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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. 1. ADHD BRAIN DEVELOPMENT & FUNCTION Peter Mason Consultant Psychiatrist Adult ADHD Service Cheshire & Wirral Partnership NHS Foundation Trust
  2. 2. Core symptoms of ADHD • Inattention • Hyperactivity • Impulsivity
  3. 3. Inattention • Distractible • Difficulty maintaining attention / concentrating • Not listening when spoken to • Difficulty organising / following instructions • Avoiding activities involving mental effort • Forgetful
  4. 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. 5. Impulsivity • Interrupting or intruding on others • Blurting out answers to questions • Trouble waiting in turn • Risk taking • Spending • Fighting
  6. 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. 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. 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. 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. 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. 11. Brain structures • Working memory • Decision making • Insight • Judgement • Inhibition of distractions Thinner in ADHD Prefrontal Cortex
  12. 12. Brain structures • Sustaining attention • Shifting attention • Integrating reinforcements Thinner in ADHD Cingulate Cortex
  13. 13. Delayed brain maturation Shaw et al, 2007
  14. 14. Brain structures • Decision making • Purposeful activity • Classification learning Smaller volume in ADHD Caudate nucleus
  15. 15. Brain structures • Mood • Motivation • Pleasure Smaller volume in ADHD Nucleus accumbens
  16. 16. Brain structures • Learning • Responding to stimuli • Memory • Regulating movement • Smaller volume in ADHD Putamen
  17. 17. Brain structures • Emotional control • Prioritising action • Smaller in ADHD Amygdala
  18. 18. Brain structures • Long-term memory • Working memory Smaller volume in ADHD Hippocampus
  19. 19. Brain networks ADHD INSTITUTE
  20. 20. Brain networks Dorsal anterior cingulate cortex • Selective attention
  21. 21. Stroop Test CARD Correct answer BLUE RED RED GREEN GREEN GREEN GREEN BLUE RED RED ORANGE GREEN
  22. 22. Brain networks Dorsolateral prefrontal cortex • Sustained attention and problem solving
  23. 23. N-back test If N = 1: • Stimulus: 4 Response: None • Stimulus: 2 Response: 4 • Stimulus: 1 Response: 2 • Stimulus: 3 Response: 1etc.
  24. 24. Brain networks Underactive networks: • Frontoparietal network (executive control circuit) Overactive networks: • Default mode network (resting brain) • Visual network • Dorsal attention network
  25. 25. Neurotransmitters • Networks consist of interconnecting neurons
  26. 26. Neurotransmitters Dopamine Transporter Presynaptic vesicle Post synaptic receptor Dopamine
  27. 27. Genetics of ADHD Polymorphisms which may influence susceptibility to ADHD: • D4 • D5 • DAT • Dopamine β Hydroxylase • SNAP 25 • Serotonin transporter • HTR 1B
  28. 28. How does Methylphenidate work? Dopamine Transporter Presynaptic vesicle Post synaptic receptor Dopamine
  29. 29. How does Dexamfetamine work? Dopamine Transporter Presynaptic vesicle Post synaptic receptor Dopamine
  30. 30. How does Atomoxetine work? Noradrenaline Transporter Presynaptic vesicle Post synaptic receptor NA & Dopamine
  31. 31. How does Guanfacine work? Noradrenaline Transporter Presynaptic vesicle Post synaptic receptor NA & Dopamine Guanfacine
  32. 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

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