ADHD Flashcards
What is the most common psychiatric disorders in children?
ADHD
In the DSM-5, what category does ADHD fall into?
neurodevelopmental disorder
- not episodic (chronic)
Grouped into 2 categories
- Inattention (ADHD-I)
- Hyperactivity and impulsivity (ADHD-H)
- Mixed (ADHD-HI)
What are some core feature of ADHD
- Motoric (physical) and verbal hyperactivity
- Problems maintaining focus
- Impulsive or erratic behaviours
What % of children diagnosed with ADHD will also carry the diagnosis into adulthood?
1/3
Where does ADHD fall in HiTOP
Disinhibited and Antagonistic Externalizing
Highly correlated with Conduct disorder, Oppositional defiant disorder and antisocial personality disorder
What did George Still say about ADHD
Children had poor
- moral control/consciousness
- inhibited volition
Disorder of abhorrent development –> thought they take different developmental trajectories but could end up in a good place with age
When did symptoms of ADHD become pathological?
With the emergence of compulsory schooling –> made symptoms visible
How did the influenza epidemic shape the history of ADHD?
Brain injured child syndrome
- Children who survived encephalitis during the epidemic or head trauma or toxin exposure or birth complications (basically any altered brain development) showed behaviour problems
- Eventually changed to “minimal brain dysfunction” because they weren’t seeing much brain damage in children with behaviour problems –> in fact some who displayed behaviour problems had NO evidence of head trauma
In the 1950’s, how was ADHD seen? In the 1970’s?
1950s called hyperkinesis
- focus on the hyperactivity aspect –> attributed to poor filtering of info into the brain
- led to the definition of hyperactive child syndrome
1970s
- Focus on attention and impulse control as core symptoms
What are the requirements to reach ADHD diagnosis?
- Symptoms present for 6 months or more
- Have to be present in more than 1 setting (affects many aspects of ones life)
- If below 18 –> 6 or more symptoms
- If 18 or above –> 5 or more symptoms
- Symptoms NEED to be present before age 12
What are the core characteristic of ADHD and why does it oversimplify the disorder?
Inattention and hyperactivity-impulsivity –> Not the full picture since ADHD patients also tend to struggle with emotion regulation
ALSO inattention and hyperactivity-impulsivity develop at the same time and involve similar neuronal structures THEREFORE may not be as separate as it seems
What is inattention?
- Difficulty, during work or play, to focus on one task or to follow through on requests or instructions
–> deficits in what they find boring (i.e. schoolwork)
-Selective attention (distractibility) –> difficulty filtering out distractions
-Sustained attention (vigilance) –> Hard to recognize what is important to focus on
Why is the predominantly inattentive specifier less studied?
- They are less disruptive in school settings
- More commonly diagnosed in girls
What are the 2 distinct subtypes of the inattentive specifier?
- Formerly combine subtype (recovered from the hyperactive impulsivity specifier)
- Always only had inattentive specifier (later onset, less aggressive/disruptive)
What is the difference between hyperactivity and impulsivity? Why are they grouped together
They are grouped together because there is a strong link between the two suggesting they BOTH are fundamental deficits in regulating behaviour
- Hyperactivity: inability to voluntarily inhibit dominant or ongoing behavior
- Behaviors include:
- fidgeting, difficulty staying seated
- moving, running, climbing about, touching everything in sight
- excessive talking and pencil tapping
- accomplishing little despite extreme activity (doing things but not productively)
- Impulsivity: unable to control immediate reactions or think before acting
*Cognitive impulsivity: disorganization, hurried thinking, need for supervision (need constant reminders)
*Behavioral impulsivity: difficulty inhibiting responses when situations require it
*Primary attention deficit in ADHD is inability to engage and sustain attention and follow through on directions or rules while resisting salient distractions
Which subtype is the least common? Which subtype is most often referred to treatment?
Rarest: ADHD-H
Most adverse outcomes: ADHD-HI
What is the gender ratio for ADHD
2.5M:1F
Why are ADHD rates varied by culture?
Cultural differences may reflect cultural norms and tolerance for ADHD symptoms –> highest rates in Africa and south America
What are some associated cognitive deficits of ADHD?
