- 22. Brain networks Dorsolateral prefrontal cortex • Sustained attention and problem solving
- 23. N-back test If N = 1: • Stimulus: 4 Response: None • Stimulus: 2 Response: 4 • Stimulus: 1 Response: 2 • Stimulus: 3 Response: 1etc.
- 24. Brain networks Underactive networks: • Frontoparietal network (executive control circuit) Overactive networks: • Default mode network (resting brain) • Visual network • Dorsal attention network
- 25. Neurotransmitters • Networks consist of interconnecting neurons
- 26. Neurotransmitters Dopamine Transporter Presynaptic vesicle Post synaptic receptor Dopamine
- 27. Genetics of ADHD Polymorphisms which may influence susceptibility to ADHD: • D4 • D5 • DAT • Dopamine β Hydroxylase • SNAP 25 • Serotonin transporter • HTR 1B
- 28. How does Methylphenidate work? Dopamine Transporter Presynaptic vesicle Post synaptic receptor Dopamine
- 29. How does Dexamfetamine work? Dopamine Transporter Presynaptic vesicle Post synaptic receptor Dopamine
- 30. How does Atomoxetine work? Noradrenaline Transporter Presynaptic vesicle Post synaptic receptor NA & Dopamine
- 31. How does Guanfacine work? Noradrenaline Transporter Presynaptic vesicle Post synaptic receptor NA & Dopamine Guanfacine
- 32. Summary ADHD is associated with differences in: • Brain structure • Brain function • Brain chemistry • Brain maturation ADHD is a continuum of symptoms of inattention, impulsivity and restlessness The brain is plastic
Notas do Editor
- Executive control circuit: role in making decisions and learning new tasks. May be responsible for mind wandering and lack of motivation or impulse control. Default mode network: switches off default network activity when focus is needed.