ADHD Flashcards
Three presentations of ADHD
Inattentive
ADHD-I
Combined
ADHD-C
Hyperactiveimpulsive
ADHD-HI
DSM inattention
Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
● Often has trouble holding attention on 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 (e.g., loses focus, side-tracked).
● Often has trouble organizing tasks and activities.
● Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as
schoolwork or homework).
● Often loses things necessary for tasks and activities (e.g.
school materials, pencils, books, tools, wallets, keys,
paperwork, eyeglasses, mobile telephones).
● Is often easily distracted
● Is often forgetful in daily activities
ADHD Hyperactivity and Impulsivity
Often fidgets with or taps hands or feet, or squirms in seat.
● Often leaves seat in situations when remaining seated is
expected.
● Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling
restless).
● Often unable to play or take part in leisure activities quietly.
● Is often “on the go” acting as if “driven by a motor”.
● Often talks excessively.
● Often blurts out an answer before a question has been completed.
● Often has trouble waiting their turn.
● Often interrupts or intrudes on others (e.g., butts into conversations or games)
ADHD in the DSM-5
Criteria based on age and conditions
Ages 16 and under > At least 6 symptoms for at least 6 months
- Ages 17+ > At least 5 symptoms for at least 6 months
Must meet the following conditions:
* Symptoms present before age 12
* Symptoms present in two or more settings
* Evidence that symptoms interfere with functioning
* Symptoms cannot be better explained by another disorder (e.g. anxiety)
ADHD in the DSM-5
Comorbidities:
- Oppositional defiant disorder (e.g. patterns of negative, hostile, disobedient,
behaviour) - Conduct disorder (e.g. uncaring of social norms, manipulation, aggression)
- Learning disabilities
- Depressive disorder
- Anxiety disorder
Diagnostic concerns
Inattentive ADHD-I
Harder to detect in early elementary school years
Age inappropriate difficulties with inattention are harder to identify early on
- Children are typically more inattentive
Diagnostic concerns
Hyperactiveimpulsive
ADHD-HI
Not separate from ADHD-C
- Could be an early form or developmental stage of ADHD-C
ADHD Diagnostic Concerns generally and contributing factors
Controversy about misdiagnosis and over-diagnosis of ADHD
* ADHD is one of the most common referral to clinical psychologists
Contributing factors?
* suggested that changes in the elementary curriculum explain increasing
referral rates
o emphasis on early literacy skills
o greater amount of academic curriculum
ADHD Impracticality of DSM-5 criteria: age requirements
Impracticality of DSM-5 criteria:
* the presence of symptoms before age 12 years
* the presence of symptoms for a period of at least 6 months
Pro: Ensures that ADHD is not a transient reaction to a stressor
Con: considered impractical by some
* difficulty that clinicians may experience in attempting to collect accurate data about the past 6 months
ADHD Diagnostic Concerns
Impracticality of DSM-5 criteria: multiple settings
the presence of symptoms in at least two different settings > cross
situational consistency
Pro: ensures consistency of impairment across environments
Con: Time of observations, demands of the setting, and level of structure differs across environments
- Need to observe and compare the behaviours taking into account the differences in
the settings - Modest degree of agreement among parents and teacher ratings > blend reports
from both sources and to count the number similarly endorsed symptoms
Blend reports from both - count symptoms endorsed across settings
impairment in one setting might be greater than impairment in other setting
ADHD Diagnostic Concerns
Impracticality of DSM-5 criteria: presence of number of symptoms
Presence of a certain number of symptoms:
* Ages 16 and under > At least 6 symptoms for at least 6 months
* Ages 17+ > At least 5 symptoms for at least 6 months
Using 6 or more symptoms to diagnose may be insensitive to sex bias
* Suggested that girls display fewer DSM symptoms and show less severe
symptom levels than boys
* Leads to higher number of false negatives among females
….perhaps cutoff scores should be adjusted to address the sex bias
Rates of diagnosis: ADHD
About 3-7% of the school-age population are diagnosed with ADHD
ADHD males vs females
Estimates of male-to-female ratios ranging from 2:1 to 9:1
Co-occurence ADHD
44% have at least one co-occurring disorder and 33% have two co-occurring disorders
*Learning disorders
* Oppositional defiant disorder
* Conduct disorder
* Depressive disorder
* Anxiety disorder
other concerns about inattention and hyperactivity/impulsivity
Inattention and hyperactivity/impulsivity could be
- a phase (related to developmental trajectory of the brain),
- a response to an environment (e.g. levels of stress), or even
- a side effect of another condition
