ADHD

Question 1

history of ADHD

Answer 1

ADHD has been around since the agricultural society

Name has been changed over time
-Minimal Brain Dysfunction (damage): 1900-1950
-Hyperkinetic / Hyperactivity Syndrome (DSM-II of 1968): 1950-1969
-Recognition of Attentional impairment and Impulsivity: 1970-1979
-DSM-III and “ADD” with or without Hyperactivity: 1980
-ADD becomes ADHD (DSM-III R) with mixed criteria: 1987
-NOW: ADHD (inattentive, hyperactive, combined subtypes) in DSM-IV: 1994

Question 2

classic triad of ADHD

Answer 2

Inattention
Hyperactivity
Impulsivity

Question 3

hyperactive symptoms

Answer 3

• Fidgets
• Leaves seat
• Runs or climbs excessively (or restlessness)
• Difficulty engaging in leisure activities quietly
• “On the go” or “driven by a motor”
• Talks excessively
• Blurts out answers before question is completed
• Difficulty waiting turn
• Interrupts or intrudes on others

Question 4

inattentive symptoms

Answer 4

• Makes careless mistakes/poor attention to detail
• Difficulty sustaining attention in tasks/play
• Does not seem to listen when spoken to directly
• Difficulty organizing tasks/activities
• Avoids tasks requiring sustained mental effort
• Loses items necessary for tasks/activities
• Easily distracted by extraneous stimuli
• Often forgetful in daily activities

Question 5

functional criteria

Answer 5

• 6 of 9 symptoms in either or both categories
• Inattentive; hyperactive-impulsive; or combined type
• Persisting for at least 6 months
• Some symptoms present before 12 years old
• Impairment in 2 or more settings
• Social / academic / occupational impairment

Question 6

natural history

Answer 6

Age related changes:

Preschool (3-5 y/o) - hyperactive/impulsive

School age (6-12 y/o) - combination symptoms

Adolescence (13-18 y/o) - more inattention with restlessness

Adult (18+) - largely inattentiveness with periodic impulsivity

Question 7

rule of thirds

Answer 7

⅓ → complete resolution

⅓ → continued inattention, some impulsivity

⅓ → early ODD/CD, poor academic achievement, substance abuse, antisocial adults

Question 8

findings from the MTA study

Answer 8

medication is looked as the treatment of choice

Four treatment arms:
- Medication (MED)
- Behavior therapy (BEH)
- Combined (COMB)
- Community “control” (CC)

Question 9

establishing a diagnosis

Answer 9

there are no tests
- must look for characteristics of behavior
- collateral interviews
- symptoms in more than one setting
-

Question 10

symptoms and subtypes of ADHD

Answer 10

Inattentive; hyperactive-impulsive; or combined type

Question 11

prevalence

Answer 11

Most commonly diagnosed behavioral disorder of childhood (1 in 20 worldwide)

3-7% of school children are affected in US !!!!!

Question 12

age importance

Answer 12

Kids first get diagnosed when they enter school

Can diagnose before

Question 13

gender importance

Answer 13

Males:females = 2-9:1

Boys
- tend to get diagnosis earlier and more often
- Hyperactive and impulsive subtype

Girls
- Behavior is judged
- Social expectations

Question 14

race importance

Answer 14

Latino and black children are less likely to be diagnosed with ADHD by parent report than are white children

Black children with ADHD are less likely to receive stimulants than white children

Question 15

impairments in executive functioning

Answer 15

Means –> how we organize and plan, how we hold things in memory

• Working memory
• Difficulties with planning
• Goal directed behaviors, including strategic planning, impulse control, organized search, and flexibility of thought and action

Question 16

brain areas implemented in ADHD

Answer 16

Prefrontal cortex
- Develops more slowly

ADHD groups have smaller posterior brain regions (occipital lobes)