ADHD Flashcards
Definition
Attention Deficit, Hyperactivity Disorder.
Neurodevelopmental.
DSM
9 symptoms each domain (18 total) Before age 12 2+ settings. Comorbid ASD now allowed Children - 6 symptoms. Adult - 5 symptoms. Inattention: no close attention, doesn't listen, doesn't follow instructions, poor organising, easily distracted, forgetful.
Hyperactivity and Impulsivity: fidgets, leaves seat without permission, dispenses energy inappropriately, difficulty with quiet activities, talks excessively, interrupts.
Presentations
‘Current’ presentation as symptoms change.
Combined - AD and HD. 6 months Predominantly Inattentive (AD) 6 months. Predominantly Hyperactive-Impulsive (HD) 6 months (EF impairments)
Executive Functioning
Ability to make and carry out plans, direct attention, control impulses/emotions and switch between tasks.
Planning, abstract thinking, rule acquisition, initiating/inhibiting actions, selecting relevant information.
Testing
EF Wechsler Intelligence Scale for Children Card Sorting Test Porteus Mazes Hand Movements Test - ‘fist-edge-palm'
Attention
Continuous Performance Test
Stop Signal Test (press X, O until you hear a beep)
Stroop Test
Delayed gratification (sweets under cup).
Diagnostic challenges
No test to absolutely confirm or disprove.
Environmental issues similar presentation (attachment, bullying)
Contradictory reports (teachers, parents)
No universalised clinical practice guidelines.
Parents oppose medication/have poor parenting styles.
Prognosis
Persists in 80% or masked by:
Autism, Conduct Disorder.
Substance abuse, criminal behaviour, holding down jobs , marital and emotional problems, personality changes.
Also evidence that 50% grow out of it.
Biological/neuro explanations
76% heritability.
Chromosomal aberrations, deletions and duplications.
Delay in frontal lobe development.
Low dopamine.
Prenatal (drinking/smoking) and birth complications.
Cognitive theories
‘Dual pathway model’ two impairments:
- Cognitive pathway: Executive Function (EF) problem.
- Motivational pathway: Delay aversion problem
Evidence:
Executive Funtioning: differences between children with ADHD and typical children: Inhibition control, working memory, planning.
Motivation: Choose small immediate rewards over larger delayed ones
Implication
Both pathways have separate impact on same academic skills deficits.
Social explanations
Mother not emotionally in tune with child.
Frequent disruptions (moving schools/house)
Father prone to antisocial behaviour.
Poor relationships with parents.
May be a form caused by environmental adversity.
Drug treatment
70-85% successful but short term.
Increase dopamine.
Side effects: stunted growth, anxiety, tics, epilepsy, insomnia, loss of appetite, edginess, digestive upsets, headaches, psychosis.
Recent increase in prescription of medication (94-04 = 7000%).
Antidepressants used to address anxiety.
‘Ritalin’ /Adderall’ Controversy
Does it just increase compliance? Are side effects worth it?
Lawsuits claiming misuse of Ritalin.
Recreational usage.
1/3 children given diagnosis are properly tested
Can be helpful and safe for most people.
Behavioural treatment
Combination of drugs and therapy.
Two types:
Clinical behavioural psychotherapy- deals with behaviour at imagined level “situations that make you feel bad”.
Direct contingency management- deals with behaviour ‘in situ’ –parent/teachers work together).
Expense/value for money.
Sarver et al. (2015)
Challenge assumption that gross motor activity in ADHD interferes with ability to engage in and sustain classroom work.
Recall numbers in ascending order with letter last 4H62 > 246H
Implications are that people can be made to benefit from disruptive behaviour e.g. walk stations.
Prevalence and costs
1-7% of children
Boys 3 times more likely than girls (more disruptive).
$12k-17.5k per child (total $45 Billion).
20-25% have other learning difficulties
Combined presentation - 50% also diagnosed with CD.
Comorbidity:
Sleep disorders, epilepsy, growth delay, mood disorders.
