NR 546 Week 7 ADHD Across the Lifespan & Sleep
Disorders – Neurotransmitters, Medications, and Clinical
Management
Neurotransmitters related to ADHD
dopamine and norepinephrine
ADHD Across the Lifespan
Symptoms change with age.
Not only a childhood diagnosis
Hyperactivity decreases markedly with age
Primary Symptoms: inattention, restlessness, cognitive & emotional impulsivity, executive
functioning deficits, and self-regulation
Adults struggling with executive functioning difficulties and disorganization may experience
occupational stress or anxiety.
Neuroanatomy of ADHD
Specific ADHD symptoms may arise from abnormalities within circuits in the prefrontal cortex
(PFC), which affect executive function.
Neural Networks of ADHD
symptoms often become noticeable - 6-7 old
Due to abnormalities in the prefrontal cortex circuits or errors in the synaptic pruning process.
Modulated by the corticostriatal-thalamocortical (CSTC) loop, the same loop that is associated
with anxiety. ADHD is an alternative diagnosis to consider when clients present with anxiety
symptoms.
Neural Signaling of ADHD
Norepinephrine (NE) and dopamine (DA) are associated with inefficient information processing
in the prefrontal circuits. ADHD medications commonly target both dopamine and
norepinephrine. Stimulants, including stimulant medications, caffeine, and nicotine enhance DA
release and arousal.
Why does atomoxetine lack abuse potential?
It increases dopamine levels in the prefrontal cortex but not in the nucleus accumbens.
, Which of the following accurately explains the effects of different stimulant formulations on
neuronal firing?
Pulsatile stimulation amplifies undesirable phasic DA and NE firing, which can lead to euphoria
and abuse.
Chris is a 44-year-old client presenting with comorbid alcohol abuse, generalized anxiety, and
ADHD. Which disorder should be treated first?
Alcohol abuse
Stimulants
stimulate the release of NE and DA or boost the firing of associated neurons may help improve
information processing.
effective for 70-80% of clients with ADHD
first choice of medications for children
schedule II controlled substances
no refills permitted
Nonstimulants
work by selective inhibition of presynaptic norepinephrine reuptake in the prefrontal cortex and
enhancement of norepinephrine neurotransmission.
help lower distractibility and improve attention, working memory, and impulsivity.
low risk of abuse or diversion
often prescribed for adults with ADHD
Methylphenidate
Low risk of adverse effects
Available formulations:
Ritalin- available in immediate release (IR) and extended release (XR)
available in beads that may be sprinkled on food for children who cannot swallow pills
Concerta- biphasic - combined immediate and delayed release in one medication
Daytrana - patch applied in the morning and removed after 9 hours
dexmethylphenidate (Focalin)
Available in immediate release and extended release
More potent than Ritalin
High risk of adverse effects
amphetamine (Adzenys)
Disorders – Neurotransmitters, Medications, and Clinical
Management
Neurotransmitters related to ADHD
dopamine and norepinephrine
ADHD Across the Lifespan
Symptoms change with age.
Not only a childhood diagnosis
Hyperactivity decreases markedly with age
Primary Symptoms: inattention, restlessness, cognitive & emotional impulsivity, executive
functioning deficits, and self-regulation
Adults struggling with executive functioning difficulties and disorganization may experience
occupational stress or anxiety.
Neuroanatomy of ADHD
Specific ADHD symptoms may arise from abnormalities within circuits in the prefrontal cortex
(PFC), which affect executive function.
Neural Networks of ADHD
symptoms often become noticeable - 6-7 old
Due to abnormalities in the prefrontal cortex circuits or errors in the synaptic pruning process.
Modulated by the corticostriatal-thalamocortical (CSTC) loop, the same loop that is associated
with anxiety. ADHD is an alternative diagnosis to consider when clients present with anxiety
symptoms.
Neural Signaling of ADHD
Norepinephrine (NE) and dopamine (DA) are associated with inefficient information processing
in the prefrontal circuits. ADHD medications commonly target both dopamine and
norepinephrine. Stimulants, including stimulant medications, caffeine, and nicotine enhance DA
release and arousal.
Why does atomoxetine lack abuse potential?
It increases dopamine levels in the prefrontal cortex but not in the nucleus accumbens.
, Which of the following accurately explains the effects of different stimulant formulations on
neuronal firing?
Pulsatile stimulation amplifies undesirable phasic DA and NE firing, which can lead to euphoria
and abuse.
Chris is a 44-year-old client presenting with comorbid alcohol abuse, generalized anxiety, and
ADHD. Which disorder should be treated first?
Alcohol abuse
Stimulants
stimulate the release of NE and DA or boost the firing of associated neurons may help improve
information processing.
effective for 70-80% of clients with ADHD
first choice of medications for children
schedule II controlled substances
no refills permitted
Nonstimulants
work by selective inhibition of presynaptic norepinephrine reuptake in the prefrontal cortex and
enhancement of norepinephrine neurotransmission.
help lower distractibility and improve attention, working memory, and impulsivity.
low risk of abuse or diversion
often prescribed for adults with ADHD
Methylphenidate
Low risk of adverse effects
Available formulations:
Ritalin- available in immediate release (IR) and extended release (XR)
available in beads that may be sprinkled on food for children who cannot swallow pills
Concerta- biphasic - combined immediate and delayed release in one medication
Daytrana - patch applied in the morning and removed after 9 hours
dexmethylphenidate (Focalin)
Available in immediate release and extended release
More potent than Ritalin
High risk of adverse effects
amphetamine (Adzenys)
