ADHD Flashcards
Prevalence
3 to 9%
Age of onset
before 7
Core symptoms
inattention and hyperactivity/impulsivity
Requirement for diagnosis
- symptoms 2. age of onset 3. impact on major life actives, 4 different environments 5. exclusions: deafness, blindness, language delay, depression, autism, psychosis
Early vs. Late onset
chronicity vs. related to depression/anxiety
Life course
40-80% will continue to have ADHD through adolescence…36% through adulthood
Comorbid conditions
ODD/CD, depression, OCD
80% have another condition/60% have two conditions
-30-40% LD
Base rate in clinical settings
50% referred to child mental health settings have ADHD
Gender differences
9 boys to 1 girl ratio. Girls have less externalizing behaviors, but more internalizing and intellectual problems (masking effect on ADHD symptoms)
Situational and contextual factors
- symptoms more noticeable 2. mothers notice symptoms more 3. deviant behavior increases with familiarity 4. fatigue and time of day have impact 5. worse in group setting. 6. best performance in morning
Impairments
- medical, developmental, adaptive,behavioral, emotional, academic difficulties than their healthy peers
- minor physical abnormalities
- less socially involved
- cognitive and psychomotor difficulties
Etiology
Mostly neurological 1. EF deficits 2. blood flow to prefrontal regions 3. less brain volume right frontal region 4. smaller cerebellum Genetics 1. family and twin studies (risk 40-57% 2. twin studies .70 to .97 degree of heritability (little to no effect of shared environment) Toxins - tobacco, lead, alcohol (small)
Outcomes
poor school performance, ODD and CD, Low intelligence/peer acceptance, emotional instability
Conceptualization of the disorder
Barkley’s behavioral inhibition (4 EFS)
- nonverbal working memory (covert self directed sensing)
- verbal working memory (internalized, self-directed speech)
- Self-regulation of affect-motivation-arousal (self-directed emotion)
- Planning or reconstitution
Assessment Considerations
- more weight to parent and teacher
- multiple observation
- no gold standards
- self report not reliable
- structured interviewing with a parent is a minimum condition for an adequate assessment
- look for comorbidity
- assess strengths and weaknesses for treatment planning
Parent ratings
- Behavior assessment system for children (better than CBCL because of adaptive functioning scales (more accurate; ostrander 1997)
- Home situational questionnaire (HSQ) measures the situational pervasiveness
- Conners Global Index (CGI) and Children’s Impairment Rating Scale (CIRS) good for progress monitoring and impairment
- Vineland – doesn’t add much over CIRS, however
- Checklist of DSM-IV symptoms using the Disruptive Behavior Disorders Scale
- screen parent for ADHD (high heritability)
The Conners’ Rating Scale - Revised demonstrates effective ADHD diagnostic utility, with sensitivity ranging between 92 and 100% and specificity ranging between 82 and 98%.[33] The Conners’ Rating Scales also include a self-report version which can be a useful addition to the assessment battery when the patient is an adolescent.
Minimum requirements for evaluation
- parent ratings of ADHD, other psychiatric disorders, and related impairments
- teacher ratings of ADHD symptoms and functioning at school
- a semistructured interview with a parent to ascertain influences on behavior
- exam by a physician to rule out phsycial causes
Teacher Ratings
- TRS from the BASC
- Disruputive Behavior Disorders Checklist (DBD)
- School Situations Questionanire (SSQ)
- Conners Global Index (CGI)
- Children’s Impairment Rating Scale (CIRS)
ADHD Checkup
- Telephone contact prior to first session
- Semistructured interview to evaluate interpersonal functioning, major presenting problems, developmental history, or other background variables
- videotaped interactions between family members and child
- Collaborative feedback with the parents regarding diagnosis and treatment recommendations
Treatments
- stimulants (methylphenidate, amphetamines)
e.g. ritalin, conerta
10-25% of children do not benefit - Parent training
- Classroom interventions
- cooperative learning (not individual work)
- positive reinforcement and response cost is optimal
- dead man’s rule (if a dead man can do it then it is not a good target)
- menu of backup reinforcers (premack)
- response cost: tokens are deducted for inappropriate behavior (make sure students doesn’t zero out).
- immediate feedback
- monitor own work
Common Classroom behaviors
- escaping effortful tasks
2. attention
Worsens ADHD symptoms
- social environment (peers)
- a boring (vs. novel) task
- individual work (vs. one-on-one — aide is EF)
Is ADHD a real disorder?
YES!
1. etiology
Meets Wakefield (1999) criteria
a. signficant deficits in inhibition and attention that are critical for self regulation
b numerous domains of inmpairment (risks of harm) over development
2. differ from normal population
What is the effectiveness of ADHD treatments?
Meds - 75-85%
behavioral techniques - 35-80%
MTA study concluded meds were superior; however,followup studies (Fabiano) found that after 36 months the differences subside.
MTA Study?
MTA study concluded meds were superior; however,followup studies (Fabiano) found that after 36 months the differences subside.
MTA
- 600 children 7-9 years old
-14 months
In other areas of functioning (e.g., anxiety symptoms, academic performance, parent-child relations, and social skills), combination treatment was consistently superior to routine community care, whereas medication alone or behavioral treatment alone were not.
Lanberg et al., 2011
Study found behavior treatment more effective in improving homework completion.
