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Abnormal 3018 > ADHD > Flashcards

ADHD Flashcards

1
Q

What are the changes to ADHD subtypes from DSM-IV to DSM-V?

A

DSM IV:

  • predominantly inattentive
  • predominantly hyperactive-impulsive

DSM V: (apparently not subtypes, but changed to PRESENTATIONS
- Inattention/disorganisation
- hyperactivity/impulsivity
- combined type
But, not the assumption that they are fixed.

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2
Q

What is the developmental trajectory related to ADHD?

A
  • HYPERACTIVITY is most pronouned in preschool and can decline over time
  • INATTENTION symptoms increasingly apparent with age (as peers undergo rapid maturation of prefrontal cortex, as school demands intensify)
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3
Q

What does the evidence suggest in terms of ADHD as a discrete syndrome vs. extreme standing on a normal-varying trait?

A
  • extensive evidence that ADHD symptoms form a continous dimension rather than a discrete taxon
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4
Q

What type of disorder is ADHD?

A
  • at the broadest level is referred to as an externalising disorder
  • currently conceptualised as neurodevelopmental disorder (as opposed to a disruptive disorder, as they are assumed to be under more environmental control)
  • clusters with ODD and CD, as well as DDs such as autism, motor coordination
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5
Q

Why is ADHD clustered with ODD and CD?

A
  • highly comorbid (about 50% also have ODD, 20% CD)
  • also phenotypic overlap with ODD/CD, particularly hyperactive/impulsive features (e.g. deliberately annoys others (ODD))
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6
Q

What is the gender difference in ADHD?

A
  • more common in male than females (2:1)
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7
Q

What is the DSM - V criteria for ADHD?

A

A. Several symptoms present prior to 12 years
B. Several symptom present in 2/more settings
C. Interferes with social, academic or occupational fning
D. Not another disorder

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8
Q

What were some of the issues with DSM-IV in relation to diagnostic criteria?

A
  • some symptoms inapplicable to adults
  • cut point of 6 symptoms may under-identify adults
  • features that cause impairment in children may not cause impairment in adults
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9
Q

How many features of inattention must adults have compared to children in the DSM V?

A
  • 5 for adults

- 6 for children

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10
Q

What are the symptoms of inattention related to ADHD in the DSM V?

A

a) fails to give close attentions to details/makes careless mistakes in schoolwork/other activities
b) difficulty sustaining attention in tasks/play activities
c) Doesnt listen when spoken to directly
d) doesn’t follow through on instructions and fails to finish work duties/ schoolwork
e) difficulty organizing tasks and activities
f) avoids, dislikes or reluctant to engage in tasks that require sustained mental effort
g) loses things necessary for tasks or activities
h) distracted by extraneous stimuli
i) forgetful in ADLS.

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11
Q

What are some changes in DSM V that make it more applicable to adults?

A

Related to examples given

f) often avoids, dislikes or reluctant to engage in tasks that require mental effort (for adolescents/adults: preparing reports, completing forms)
h) easily distracted (for adults: may include unrelated thoughts)
i) often forgetful in ADLS (adults: returning call, paying bills)

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12
Q

What’s a change to the DSM in terms of hyperactivity symptoms to make it more applicable to adults?

A

c) often runs/climbs in situations where it is inappropriate (adults: may be feeling restless)
i) often interrupts of intrudes on others (adults: may intrude into or take over what others are doing)

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13
Q

What does the research suggest about genes versus environmental influences on ADHD?

A

twin/adoption studes: heritability coefficient = 0.7
studies of parent - ratings>0.8 heritability
parent-teachers ratings =0.78 heritability

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14
Q

What are some suggestions of non-inherited factors

A
  • focus on factors that still work on biological systems including:
    a) teratogens & toxins (exposure during critical periods in pregnancy e.g. outdoor pesticides, prenatal nicotone)
    b) dietary factors (e.g. synthetic food colors)
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15
Q

What did the Hawes et al (2013) study find in regards to parenting practices tested as predictors of ADHD features controls for baseline hyperactivity/inattentions, socioeconomic indices, conduct problems

A
  • high levels of parental involvement predicted a reduction in hyperactivity/inattention, ONLY IN EARLY CHILDHOOD
  • there were increases in child age were associated with increases in hyperactivity/inattention across middle childhood among CHILDREN EXPOSED TO HIGH LEVELS OF INCONSISTENT DISCIPLINE
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16
Q

What are some alternative explanations for the suggestions that parentings plays a causal role in ADHD?

