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 ADHD No attention to details Can’t sustain attention Doesn’t listen No follow-through Disorganized Avoids sustained tasks Loses things Easily distracted Forgetful Antshel et al., 2007

Hyperactive / Impulsive symptoms DSM-IV SYMPTOM Typical ADHD Fidgets Leaves seat Runs/Climbs Loud Driven by a motor Talks too much Blurts out answers Can’t wait turn Interrupts 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