John is a 7-year-old boy who is being treated with methylphenidate (Concerta) for ADHD. In your own words, explain the pathophysiology of ADHD. His mother asks if he can be switched to a non-stimulant medication. Explain the difference between stimulant and non-stimulant medications for this disorder
Pathophysiology of ADHD
The functional and structural changes within the brain as well as changes in the level of specific neurotransmitters in the brain such as dopamine are associated with the development of ADHD (Cabral, Liu & Soares, 2020). For example, the frontal and prefrontal brain regions are associated with ADHD as evidence indicates that children with deformed basal ganglia nuclei have worse ADHD symptoms and also ADHD alters the activation of the brain when carrying out specific activities. Similarly, the level of neurotransmitters such as norepinephrine and dopamine cause ADHD because these brain chemicals help in controlling behavior (Cabral, Liu & Soares, 2020). Therefore, changes in these neurotransmitters cause changes in the brain in regions associated with automatic attention and task-positive network. This is the reason ADHD is characterized by inattention and hyperactivity.
Difference between Stimulants and Non-Stimulants in ADHD
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ADHD medications belong to stimulants and non-stimulants. Stimulants normally target dopamine receptors and thus they increase the amount of dopamine within the brain (Brown, Samuel & Patel, 2018). As a result, stimulants are very effective in improving attention and decreasing impulsivity and hyperactivity. On the other hand, non-stimulants target receptors of norepinephrine within the brain (Brown et al., 2018). Non-stimulants also reduce hyperactivity and impulsivity and improve attention. Another key difference is that stimulants are fast-acting and thus their effects are felt within 30-90 minutes after administration of the first dose. Since stimulants are fast-acting, their effects leave the body within 3-12 hours. However, non-stimulants are not fast-acting and hence they take a longer time (2-4 weeks) for the medication to show its efficacy (Brown et al., 2018).
Stimulants are normally the first-line treatment choices for children with ADHD (Brown et al., 2018). Non-stimulants may be prescribed if the stimulants are not effective if the side effects of stimulants are intolerable or combined with stimulants for children with severe ADHD symptoms (Bahn & Seo, 2021).
Bahn, G. H., & Seo, K. (2021). Combined Medication with Stimulants and Non-stimulants for Attention-deficit/hyperactivity disorder. Clinical psychopharmacology and neuroscience: the official scientific journal of the Korean College of Neuropsychopharmacology, 19(4), 705–711. https://doi.org/10.9758/cpn.2021.19.4.705
Brown, K. A., Samuel, S., & Patel, D. R. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: a review for practitioners. Translational Pediatrics, 7(1), 36–47. https://doi.org/10.21037/tp.2017.08.02
Cabral, M., Liu, S., & Soares, N. (2020). Attention-deficit/hyperactivity disorder: diagnostic criteria, epidemiology, risk factors and evaluation in youth. Translational Pediatrics, 9(Suppl 1), S104–S113. https://doi.org/10.21037/tp.2019.09.08