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Adhd brain-development-and-function-space-stockport-19-10-2018
ADHD is associated with differences in brain structure, function, chemistry and maturation compared to those without ADHD. Core symptoms include inattention, hyperactivity and impulsivity. Common treatments target the brain's neurotransmitters like dopamine and norepinephrine. While genetics play a role, environment and brain plasticity also contribute to ADHD.
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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 ofADHD • Inattention • Hyperactivity • Impulsivity
- 3. Inattention • Distractible • Difficultymaintaining 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 orintruding 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 • Brainplasticity (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 • Workingmemory • Decision making • Insight • Judgement • Inhibition of distractions Thinner in ADHD Prefrontal Cortex
- 12. Brain structures • Sustainingattention • Shifting attention • Integrating reinforcements Thinner in ADHD Cingulate Cortex
- 13. Delayed brain maturation Shawet al, 2007
- 14. Brain structures • Decisionmaking • 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 • Emotionalcontrol • Prioritising action • Smaller in ADHD Amygdala
- 18. Brain structures • Long-termmemory • Working memory Smaller volume in ADHD Hippocampus
- 19.
- 20. Brain networks Dorsal anterior cingulatecortex • Selective attention
- 21. Stroop Test CARD Correctanswer 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 consistof interconnecting neurons
- 26. Neurotransmitters Dopamine Transporter Presynaptic vesicle Postsynaptic receptor Dopamine
- 27. Genetics of ADHD Polymorphismswhich may influence susceptibility to ADHD: • D4 • D5 • DAT • Dopamine β Hydroxylase • SNAP 25 • Serotonin transporter • HTR 1B
- 28. How does Methylphenidatework? Dopamine Transporter Presynaptic vesicle Post synaptic receptor Dopamine
- 29. How does Dexamfetaminework? Dopamine Transporter Presynaptic vesicle Post synaptic receptor Dopamine
- 30. How does Atomoxetinework? Noradrenaline Transporter Presynaptic vesicle Post synaptic receptor NA & Dopamine
- 31. How does Guanfacinework? Noradrenaline Transporter Presynaptic vesicle Post synaptic receptor NA & Dopamine Guanfacine
- 32. Summary ADHD is associatedwith 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
Editor's Notes
- #25 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.