7b. ADHD Flashcards
Which neuropsychological functions are involved in ADHD? (4x)
And which areas are ‘responsible’ for these functions?
• Attention (focused and sustained)
• Executive functioning
– Working memory
– Response inhibition
• Reinforcement sensitivity
– Reward learning
– Delay aversion
• Temporal information processing
- Attention: frontal-parietal network
- EF: dorsal prefrontal-striatal network, including caudate nucleus
- Reinforcement sensitivity: ventromedial prefrontal-striatal network
- Temporal information processing: prefrontal-cerebellar network
Which executive functioning domains are involved in ADHD? (5x)
And which one of these mostly?
- Planning
- Error monitoring
- Cognitive flexibility
- Working memory
- Response inhibition –> mostly
What attentional effects can you see in a neuropsychological test? (3x)
- Time-on-task effects (sustained attention)
- Distractibility (focused attention)
- Contextual variation
What is contextual variation in task performance?
Performance in slow and simple tasks tend to be less optimal than performance in fast and more difficult tasks, since children with ADHD tend to zone out more in slower and simple tasks, resulting in more errors. So adaptive testing is needed!
Reinforcement sensitivity, explain:
- Reward learning
- Delay aversion
- Reward learning: reinforcers/rewards have diminished control over children with ADHD compared to children without ADHD, resulting in a pattern where these children need larger and clearer reinforcers, directly followed by the positive behavior, and more frequent, in order to be effective. This also means that learning new adaptive strategies/behavior takes longer in ADHD and requires more effort from the environment
- Delay aversion: children with ADHD show a preference for immediacy, so have trouble waiting. It is a little bit as if “the internal clock is running faster” for their perception. Impulsivity may then be thought as a means of reducing the subjective experience of the passage of time, because it has a rewarding effect.
What is the temporal discounting effect?
In a temporal discounting task you see that the majority of children with ADHD will choose for the faster option, even if it results in less rewards (=delay aversion). So the temporal discounting effect is geared towards immediacy rather than gain in ADHD.
Timing and expectancy difficulties are often present in ADHD. Which area is involved in this?
Cerebellar dysfunction may underly the finetuning of motor and cognitive timing, because the cerebellum makes “internal models” of when you can expect a certain event to happen (expectancy formation), which tends to be slightly off in ADHD.
Can neuropsychological tests predict who will improve at a later age and who won’t?
And can neuropsychological tests at an early age predict which children will receive an ADHD diagnosi?
NO! Symptom improvement does not co-occur with neuropsychological improvement per se.
YES! Neurocognitive deficits appear to precede the diagnosis.
Which treatments are recommended in 6-12 year olds? (3x)
Besides these 3 treatments, which treatment is added in 13-18 year old?
6-12 year olds:
- Psycho-education: explanations of behavior, what can you expect in terms of development?
- Behavioral interventions: particularly parent and teacher training
- Pharmacological intervention: medication, in the more severe cases
13-18 year olds, added:
- Cognitive behavioral and/or skill-oriented training for the patient: towards coping with for example executive functioning problems
What is the working of methylphenidate?
In which percentage of patients does it work?
And on which domains are beneficial effects found? (4x)
It blocks the neurotransmitter re-uptake pump on the pre-synaptic dopamine neurons, with as a net result that more dopamine is present in the synaptic cleft, resulting in an increase of neurotransmission/signal.
70%
Beneficial effects:
- Behavioral symptoms
- Cognitive performance
- Time-on-task behavior in school: amount of school work completed improves, not the quality!
- Imaging: brain activation patterns & brain anatomy appear to normalize
Which non-pharmacological interventions may have effects on ADHD symptoms? (2x) And which one may not?
Only cognitive training & fatty acids supplementation had small positive effects on blinded raters, the restrictive diet was not (but it was significant by proximal raters)
