1 young, fast and wild

Question 1

ADHD

Answer 1

dhd is characterized by a persistent pattern of difficulties sustaining attention and/or impulsiveness and excessive or exaggerated motor activity.

Question 2

what makes ppl with adhd different than “average” human?

Answer 2

• we all fluctuate in quality of attention and energy levels however with adhd these issues need to be persistent, numerous and cause some significant issues at home, school, workplace etc.
• kids with adhd often score 7-15 points lower on IQ test
• kids show deficits on neuropsychological testing
• difficulties in reading and school activities
• other than school issues, there is also social impairments
  
  • hard to create good relation with parents cuz usually fail to obey rules
  • (their behavior problems can also stem from being viewed negatively by their peers)

Question 3

main DSM criteria for ADHD

Answer 3

inattention and hyperactivity/impulsivity. within these categories, there are more specific examples.

Question 4

the 2 diagnostic subtypes of ADHD

Answer 4

attention deficit hyperactivity disorder, predominantly inattentive presentation.
attention deficit hyperactivity disorder, predominantly hyperactive/impulsive presentation.
Third subtype: combined presentation (inattentive + hyperactive/impulsive)

Question 5

how do ppl with ADHD experience academics, and peer relationships?

Answer 5

Academics: more academically frustrated; more prone to outburst and temper tantrums; lower self esteem; inattentiveness + hyperactivity also negatively affects peer relationships and thus academics
Score lower on IQ tests
Peer relationships: experience peer rejection; bad at turn taking

Question 6

if you have ADHD: what happens to your sustained attention, selective attention, and executive function?

Answer 6

Impaired sustained attention, but not selective attention

Impaired executive functions; leads to impulsivity and other common “symptoms”

Question 7

prevalence of ADHD

Answer 7

one source:
around 5% of school-age children worldwide are diagnosed with ADHD and 2.5% of adults (DSM-5).
Similar rates in pre-school children (aged 2-5 years) and ½ will carry that diagnosis into adulthood. )

book:
- fairly prevalent
- around 9 kids and adolescents have it
- one of most frequently diagnosed disorders
- higher rate in boys 14%
- rate in girls just 4%

Question 8

ADHD comorbidity

Answer 8

Comorbid with conduct disorder and oppositional defiant disorder (also may be comorbid with anxiety disorders)

Question 9

etiology; cause or origin of ADHD
genetic factors:

Answer 9

ADHD is one of the most heritable psychiatric disorders (Twin studies: heritability estimate of 76%)
Genes may underlie abnormalities in neurotransmitter systems (the dopamine, norepinephrine and serotonin systems).
Affects to amount of dopamine
Evidence: adoption studies

Question 10

etiology; cause or origin of ADHD
neuroscience:

Answer 10

Smaller total brains volume
Brains of children w/ ADHD are smaller + they develop more slowly.
Main areas affected: frontal, parietal, temporal and occipital lobes + global reduction in grey matter.
Decreased frontal lobe volume → deficits in executive functioning (involving planning and problem solving); difficulty inhibiting responses + poor performance on tests of attention.
Impaired cerebellum: influences motor and cognitive responses

Question 11

etiology; cause or origin of ADHD
prenatac factors + environmental toxins

Answer 11

Prenatal factors: Maternal smoking and drinking during pregnancy
General complications associated with childbirth; low birth weight, respiratory distress and birth asphyxia.

Environmental toxins:
Little evidence to suggest that food additives generally influence ADHD.
Both the levels of lead in the blood and chronic exposure to nicotine or tobacco smoke may increase hyperactivity (some support).

Question 12

etiology; cause or origin of ADHD
psychological factors

Answer 12

Parent-child interactions:
Children with ADHD are more likely to be raised by parents who also have the disorder → may exacerbate any symptoms caused by the genetic component alone.
Ineffective parenting (inconsistent or authoritarian) → may exacerbate ADHD symptoms.

Theory of mind deficit

Question 13

treatments of ADHD

Answer 13

Psychostimulants: medications that increase central nervous system activity.
Most commonly prescribed psychostimulants: Ritalin, Dexedrine, Cylert, and Adderall.
Increase alertness, arousal, and attention. (main effect on behavior, more than attention)
Produce immediate and noticeable improvements in the behavior of about 75% of children with ADHD.
Myth: psychostimulants have a “paradoxical effect” on overactive children (makes “normal” children restless while slowing down overactive children.)
Truth: affect normal children in the same way as ADHD children; improves attention and decreased motor activity.
Side effects:
Decreased appetite, trouble sleeping, increased heart rate.
effects on physical growth (children maintained on psychostimulants fall somewhat behind expected gains in height and weight).

this is all bullshit, use holistic ways to regulate the nervous system

Question 14

Autistic spectrum disorder (ASD)

Answer 14

Autistic spectrum disorder (ASD): An umbrella term that refers to all disorders that display autistic-style symptoms across a wide range of severity and disability.
spectrum of developmental impairments and delays include social and emotional disturbances, intellectual disabilities, language and communication deficits, and the development of stereotyped or self-injurious behaviour patterns.

