Kevin M Antshel PhD Associate Professor of Psychiatry Licensed Psychologist State University of New York Upstate Medical University Outline ADHD basics Executive functioning ADHD and PKU ID: 312908
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Slide1
ADHD, Executive Functions and PKU
Kevin M. Antshel, Ph.D.
Associate Professor of Psychiatry / Licensed Psychologist
State University of New York – Upstate Medical UniversitySlide2
Outline
ADHD basics
Executive functioning
ADHD and PKU
QuestionsSlide3
ADHD
Is characterized by
pervasive
and
often
occurring…
Impairing
inattentive symptoms
AND/OR
Impairing
hyperactive / impulsive symptomsSlide4
Inattention symptoms
DSM-IV SYMPTOM
Typical
ADHD
No attention to details
6.0 69.5
Can’t sustain attention 10.3 77.0
Doesn’t listen 7.6 68.3
No follow-through 5.0 77.7
Disorganized 3.3 76.0
Avoids sustained tasks 7.3 62.7
Loses things 13.9 79.2
Easily distracted 14.5 86.1
Forgetful 5.3 68.1
Antshel et al., 2007Slide5
Hyperactive / Impulsive symptoms
DSM-IV SYMPTOM
Typical
ADHD
Fidgets
16.6 69.5
Leaves seat
6.7 63.6
Runs/Climbs 0.6 91.3
Loud 1.9 46.8
Driven by a motor 5.2 55.1
Talks too much 19.7 63.6
Blurts out answers 10.2 65.3
Can’t wait turn 4.3 56.9
Interrupts 16.7 80.1
Antshel et al., 2007Slide6
ADHD diagnosis
Symptoms present before 7 years of age
Symptoms must be present in 2 or more settings (e.g., school, work, home)
Symptoms must have persisted for at least
6
months
The disturbance causes clinically significant impairment in functioning
Is not better accounted for by another disorderSlide7
ADHD “facts”
Prevalence: 5 – 7 %
2:1 – 9:1 male: female ratio
Co-occurs with multiple other psychiatric disorders
Strong heritability
60+% continue to have ADHD as adultsSlide8
Research-supported treatments
Medications
Stimulants (e.g., Ritalin,
Adderall
, etc.)
Noradrenergic (
Strattera
)
Anti-
hypertensives
(e.g.,
Clonidine
,
Tenex
)
Parent Training in Child Management
Children (<11 yrs., 65-75% respond)
Adolescents (25-30% show reliable change)
Teacher Training in Behavior ManagementSlide9
The Usual Questions…
Nigg, 2006Slide10
ADHD affects two primary brain areas
Toga et al., 2006Slide11Slide12
Executive Functions
Planning
Organization
Self-Monitoring
Prioritizing
Goal-oriented, problem solving behavior Slide13
Low Dopamine Availability Links PKU and ADHDSlide14Slide15Slide16Slide17Slide18
Decision Tree for Diagnosing ADHD in PKU
Do ADHD symptoms
dramatically
lessen / become less impairing with better phenylalanine control?
Probably not ADHD – no real need for an evaluationSlide19
Decision Tree (cont’d)
Do ADHD symptoms lessen with tighter phenylalanine control yet continue to
impair
functioning?
Could be worth considering an evaluationSlide20
Decision tree (cont’d)
Do impairing ADHD symptoms continue in the presence of historically and currently well-treated PKU?
Should have an evaluationSlide21
Conclusions
ADHD and PKU share
neurochemical
(dopamine),
neurological
(prefrontal,
striatal
) and
psychological
(executive function deficits) characteristics
To reliably diagnose ADHD, however, ADHD symptoms need to
persist and impair functioning in the context of well-treated PKU