- Cognitive processes (working memory, planning, flexible thinking, organization)
- Language processes (verbal fluency)
- Motor processes (allocation of effort, prohibitive instructions)
- Emotional processes (regulating arousal level, tolerating frustration)
What are some associated outcomes of ADHD
- Poor academic and vocational performance
- More interpersonal problems
- Problems with parent-child relationships
- Higher rates of accidents
- Initiate sexual activity earlier and less safely (higher STI and pregnancy)
- Reduced life expectancy
- Problems with self-care (hand washing)
What % of children with ADHD also have another co-occurring psychological disorder?
80%
ODD
CD
Anxiety disorders
Substance use
Mood disorders
What is the homotypic and heterotypic continuity of ADHD
Homotypic –> ADHD in childhood is associated with ADHD in adolescence and/ or adulthood
Heterotypic –> ADHD in childhood is associated with MDD or SUD in adolescence and/or adulthood
-Suggests a non-specific process: * Underlying processes or factors that contribute to one disorder can also lead to
the development of a different disorder over time
What % of children with ADHD will carry it into adolescence? What impairments is this associated with?
50% will carry it into adolescence –> more likely to be involved in the juvenile justice system (display oppositional defiant behaviours)
What does the Longitudinal study of ADHD tell us?
proof that ADHD is heterotypic AND homotypic
-Of all disorders, ADHD showed the most cross-domain effect –> predicted the more different types of disorders at a later age if diagnosed as a child
- ADHD is also related to internalizing disorders –> strongest predictor of GAD
What happens during the course of ADHD in adulthood?
- Rates of ADHD persistence vary widely (5-75%)
- BUT high symptomatic persistence, meaning even though they no longer meet the diagnostic criteria they still exhibit related behaviours
- Rates may not be properly captured because criteria was developed for children
- Hyperactivity problems less relevant for adults since they can choose their own environment (not forced to be in a classroom setting) –> better able to mask symptoms or make them less relevant to their lives
BUT, adults with childhood diagnosed ADHD have significant impairments in:
- Mental health (4x substance use disorder, 5x anxiety, 2x personality (ASPD), NSSI, suicide attempts (15%))
- Occupational functioning
- Antisocial personality disorder
- Criminality
- Educational functioning
What are the two models that explain the heterotypic continuity of ADHD?
Failure model
-Impulsivity/hyperactivity/inattention leads to interpersonal problems, rejections, lack of support
- All these factors further increase risk of subsequent forms of psychopathology
- Aggression in childhood predicts later depression though being rejected by peers
Shared etiopathogenic factors
- Common casual mechanism of irritability shared by many different pathologies –> broad transdiagnostic factor
- Irritability expresses itself differently across the lifespan (CD, ODD, depression, anxiety, ADHD
What Etiological factors help explain ADHD
- ADHD runs in families –> 3x higher in biological families than adoptive families –> Genetic factor
- Factors that complicate development before and after birth (mothers use of cigarettes/alcohol/drugs) are related to elevated risk of ADHD (NON-SPECIFIC)
How do parent/child interactions affect ADHD
RECIPROCAL NEGATIVE INTERACTIONS (passive and evocative gene interactions)
- Children with ADHD are less compliant and have more trouble following through with demands
- Parents with ADHD who have children with ADHD have lower levels of involvement and positive parenting, and higher levels of inconsistent and negative parenting (harder for the child to pair their behaviour to the outcome)
How does emotion regulation predict inattention symptoms over time?
- Poor emotion regulation, ESPECIALLY poor positive emotional regulation predicts and increase in inattention symptoms over time
- Good emotional regulation predicts a decrease in inattentional problems over time
What neuroanatomy markers are common for ADHD
-Lower volume and activation in the PFC and the striatum (ACC, caudate, cerebellum, corpus callosum)
- Worse connectivity between the two regions
- Sometimes, we see disturbances in dopamine transmission (elevated)
What are the results of the GO/NO -GO trials? How do the brains of ADHD children differ from healthy controls?
ADHD children are more likely to push the button when they weren’t supposed to –> had worse inhibitory control regardless of the number of trials preceding the no-go trial
During inhibitory control
- Controls –> more frontro-striatal activation (better inhibition) and more basal ganglia activation (better direction)
- ADHD children –> Diffuse, disorganized brain activation, no consistent communication of networks
