L4 ADHD
15 important questions on L4 ADHD
What are some symptoms of the DSM-5 for ADHA and when are you diagnosed?
- Makes careless mistakes/lacks attention to detail
- Difficulty sustaining attention
- Does not seem to listen when spoken to directly
- Fails to follow through on tasks and instructions
- Exhibits poor organization
- Avoids/dislikes tasks requiring sustained mental effort
- Loses things necessary for tasks/actvities
- Easily distracted
- Is forgetful in daily activities
- Fidgets with or taps hands or feet, squirms in seat
- Leaves seat in situations when remaining seated is expected
- Experiences feelings of restlessness
- Has difficulty engaging in quiet, leisurely activities
- etc.
Six (or more) of these symptoms have persisted for at least 6 months
Next to 6> symptoms of DSM-5 other criteria are present (4)
- Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years
- Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (home, school, work, with friends etc.)
- There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning
- The symptoms do not occur exclusively during the course of schizophrenia or another psychosis disorder and are not better explained by another mental disorder (mood disorder, anxiety, dissociative, personality disorder etc)
The 6 steps of clinical practice for ADHD
- Reason for referral
- conflicts, development school, anxiety, oppositional behaviour etc.
- Objectivy and quantify symptoms
- Developmental interview, observations, questionnaires
- Identification of possible causes
- Since when? In all situations? What happened beforehand? What works?
- Diagnosis
- Clustering of symptoms (DSM classification) + identification of possible causal factors
- Treatment indication
- Treatment
- Focused on child & environment (parents, school)
- Higher grades + faster learning
- Never study anything twice
- 100% sure, 100% understanding
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What are comorbidities of ADHD
- Learning disorders
- Autism spectrum disorders
- Rule-breaking behaviours
- Emotion dysregulation
- Mood and anxiety disorders
- Parent-child relationship problems
What is the etiology (=cause) of ADHD
- Genes (±76%): complex genetic architecture
- Brain
- alterations in brain networks
- Impaired functions
- Environment
- Prenatal (smoking, stress, alcohol when pregnant)
- Perinatal (breast feeding, premature bird)
- Contribute directly or indirectly
- Genes X environment
What treatments are there for ADHD?
- Psychoeducation
- advising school and parents
- Parent and/or teacher training aimed at behavioural problems
- shaping behaviour through parent or teacher
- Medication
What are the conclusions for
- Artificial food colors and preservatives
- Sugar
- Supplementation of Omega-3 fatty acids
- Artificial food colors and preservatives
- Not qualified as stand-alone treatment, but should be minimised in the food supply until proven to be universally safe
- Sugar
- Not qualified as stand-alone treatment, but easy to examine in individual cases and a strong need for studies examining long term effects of high sugar intake
- Supplementation of Omega-3 fatty acids
- Sufficient evidence to consider omega-3 fatty acids as a supplementary treatment, but unclear for whom the intervention is effective
What are the conclusions for
- Supplementation of micro-nutrients
- Elimination diet
- Healthy diet
- Probiotics
- Supplementation of micro-nutrients
- All multi-ingredient trials showed promise, no safety concerns were raised, but more research is needed
- Elimination diet
- Benefits some children with ADHD, but is an invasive treatment and long-term effect are unknown. Unknown whether a healthy balanced diet is equally effective.
- Healthy diet
- Causality is unclear, no sufficient RCTs: not qualified yet as stand-alone treatment
- Probiotics
- ?? (no conclusion)
Which treatments are the most promising for children with ADHD?
- Removing artificial food colouring
- Elimination diet
- Healthy diet
- Omega-3 supplements
- Elimination diet
- Healthy diet
- Omega-3 supplements
How many children with ADHD have symptoms related to food colors?
What are limitations of the elimination diet?
- Expectation bias
- Sample bias
- Long-term effects are unknown
- Underlying mechanism
- Cost-effectiveness
Where stands TRACE for?
Comparing the immediate (5 week) and long term (1 year) clinical and biological effects of an elimination diet and a healthy diet in children with ADHD
-> feasibility
-> cost-effectiveness
What does the TRACE-BIOME study do?
- Explorative
- Microbiome: brain-gut-axis
- Potential markers --> individualised treatment
- Saliva, blood and stool samples
- fMRI
What is the difference between Elimination diet and Healthy diet?
- 5 weeks total change of diet, in which the patient is only allowed to eat a few different hypo-allergenic foods
- Next, 8 month reintroduction phase to find out which products trigger ADHD symptoms
Healthy diet
- Healthy diet based on the strict guidelines of the World Health Organization (WHO)
- Next, 2 monthly supervising by nutritionist
What are challenges of the TRACE study?
- Parents with ADHD
- Parent-child relationship problems worsen during dietary treatment
- Parent and teacher have different views on behavior problems
- Comobidity children
- Adherence
- to diet
- to participating in measurements
The question on the page originate from the summary of the following study material:
- A unique study and practice tool
- Never study anything twice again
- Get the grades you hope for
- 100% sure, 100% understanding