A
  • ADHD symptoms may elicit negative responses from parents and family members
  • gene-environmental correlation
17
Q

What is some evidence to suggest that there are children-driven effects of ADHD on parenting?

A

Schachar et al (1987): children treated with stimulants showed improvements in:
- symptoms of ADHD
- also quality of parenting
Longitudinal data:
- high levels of child hyperactivity predicted: decreased levels of parental involvement, increased problems with supervision, increased corporal punishment

18
Q

What is the gene- environmental (rGE) correlation?

A
  • suggestion that:
    EVOCATIVE rGE: child characteristics that are genetically based are having negative response from parents
    PASSIVE rGE: same genes that underlie ADHD in child, are also present in parents and therefore create parenting problems
19
Q

What are some of the findings from studies examining the gene-environmental (rGE) correlation? (Gordon et al.)

A

Significant indirect pathways: 1. from ADHD in the child’s BIOLOGIAL MOTHER to child’s impulsivity to maternal hostility, and child ADHD
2. child impulsivity via maternal hostility to child ADHD
PROVIDES EVIDENCE FOR THE EVOCATIVE rGE as there is a r/s btw gene-environment interaction

20
Q

What is some further evidence for a gene-environment interaction? (Martel et al., 2011)

A
  • association between inconsistent parenting has stronger association with ADHD symptoms for those with DRD4 gene
21
Q

What is the dual pathway model of ADHD? (Sonuga-Barke, 2005)

A
  1. deficits in inhibitory - based executive processes (pre-requisite for self-control, emotion reg, cog flexibility; dopamine regulated; frontal - striatal circuit)
  2. motivational dysfunction involving disruptive signaling of delayed reward (impairment in power to discount future rewards; frontal-limbic circuitry e.g. amygdala; unable to discount future rewards)
22
Q

What is the delay aversion hypothesis?

A
  • over time negativity associated with this failures becomes associated with situations that signal need to delay gratification
  • this ‘delay aversion’ manifests as attempts to avoid/escape delay (through attending to more interesting things, or hyperactivity- getting out of seat)
23
Q

How can environments amplify ‘delay aversion’?

A
  • inconsistent parenting: promised rewards not delivered as predicted, may come to signal uncertainty/disappointment
  • hyperactive behaviour may elicit punitive responses from parents/caregivers
  • more child avoids delay, fewer organisational skills to manage delay
24
Q

How do the two pathways in the DUAL PATHWAY MODEL contribute differentially to the core dimensions of ADHD (ie. inattention and hyperactivity)

A

INATTENTION: breakdowns in top-down mechanisms (in frontal striatal circuit)
HYPERACTIVITY: breakdowns in bottom-up signalling, involving reactive control/motivational response processes (frontal-limbic circuitry)

25
Q

What does a comprehensive assessment include for ADHD?

A
  • PHYSICAL EXAMINATION
  • assessment of family
  • social/educational circumstances
  • coexisting conditons
    Should only be formulated following assessment by a specialist clinician
26
Q

Can a child under 7 years be diagnosed with ADHD?

A
  • YES but significant caution needed to distinuguish from normal expectations in period
  • if started school, needs to have been there for atleast 1 yeasr
27
Q

What are some conclusions about psychosocial treatments that do not work for ADHD?

A

COGNITIVE SELF-TALK strategies:

one of core deficits of ADHD, reduced awareness of problem, and therefore decreased motivation to sustain change efforts

28
Q

What are some well-established psychosocial treatments for ADHD?

A
  1. Behavioural parent training
  2. Behaviour modification in classroom (can have strong effects but may not generalise; most promising is when parents and teachers work together for constructive, positive environment)
29
Q

What did the Multimodal treatment study of children with ADHD (MTA) show for treatment in ADHD?

A

CLOSELY MONITORED STIMULANT MEDS VS. PSYCHOSOCIAL INTEVENTION (>35 sessions of parent-trains +teachers+8 wk behavioural)
FINDINGS: MEDICATION superior on measures of ADHD symptoms and related variables;
however, COMBINATION superior to medication alone for some MTA variables (e.g. social skills, child-parent r/s)

Abnormal 3018 (9 decks)

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