Question 15

DSM criteria for ASD

Answer 15

ongoing deficits in social situations following:
- failure to respond or initiate appropriately to social interactions
- nonverbal communication deficits such as eye contact abnormalities
- inability to develop or maintain relationships
restricted and repetitive patterns of behavior, interest or activity as marked by at least 2 of the following
- repetitive motor movement or speech
- strong adherence to routine and inflexibility
-abnormally intense fixated interests
- hypersensitivity to sensory input,
symtoms start in early childhood

Question 16

Neuroimaging in regard to ASD

Answer 16

decreased activity in prefrontal cortex, increased activity in occipital/temporal areas.

Question 17

echolalia (in asd)

Answer 17

immediate imitation of words or sounds that have just been heard.

Question 18

ASD: Impairments in imagination and flexibility of thought

Answer 18

Restricted, repetitive and stereotyped patterns of behaviour and interests.
Childhood: specific and detailed interest in only a small number of toys + may form strong attachments
Need to retain ‘sameness’ in all their experiences + distressed if their routine is disrupted.
Stereotyped body movements (self-stimulatory, ex. hand clapping, finger snapping, rocking, dipping and swaying)
Tantrums over small changes

Question 19

ASD intellectual deficits

Answer 19

80% exhibit signs of intellectual disability + IQ score of less than 70
Usually perform much better on tests of visuospatial ability than tests of social understanding or verbal ability.
May excel at one specific task or in one particular area.

Question 20

savant syndrome

Answer 20

extraordinary proficiency in one isolated skill in individuals w/ multiple cognitive disabilities.

Question 21

ASD prevalence

Answer 21

around 0.05%-1.1% of births.
prevalence rate of the disorder has been increasing significantly over the past two decades

Question 22

ASD gender ratio

Answer 22

around 80% of those diagnosed are boys.
this is criticized. rate in girls could be higher but it is harder to diagnose since girls are more prone to masking.

Question 23

ASD age of onset

Answer 23

ge of onset: from as young as less than 1 year of age (/13 months) it will become apparent that the infant’s development is not proceeding normally.

Question 24

Etiology ASD
genetic factors

Answer 24

2-14% probability of having ASD if a sibling does
Evidence for a strong familial aggregation of autistic symptoms (up to 90% heritability in some studies.)

Co-occurs with several known genetic disorders → implying a genetic link in its aetiology.

Partially caused by problems in gene sequencing; a single gene is not responsible for the expression of autism, and as many as 15 different genes may be involved.

Chromosome 16 + 5

Question 25

etiology of ASD
prenatal factors

Answer 25

May be influenced by teratogens

Risk factors: maternal infections (ex. maternal rubella) during pregnancy, intrauterine exposure to drugs (ex. thalidomide and valproate), maternal bleeding after the first trimester of pregnancy, and depressed maternal immune functioning during pregnancy.

Probably account for a very small % of cases of ASD.

Question 26

etiology of ASD
brain abnormalities

Answer 26

Autism is associated with aberrant brain development.
Abnormalities in a number of brain regions: frontal lobes, limbic system, cerebellum and basal ganglia.
Significantly poorer neural connectivity (limbic system).
Lack of ‘theory of mind’ associated with decreased activation of the prefrontal cortex and amygdala.
Overly large brain size and enlarged ventricles in the brain.
Grows rapidly early on, but then slows down.
(Biochemical factors: Abnormalities in the brain neurotransmitters that regulate and facilitate normal adaptive brain functioning (ex. low levels of the neurotransmitters serotonin and dopamine). Inconclusive research. )

Question 27

etiology of ASD
cognitive factors

Answer 27

Deficits in executive functioning: exhibit deficits in executive functioning, resulting in poor problem-solving ability, difficulty planning actions, controlling impulses and attention, and inhibiting inappropriate behaviour → impacts social skills

Theory of mind (TOM) deficits: fail to develop an awareness that the behaviour of other people is based on mental states that include beliefs and intentions about what they should do.

The empathizing-systematizing theory: A theory of the social and communication difficulties experienced by individuals with autistic spectrum disorder.

Individuals with ASD may even have superior skills in systematizing (analysing or constructing systems to understand the world).

Question 28

difficulties in treating ASD

Answer 28

Main characteristics of ASD include not liking changes from routine, and any intervention is designed to implement change.
Often appear to be oblivious to the outside world → programme has to begin at a very basic communication level.
Show interest in only a very limited range of events and objects → difficult to find effective reinforcers that can be used to reward them.
Overly selective attention → if they do attend to the training task, anything that is learnt may be situation specific and will not generalize to other environments or to other similar tasks.

Question 29

types of treatment for ASD

Answer 29

Conditioning-based approach: clinician attempts to reinforce basic behavioural skills such as attention (eye contact), toileting behaviour, self-help behaviours, initiating interactions with peers and adults, and play behaviour with peers. -involves modelling

Parent-implemented early intervention: using parents as effective trainers to teach children with intellectual disabilities basic self-help and communication skills.

(improves child communication behaviour, increase maternal knowledge of autism, enhance maternal communication style and parent- child interaction, and reduce maternal depression).

