ADHD, Executive Functions and PKU
Kevin M. Antshel, Ph.D.Associate Professor of Psychiatry / Licensed Psychologist
State University of New York – Upstate Medical University
Outline
• ADHD basics• Executive functioning• ADHD and PKU• Questions
ADHD
Is characterized by pervasive and often occurring…
Impairing inattentive symptoms
AND/OR
Impairing hyperactive / impulsive symptoms
Inattention symptoms
DSM-IV SYMPTOM Typical ADHDNo attention to details 6.0 69.5Can’t sustain attention 10.3 77.0Doesn’t listen 7.6 68.3No follow-through 5.0 77.7Disorganized 3.3 76.0Avoids sustained tasks 7.3 62.7Loses things 13.9 79.2Easily distracted 14.5 86.1Forgetful 5.3 68.1
Antshel et al., 2007
Hyperactive / Impulsive symptoms
DSM-IV SYMPTOM Typical ADHDFidgets 16.6 69.5Leaves seat 6.7 63.6Runs/Climbs 0.6 91.3Loud 1.9 46.8Driven by a motor 5.2 55.1Talks too much 19.7 63.6Blurts out answers 10.2 65.3Can’t wait turn 4.3 56.9Interrupts 16.7 80.1
Antshel et al., 2007
ADHD diagnosis
• Symptoms present before 7 years of age• Symptoms must be present in 2 or more settings (e.g., school, work, home)• Symptoms must have persisted for at least 6 months• The disturbance causes clinically significant impairment in functioning• Is not better accounted for by another disorder
ADHD “facts”
• Prevalence: 5 – 7 % • 2:1 – 9:1 male: female ratio• Co-occurs with multiple other psychiatric disorders• Strong heritability• 60+% continue to have ADHD as adults
Research-supported treatments
• Medications•Stimulants (e.g., Ritalin, Adderall, etc.) •Noradrenergic (Strattera)•Anti-hypertensives (e.g., Clonidine, Tenex)
• Parent Training in Child Management •Children (<11 yrs., 65-75% respond)•Adolescents (25-30% show reliable change)
• Teacher Training in Behavior Management
The Usual Questions…
Nigg, 2006
ADHD affects two primary brain areas
Toga et al., 2006
Executive Functions
• Planning• Organization• Self-Monitoring• Prioritizing• Goal-oriented, problem solving behavior
Low Dopamine Availability Links PKU and ADHD
Decision Tree for Diagnosing ADHD in PKU
Do ADHD symptoms dramatically lessen / become less impairing with better phenylalanine control?
Probably not ADHD – no real need for an evaluation
Decision Tree (cont’d)
Do ADHD symptoms lessen with tighter phenylalanine control yet continue to impair
functioning?
Could be worth considering an evaluation
Decision tree (cont’d)
Do impairing ADHD symptoms continue in the presence of historically and currently well-
treated PKU?
Should have an evaluation
Conclusions
• ADHD and PKU share neurochemical (dopamine), neurological (prefrontal, striatal) and psychological (executive function deficits) characteristics• To reliably diagnose ADHD, however, ADHD symptoms need to persist and impair functioning in the context of well-treated PKU