ADHD Flashcards
Symptoms of ADHD (names)
Inattention, hyperactivity, impulsivity
Inattention symptoms of ADHD
Does not pay attention
Can’t sustain attention
Doesn’t seem to listen
Avoids sustained effort
Fails to finish tasks
Can’t organise
Loses things
Is forgetful
Easily distracted
Hyperactivity symptoms of ADHD
Fidgets
Leaves seat in class
Runs / climbs excessively
Always “on the go”
Talks excessively
Implusivity symptoms of ADHD
Talks excessively
Blurts out answers
Cannot await turn
Intrudes on others
Interrupts others
Clinical presentations of ADHD
Hyperactive-Impulsive (AD/HD)
Inattentive (ADD)
Combined (ADHD)
How does diagnosis start?
Evidence of symptoms and impairment from parents or caregivers as well as a teacher or school professional
How is ADHD diagnosed?
Rating scales are used in addition to narrative reports and observations, and the collection of a clinical history
For example, Conners’ Rating Scales: Based on DSM-IV criteria and has normative data. Good reliability and validity.
Comorbidity of dyslexia
20-40% of individuals with a diagnosis of either ADHD or dyslexia show significant signs of the other (Wilcutt & Pennington, 2000)
Comorbidity of Bipolar
Some researchers propose that bi-morbid BD and ADHD should form a separate clinical phenotype of BD (e.g. Perugi et al., 2013)
Pliska (1998)
Oppositional defiant disorder, anxiety, and learning disorders are also comorbid
Rapport et al (2007)
Biological and environmental systems cause a poor executive function, which in turn causes the symptoms of ADHD.
Familial transmission of ADHD
Evidence agues for a familial transmission of ADHD
The correlation of symptoms in MZ twins is greater (0.86) than that in DZ twins (0.47)
Heritability estimates range from 0.75 to 0.91
Genetic causes of ADHD
The dopamine D4 (DRD4) and dopamine D5 (DRD5) genes
Debated causes of ADHD
- Birth complications
- Smoking during pregnancy
- Low birth weight
- A dysfunctional family environment
- Food additives, colourings and preservatives
- Television and computer games
What brain area is associated with ADHD?
The frontal lobes
Executive function definition
High level cognitive processes responsible for control and regulation, goal formation, planning, and effective performance
Areas of executive function that are effected by ADHD
- Shifting / cognitive flexibility
- Selective attention
- Planning
- Updating working memory
- Retrieval from long term memory
- Inhibition
Martinussen et al (2005)
Analysed 26 studies, demonstrating that children with ADHD exhibited deficits in multiple aspects of working memory
Kasper et al (2012)
Analysed 45 studies, finding that children with ADHD exhibit significant large magnitude deficits
Alderson et al (2013)
Analysed 38 studies of adults with ADHD, indicating that deficits persist into adulthood
Kennedy, Quinlan, and Brown (2019) - Study
Tested 220 adolescents and adults with ADHD on two working memory tasks (digit recall and a more practical working memory task of recalling a story), considering their verbal ability.
Kennedy, Quinlan, and Brown (2019) - Findings
They found ADHD negatively impacts working memory (they got scores lower than expected based on ability).
Qian et al (2013) - Study
Examined the developmental trajectories of executive functions
* Inhibition- Stroop task
* Shifting- trail making
* Working memory- digit span
* Planning- tower of Hanoi
Qian et al (2013) - Findings
They found the ADHD group took longer on the Stroop test (only significantly different under the age of 12) and the trail making task. There was however no significant differences in working memory and tower of Hanoi.
Krieger and Amador-Campos (2018)
Examined executive functions via task performance and also rating scales. There were statistically significant differences between working memory, processing speed, IQ, planning, inhibition, and all behavioural executive functions.
Roberts et al (2017)
Examined whether there were Executive Dysfunction Subtypes in ADHD
* 357 children with ADHD were assessed on measures on executive function and ability
* They conducted a cluster analysis to examine patterns of executive functioning
* Three clusters were found (poor inhibitory control, poor set-shifting/ speed, and intact task performance)
* The poor set-shifting/ speed cluster had significantly greater ADHD symptoms, lower intelligence and academic performance
Carmona et al (2005)
Assessments of general brain volume have found reductions in ADHD patients
Filipek et al (1997)
There is a reduction in both grey and white matter in ADHD, especially in the prefrontal cortex.
Krain and Catellanos (2008)
A reduction in the prefrontal cortex, particularly on the right side of the brain
Makris et al (2010)
Reductions in the anterior cingulate cortex
Monuteaux et al (2008)
Reductions in the cerebellum
Shaw et al (2007)
Does maturation follow the same pattern but is developmentally delayed?
What areas of the brain cause hypo-activity?
frontal regions, including anterior cingulate, frontal cortices, and related regions including basal ganglia and thalamus
What areas of the brain cause hyperactivity?
Some frontal and parietal areas, possibly reflecting compensatory mechanisms
Dopamine and ADHD
A reduction in dopamine receptors and transporters is thought to cause delay aversion
This causes a preference for small immediate rewards over larger delayed rewards (impulsive choice)
The drive for immediate rewards induces a negative affective state in delay situations
This can lead to frustration and premature
disengagement, and attending to other aspects of the environment to reduce the experience of the delay
Antrop et al (2006)
Administered a task in which participants had to make a choice between a small immediate reward (1 point after 2 seconds) and a larger delayed reward (2 points after 30 seconds)
Extra visual stimulation was included, in the form of coloured cartoons.
ADHD participants were less likely to wait for gratification, however with visual stimulation they matched the waiting times of the neurotypical group.
Sonuga-Barke et al (2003)
Proposed a dual pathway model of ADHD
Medicine names of ADHD
Methylphenidate or Amphetamine
Aron et al (2003)
Improvements in behavioural inhibition tasks
Kobel et al (2008)
Improvements in working memory tasks after taking medication
Solanto (2001)
Not everyone benefits from medication - up to 25% of cases do not respond.
Other treatments for ADHD
- Developing compensatory strategies e.g. cognitive behavioural therapy focused on problem solving and strategies such as self-monitoring, self-instruction, and generating alternatives in decision making
- Environmental/ curricular restructuring e.g. minimising attentional or working memory demands of classroom activities
- Facilitative training e.g. using computer based activities to strengthen executive functions
- Neurofeedback
Meisel et al (2013)
Neurofeedback versus pharmacological intervention - Neurofeedback was just as successful as pharmacological interventions
