ADHD Flashcards
ADHD facts and key symptoms
- ADHD has the lowest years of affect in relative to all other mental health conditions (due to ability to adapt ADHD as part of your lifestyle choices)
- ADHD is an externalising disorder (because highly comorbid with ODD - 50% and CD - 20%)
- ADHD is conceptualised as a neurodevelopmental disorder (ADHD, ASD, Learning disorders)
- Phenotypic overlap with ODD/CD, particularly hyperactve/impulsive features
- Overlap with ASD, delayed motor coordination, learning difficulties
- Inattention (Not a problem with perception, filtering or process)
- Difficulties in persistence (sustained attention onto one task/goal; inability to resist disractions)
- Failure in future thinking
- sensitive to reward - Hyperactivity & Impulsivity
- Emotional impulsivity? Currently missing from DSM criteria
DSM Criteria ADHD
A. Several symptoms present prior to age 12
B. Several symptoms present in two or more settings
C. Clear evidence that the symptoms interfere with social, academic or occupational functioning
D. Not better explained by another condition
Developmental trajectory of ADHD
Causes?
Hyperactivity: evident first, then decline as child ages
Inattention symptoms: Increasingly apparent with age as peers undergo rapid maturation of prefrontal cortex.. as school demands intensify
Environmental causes: toxins (some evidence for lead), diet (synthetic food colors), coeliacs disease?
Very high genetic loading: 80% contribution
- ADHD symptoms may elicit negative responses from parents and family members
RCT data shows that treating children with stimulants will improve symptoms of ADHD AND quality of parenting - Gene-environment correlation (adoption studies)
Evocative: Child genetics evoke negative reponses from parents
Passive: The same genes that underlie ADHD in child underlie parenting problems in their parents
- Association between [biological mothers symptoms] and [childs impulsivity at age 4.5] correlated to [rearing (adoptive) mothers hostility to child] as well as [childs ADHD symptoms at age 6]
- Association between inconsistent parenting and ADHD stronger for those with long allele of DRD4 gene (interaction)
DUAL PATHWAY MODEL OF ADHD
Delay aversion hypothesis?
Two distinct processes involving distinct but overlapping neural architecture, and both shaped by environmental processes
- Deficits in inhibitory-based executive processes
Response inhibition: ability to inhibit an inappropriate propotent or ongoing response in favour of a more appropriate alternative - Motivation dysfunction involving disruptive signaling of delayed reward
ADHD arises from neurobiologic impairment in the power and efficiency with which the contingency between present action and future rewards is signaled.
DAH - Failure to delay gratification
Over time the negativity associated with this failure becomes associated with situations that signal the need to delay gratification
This ‘delay aversion’ manifests as attempts to avoid/escape delay by attending to the most interesting/absorbing aspects of the environment or acting on that environment (hyperactively)
Environments can amplify ‘delay aversion’
Negative/punitive parenting
Inconsistent parenting
Diagnosis and Treatment?
NO SINGLE TEST TO IDENTIFY ADHD
- Must be multifactorial
- Must include clinical interview to rule other possibilities
- Interview a range of people across the ecology
- Outside normal range or not?
Rating scales
Conners (for teachers, parents, affected adults)
Treatments MUST BE BY CLINICAL PSYCHOLOGIST
No support for Elimination or restriction diets
- Diet supplementation; essential fatty acids
- Chiropractic treatment
- Behavioural optometry
- Biofeedback
- Homeopathy; acupuncture
- Physical activity; Massage; Sensory integration therapies
What is the best treatment?
- 14 months of stimulants
- CBT
- TAU in the community
All groups showed ADHD reductions over time
- Medication alone and combined treatment did better than behavoural treatment alone and TAU
- On many measures combined treatment was not significantly better than medication alone
Summary: medication targets core ADHD (inattention, hyperactivity) itself, the psychological treatment targets the side effects of core ADHD
Combined treatment was superor in terms of functioning in society
6-8 year follow up
As a group, children with combined type ADHD exhibit significant impairment in adolescence (9-21 measures)
- Original treatment assignment not associated with any of the 24 outcomes
- ADHD symptom trajetory in first 3 years predicted 55% of the outcomes
- Suggests need for sustained treatment over the long term
Children do not become reliant on the stimulants for ADHD, this is a myth. It is actually protects them from future alcohol/drug abuse
- But can stunt growth
