ADHD Flashcards
When did Attention Deficit Disorder first appear?
DSM III
What did Alexander Crichton observe and when?
A disease of attention, in 1798, “they say they have the fidgets,” boys more than girls, attention difficulties emerged in early life, believed symptoms were exacerbated by the rigid British educational system and advocated for customizing education environments to capitalize on individual strengths and improve learning
Selective attention
The ability to concentrate on relevant stimuli and not be distracted by noice or other elements of the external environment
Sustained attention
The ability to concentrate and maintain persistent focus over time or when fatigued
How do we classify ADHD?
A neurodevelopmental disorder
What is a neurodevelopmental disorder?
Something people are born with and which changes as they change throughout their lives, long term, evident from very early in life
What are the 3 subtypes of ADHD?
- Predominantly inattentive
- Predominantly hyperactive-impulsive
- Combined
ADHD Diagnostic Criteria intro
A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by either A or B
ADHD Criteria A
Inattention:
Six or more (5 for age 17+) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
- Often fails to give close attention to details or makes careless mistakes in school work, at work, or during other activities
- Often has difficulty sustaining attention in tasks or play activities
- Often does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
- Often has difficulty organizing tasks and activities
- Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
- Often loses things necessary for tasks or activities
- Is often easily distracted by extraneous stimuli
- Is often forgetful in daily activities
ADHD Criteria B
Hyperactivity or impulsivity:
Six or more (5 for age 17+) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
- Often fidgets with or taps hands or feet or squirms in seat (psychomotor agitation)
- Often leaves seat in situations when remaining seated is expected
- Often runs about or climbs in situations where it is inappropriate (feeling restless in adults)
- Often unable to play or engage in leisure activities quietly
- Is often on the go, acting as if driven by a motor
- Often talks excessively (hyperverbal)
- Often blurts out an answer before a question has been completed
- Often has difficulty waiting their turn
- Often interrupts or intrudes on others
ADHD other criteria
Several symptoms (doesn’t have to be all) present before age 12
Several symptoms present in two or more settings
Clear evidence symptoms interfere with quality of functioning- poses some degree of problem
Not during schizophrenia or better explained by another mental disorder- decline in attention is part of a lot of disorders, ie mood disorders
ADHD C
Meet full diagnostic criteria for A and B- 12 symptoms total
Which ADHD type is most often referred for treatment?
Combined, probably because cumulative impact of 12 symptoms (least common though and seems least malleable)
Prevalence of ADHD
2-4% girls, 6-8% of girls
Gender differences in ADHD in childhood
Girls may be more likely to display inattentive and disorganized symptoms, less disruptive than hyperactive (most referrals by schools not parents)
Girls with HI are referred at a younger age (bc social expectations for girls), hyperverbal (interrupting, talking a lot) rather than hyperactive
*We often miss diagnoses girls, girls more likely to be inattentive, bc ADHD diagnosis developed based on young boys and adapted for girls
ADHD comorbidity (not anxiety)
Many kids w ADHD meet criteria for other disorders too, highly comorbid- diagnostic difficulty, what is a difficulty w attention due to ADHD or something else
Earlier onset of ADHD associated with elevated risk for comorbid externalizing- CD and ODD, ADHD tends to precede these (not majority w ADHD go on to ODD but yes a majority of ODD have attentional symptoms before ODD diagnosis)
Comorbidity with externalizing is more common among ADHD-HI subtype
ADHD comborbidity w anxiety
Internalizing disorders are more likely to be comorbid w inattentive subtype, high comorbidity particularly w anxiety disorders
Compared w children w anxiety disorders and NOT ADHD, kids w ADHD and anxiety are less likely to have fears of concrete things and more likely to express anxiety related to ADHD- worries about competency, what other people think of them, school performance
Internalizing disorders tend to emerge after onset of ADHD, maybe explained by lived experience and ADHD related stress
Basal ganglia
Group of structures that work together, important for response control and inhibition and impulsivity, lesions here result in symptoms look like ADHD
Striatum
Part of BG
Frontostriatal circuitry
Neural pathways between striatum and frontal lobe, messages passed through this neural network