Antipsychotic medications (haloperidol, risperidone): reduce repetitive and stereotyped behaviours, levels of social withdrawal, symptoms associated with aggression, and challenging behaviour such as hyperactivity, temper tantrums, mood changes and self-abusive behaviour.
Can have very bad side effects

Inclusion strategies: Supported employment has proven successful at helping higher functioning individuals with autism to find and maintain employment.

Question 30

ADHD difference between girls and boys

Answer 30

Boys more likely to be treated than girls
Girls tend to have the inattentive form - boys more likely to be diagnosed because they are more hyperactive

Symptoms:
Girl
Trouble with social/home life
More verbally aggressive
More internal symptoms (affects themselves)
Space out during conversations
Focus anger and pain inward
Low self-esteem, anxiety, depression

Boy
Trouble at school/work
More physically aggressive
More external symptoms -> affects others
Interrupt conversations
Externalize their frustrations
Behavioural issues

Question 31

Aetiology of ADHD (cause)

Answer 31

Genetics - one of most heritable psychiatric disorders - 76%
-> make people more susceptible to environmental factors
- environment - nicotine or tobacco exposure - increases hyperactivity
- Hyperactivity - food additives, refined sugar cane and lead poisoning

• Prenatal factors - exposure to nicotine and alcohol associated with children having a genetic predisposition to ADHD
  Low birth weight, respiratory distress, birth asphyxia
  Parent child interactions - parents with ADHD more likely to have children with disorder - inconsistent parenting

Question 32

brain differences in ADHD

Answer 32

Smaller brain
Develops more slowly
Smaller frontal cortex, basal ganglia, cerebellum
Deficits in executive functioning
Abnormalities cortical-striatal-thalamo-cortical circuits -> choosing,initiating, and carrying out complex motor and cognitive responses
Reduction gray matter

Question 33

treatments

Answer 33

Psycho stimulants - increases activity in CNS - increases alertness, attention = first line treatment
->criticism: don’t have any long term benefits for hyperactivity and inattention
-> paradoxical effects -
-> same effects in adults, same effects on people that do not have ADHD
CBT - cognitive behavioral therapy
Children only when older and more severe treatment with medication

Question 34

Oppositional defiant disorder

Answer 34

Some patients also diagnosed with oppositional defiant disorder
50% diagnosed with combined presentation tend to be diagnosed with disorder
More aggressive
Both diagnosis - brings out worst of both
Cause - vicious circle - aggressive behavior - increases likelihood to show that behavior

Question 35

theory of mind

Answer 35

definition - ability to understand other people’s mental states
Children poorer understanding of intention of others

Question 36

prevalence ASD

Answer 36

between 5 and 13 in 10000

Question 37

epidemiology ASD (prevalence, gender ratio, cultural differences, age of onset, course)

Answer 37

80% boys - happens equally in all classes and culture
Behavior patterns may change with age, symptoms may be manifested with varying degrees of Intellectual disabilities, often comorbid with other problems
Impairment social interactions - some non-verbal behaviors, unable to regulate social interaction and communication (younger children, lack of interest in making friends)
Trouble understanding emotions of others and their own
-> fail to develop theory of mind
Intelligence levels - 80% IQ score lower than 70
Autism is a spectrum

Question 38

asperger syndrome

Answer 38

Asperger’s syndrome was delineated in the DSM-IV, and was then folded into the diagnosis of autism spectrum disorder in the DSM-5. (For more on autism, see here.) Symptoms include:

Atypical verbal and nonverbal communication
Inability to engage in typical back and forth conversation
Inability to reciprocate social or emotional feelings
Not seeking to share enjoyment, interests, or achievements with others
Failure to develop and maintain peer relationships
Inflexibility about specific routines or rituals
Intense preoccupation with a narrow area of interest
Repetitive finger tapping, twisting, or whole-body movements
Unusually sensitive to sensory aspects of the environment

Question 39

savant syndrome

Answer 39

SAVANT SYNDROME is the condition in which a person having a developmental disorder (such as autism or intellectual disability) exhibits exceptional skill or brilliance in some limited field (such as mathematics or music). How to use savant syndrome in a sentence.

Question 40

case study about child diagnosed with ASD

Answer 40

Elijah is a six-year-old boy who has trouble making eye contact with listeners.
His expressive language is vague: his sentences are long enough and have the right grammar and syntax, but the words he chooses do not quite communicate his meaning. - fluent aphasia (wernicks)
Sometimes it is hard to have a conversation with Elijah: he tends to monopolize the talking, works hard to steer it towards one of his favorite subjects and does not appear to be listening when it was the other person’s turn to talk. He has trouble with focus and attention: he is quite distractible. He has two favorite subjects (farm tractors and images of Mt. Everest) and does not really talk much about anything else.
He rarely plays with other children at school or in the neighborhood, and interacts mainly with adults.
What is Elijah diagnosed with?

Result: overlapping - autism (does not really talk about anything else)
→ obsession with his things

Sufficient to diagnose? - not sufficient, need tests along with observations to be sure