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ADHD ADHD is a complex neurological condition..

ADHD is a

ADHD and Brain

The Neuroscience of the ADHD Brain, January 2023

of the brain. The ADHD brain has impaired activity in four functional regions of the brain.

1. Frontal Cortex

1. Frontal Cortex

This region controls high-level functions:

 Attention

 Executive Function

 Organization

2. Limbic System

This region is located deeper in the brain. It regulates our emotions and attention.

3. Basal Ganglia

A deficiency in this area can cause inter-brain communication & information to “short-circuit.” that results in inattention or impulsivity.

4. Reticular Activating System

This is the major relay system among the many pathways that enter & leave the brain. A deficiency can cause inattention, impulsivity, or hyperactivity.

The Neuroscience of ADHD Brain, January 2023

Neurotransmitters involved in ADHD.

Dopamine and norepinephrine are two neurotransmitters that are associated with ADHD.

Norepinephrine plays an important role in the prefrontal cortex. ADHD may disrupt its transmission in the brain. Symptoms include difficulty retaining the information needed to complete tasks successfully. It may also impair the individual’s inhibitory control, suppress distractions, urges, or behaviors that interfere with one’s goals.

Dopamine helps regulate one’s emotions and is linked to feelings of pleasure and reward.

In ADHD, there is decreased levels of dopamine in the brain. This makes it harder to maintain motivation, especially when the rewards seem small or not immediate. ADHD brains tend to favor short-term, smaller rewards over long-term, more significant ones. (Silver, L., January 2023).

First line, second line and third line treatment

Stimulant medicines are the first-line ADHD treatment for school-aged children. Two medicines, methylphenidate and amphetamines, are the most commonly used stimulants for the treatment of ADHD.

●Methylphenidate – Methylphenidate (sample brand names: Concerta, Focalin, Metadate, Methylin, Ritalin) is available as a tablet, capsule, liquid, oral disintegrating tablet, or patch (brand name Daytrana).

•Short-acting formulas are usually started with one dose per day and then increased to two or three times daily. •Long-acting formulas are usually taken once per day in the morning.

●Amphetamines – Amphetamines are also available in short-acting and long-acting formulas ( brand names: Adderall, Dexedrine, Dextrostat, Vyvanse)

Atomoxetine, guanfacine XR and clonidine XR are considered second- line (second choice) treatments. Atomoxetine (Strattera) is a non-stimulant approved by the FDA for the treatment of ADHD. It is in the class of medications known as selective norepinephrine reuptake inhibitors.

Antidepressant medications including Wellbutrin are considered third line and can be used off-label to treat ADHD symptoms. is a

ADHD is a complex neuroligal conditioncondition.

ADHD is a

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ADHD is a complex neuroligal conditioncondition.

ADHD is a

ADHD ADHD is a complex neuroligal conditioncondition.

ADHD is a

COMMON MEDICATIONS and SIDE EFFECTS

Stimulant ADHD Medications and Side Effects

Medications

Dextroamphetamine

Dextroamphetamine and amphetamine

Dexmethylphenidate

Methylphenidate

Side Effects

Side effects include loss of appetite, weight loss, sleep problems, crankiness, and tics. Long-acting medicines may have greater effects on appetite and sleep.

The FDA has issued a warning about the risk of drug abuse with amphetamine stimulants. FDA safety advisers are also concerned that all amphetamine and methylphenidate stimulants used for ADHD may make heart and psychiatric problems more likely. ( Bhandari, S., March 2023)

DHD is a

COMMON MEDICATIONS and SIDE EFFECTS

Non-Stimulant ADHD Medications and Side Effects

Medications

Atomoxetine (Strattera)

Clonidine (Catapres)

Guanfacine (Intuniv)

Viloxazine (Qelbree)

Side effects

Non-stimulant medications usually take a while to start working. It could be several weeks before the full effects. Also, they may not work as well as stimulants. Some non- stimulant medications may raise the risk of suicidal thoughtsand death by suicide in teens. The FDA warns that anyone taking atomoxetine (Strattera) should be monitored for suicidal thoughts, especially during the first few weeks. Common side effects of these drugs include fatigue, upset stomach,dry mouth, dizziness, sleep problems, dry mouth and nausea.

ADHD is a

COMMON MEDICATIONS and SIDE EFFECTS

Antidepressant ADHD Medications and Side Effects

These medications can be used off-label to treat ADHD symptoms. The FDA has also warned about a connection between antidepressants and a higher risk of suicide in adults ages 18-24, especially in the first 1 or 2 months. (Bhandari, S., March 2023)

Bupropion (Wellbutrin)

Side effects

Headaches. Although rare, may make an individual more likely to have seizures.

Desipramine (Norpramin) Side effects Not recommended for children. Associated with rare cases of fatal heart problems.

Imipramine (Tofranil)

Side effects

Anxiety, fatigue, upset stomach, dizziness, dry mouth, higher heart rate, risk of heart arrhythmias.

Nortriptyline ( Aventyl, Pamelor)

Side effects : Anxiety, fatigue, upset stomach, dizziness, dry mouth, higher heart rate, risk of heart arrhythmias.

MECHANISM OF ACTION

Stimulants increase the availability of both dopamine and norepinephrine in prefrontal cortex, which enhances the efficiency of information processing at pyramidal neurons, resulting in the improvement of symptoms in attention-deficit/hyperactivity disorder (ADHD).

 Stimulants have long been known to increase dopamine (DA) in the prefrontal cortex (PFC).

 It is generally less well appreciated that stimulants also increase norepinephrine (NE).

 Symptoms of ADHD are theoretically linked to inefficient information processing by pyramidal neurons in PFC, perhaps due in part to imbalances in the neurotransmitters DA and NE.

 Stimulants such as methylphenidate and amphetamine hypothetically act at these pyramidal neurons to enhance signal strength by increasing NE and to reduce noise by increasing DA, thereby reducing symptoms of inattention, hyperactivity, and impulsivity in ADHD.

Stahl, S., January 2010

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RESOURCES IN CHILD PSYCHIATRY

>American Academy of Child and Adolescent Psychiatry. This organization provides support and resources aimed at helping the health of children, adolescents, and their families.

>American Academy of Pediatrics The American Academy of Pediatrics (AAP) dedicate their efforts and resources to the health, safety and well-being of infants, children, adolescents and young adults.

>Child Mind Institute The Child Mind Institute is dedicated to transforming the lives of children and families struggling with mental health and learning disorders by giving them the help they need to thrive.

ADHD is a

References

Adda Editorial Team (December, 2022). Inside the ADHD brain: Structure, function and chemistry. Attitude. Retrieved from https//add.org/adhd-brain/adda.

Bhandari, S. (March 2013). ADHD medications and side effects. WebMD. Retrieved from https://www.webmd.com/add-adhd/adhd-medication-chart

Felt, B. Biermann, B., Christner, J., Kochhar, P., Van Harrison, R. (October 2014). Diagnoses and Management of ADHD in Children. American Family Physician. Retrieved from https://www.researchgate.net/profile/Jennifer...

Silver, L.(January 2023). The neuroscience of the ADHD brain. Attitude. Retrieved from https://www.additudemag.com/neuroscisnce-of-adhd-brain/.

Stahl, S. (January,2010). Mechanism of action of stimulants in ADHD. The Journal of Clinical Psychiatry. Retrieved from https:// www.psychiatrist.com

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