Adhd

Question 1

CBT for ADHD

Answer 1

Aims to develop coping strategies through changing negative cognitions (thoughts, beliefs, attitudes), behaviours and emotions
Learning strategies and techniques to modify problem behaviour
May help older children and young adults with ADHD to manage their difficulties
Particularly useful for children with comorbid anxiety and mood disorders

Question 2

SubTypes and main symptoms of adhd

Answer 2

Predominantly inattentive
Predominantly hyperactive-impulsive
Combined type

Inattention - lack of focus/careless behaviour
Hyperactivity - constant motion
Impulsivity - activity without thinking

Question 3

Prevalence of adhd

Answer 3

3-5% of children

More common in boys 3:1 to 9:1

Question 4

Outcomes associated with adhd

Answer 4

Poor ed attainment
ASB
Underperformance at work
Higher prevalence of teenage pregnancy
Higher prevalence of car accidents
Higher prevalence of personality disorders and depression

Question 5

DSM 5 criteria

Answer 5

A) 6 symps of inattention and/or hyperactivity to extent that is inconsistent with dev level and that sig interferes with soc/acad functuining

b) several symp were present before age 12
c) several symps are present in 2 or more settings
d) clear ev that symps interfere w/ soc/acad func
e) symps do not occur exclusively during psycotic disorder and are not better explained by another mental disorder

Question 6

limitations of DSM 5 criteria

Answer 6

takes a categorical view - either has ADHD or not rather than continuum
developmental insensitivity - applies same symps to diff ages and requires same number of symps to all under 17

Question 7

ICD 10 criteria

Answer 7

hyperkinetic disorder
both impaired attention and overactivity excessive for child's age/IQ
must occur in 2 or more settings
onset before age 6 and long duration
excludes anx dis, pdd, schiz or mood dis

Question 8

cog theories of ADHD

Answer 8

beh inhibition deficit (Barkley 1997) - inability to inhibit prepotent response to bring response under self-directed control (BUT EF is based on beh inh and correlations between EF and severity of ADHD are weak and small)
variability of performance theory (castellanos et al 2005) - perform cog func normally but performance varies

Question 9

motivational theories of ADHD

Answer 9

delay aversoin theory (Sanuga-Barke et al 1992) - aversive to delay of rewards, prefer immediate rewards and fill delays with distracting and hyperactive beh
cog eneretic model (Sergeant 2005) - struggle maintaining optimum arousal state and perform more normally at a faster pace of presentation

Question 10

bio risk factors of ADHD

Answer 10

genetic: runs in families
neurobio: diff measures of brain func, diffferenes in brain structure, NT deficiencies (dop and norep.)

Question 11

env risk factors of ADHD

Answer 11

preg/birth complications: maternal exposure to toxins, stress during preg, low birth weight, malnutrition, neuro trauma, infant diseases
diet, allergy and lead: additives, allergies, asthma and impetigo, exposure to lead, abnormal metab of zinc/iron
fam infl: fam conflict, interfering/insensitive early caregiving, poor match between the child’s temperament and parent’s interaction style
BUT many are correlations

Question 12

comorbidity in ADHD

Answer 12

high comorbid rates with: ODD, conduct disorder, mood disorders, anxiety disorders, DCD, tic disorders

Question 13

ADHD assessments

Answer 13

multidisciplinary assessments inc: school/clinical obs, interviews w/ parents and teachers, standardised measures of assessment, parent and teacher’s ratings of child’s beh

Question 14

beh rating scales for ADHD

Answer 14

Conners’ Rating Scales: 6-18; rates ADHD behaviours using a DSM-V scoring system; also addresses ODD and CD; parents, teachers or self-report (8+) versions
Child Behaviour Checklist: preschool (1.5-5) or school-age (6-18); identifies various DSM disorders; parents, teachers or self-report (11+) versions
Strength and Difficulties Questionnaire (SDQ): 3-16; 5 scales (emotional symptoms, conduct problems, hyperactivity / attention, peer relationship problems, prosocial behaviour); completed by parents / teachers or self-report (11+)
ADHD Comprehensive Teachers Rating Scale (ACTeRS): 25 items on 4 scales (attention, hyperactivity, social skills and oppositional behaviour); separate norms for boys / girls

Question 15

obs and interviews for ADHD

Answer 15

observation schedules:
TOAD (Goldstein, 1995): Talking when shouldn’t, Out of seat, Attention problems, Disrupting other children; observe for 30 second periods (e.g. 10 times) and score the number of each behaviour
Semi-structured interviews:
Parental Account of Children’s Symptoms (PACS)

Question 16

standardised assessments of attention

Answer 16

Continuous Performance Test (Conners): computerised attention test; 8+; covers four dimensions (inattentiveness, impulsivity, sustained attention and vigilance)
Test of Everyday Attention for Children (TEA-Ch): 6-16; assesses children’s ability to selectively attend, sustain their attention, divide their attention between two tasks, switch attention from one thing to another and inhibit verbal and motor responses; parallel forms
NEPSY-II: 3-16; includes various tests of attention and executive function including auditory attention, statue, animal sorting and inhibition

Question 17

ADHD interventions

Answer 17

Complex disorder, therefore a multi-professional approach will be most effective

Cognitive behavioural therapy
Environmental support
Pharmacological

Question 18

pharmacological treatment for ADHD

Answer 18

Most commonly used and effective treatment, Primarily stimulant medications
Ritalin (methylphenidate) is the most commonly used
Affect NTs (dop) in the frontostriatal region
Increases sustained attention, impulse control and persistence of work effort; decreases task-irrelevant activity and noisy /disruptive behaviours
Potential side effects: reduced appetite, weight loss, slowing of expected gains in height / weight, increased heart rate / blood pressure; sleep difficulties
Do not cure ADHD – continued use necessary

Question 19

env supports for child w/ adhd in school

Answer 19

Decrease the length of assignments or lessons
Alternate physical and mental activities
Increase the novelty of lessons
Incorporate the children’s interests into lessons
Give simple, concrete instructions, once
Avoid unstructured/idle time
Have adequate supervision
Cut down distractions

Question 20

env supports for child w/ adhd at home

Answer 20

Parent and family training is important so that the family understand the difficulties
Family and household rules should be clear, well defined and consistently applied
Predictable routines may be helpful
Quiet area, free of distractions for homework
Break chores into small sequential steps