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Atypical Development > ADHD > Flashcards

ADHD Flashcards

1
Q

Problems when it comes to researching ADHD

A
  • have to be careful!
  • a lot of talk about it in the media, especially when it comes to medicating children
  • potential side effects
  • the ‘label’ of ADHD
  • big debate as to whether it is a real disorder or not?
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2
Q

Wang et al (2016) - negative media publicity

- background

A
  • impact of negative publicity on ADHD disorder medication in Taiwan
  • explored trends in ADHD medication between 2000-2011 and whether negative media coverage of Ritalin in Jan 2010 impacted prescriptions throughout the country

Media story - Ritalin = ‘children’s cocaine’
- reported the many adverse side effects causing panic among children diagnosed with ADHD and their parents

Wanted to see if this had a nationwide effect

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3
Q

Wang et al (2016) - negative media publicity

- results

A

Compared with ADHD P’s first diagnosed before the negative media coverage, ADHD P’s first diagnosed after the negative media coverage were less likely to be prescribed medication to manage their ADHD

  • SO the negative coverage did affect stimulant prescriptions for ADHD throughout Taiwan
  • parents - less willing to let their kids receive stimulant treatments?
  • physicians - also starting to question the safety claims of stimulants so became more reluctant to prescribe them?
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4
Q

ADHD - a real disorder or not?

A

Big debate over whether it is a real disorder or not

  • is this because of the growing number of medicated children for the disorder
  • is it a real disorder or are children just behaving according to their age?
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5
Q

Barkley et al (2002) - ADHD is a real disorder

A
  • consortium of 70 ADHD researchers
  • concerned about the inaccurate portrayal of ADHD in media reports may be causing P’s to not seek treatment as well as promoting a poor public perception
  • ALL of the major medical associations and governmental health agencies recognise ADHD as a genuine disorder because the scientific evidence indicating it is so overwhelming
  • state that there is SO much evidence on the behavioural inhibition and sustained attention, impairments in major life activities as well as neurological studies showing differences in brain activities/areas
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6
Q

ADHD - a real disorder?

A
  • evidence from growing links with neurological and genetic components
  • evidence of behavioural patterns worldwide
  • this is something! –> not just an inconvenience!!!!!
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7
Q

ADHD - Prevalence

A
  • UK - affects approximately 4% of children
  • these rates differ internationally - between 1-20%
  • 40% of children with ADHD continue to meet the diagnostic criteria into adulthood!
    (people initially thought you would just grow out of the disorder!)
  • 65% of children with ADHD have one or more co-morbid conditions
  • significant discussions around gender:
    > boys are diagnosed more than girls!
    > adults - more tolerant to girls hyperactivity
    > diagnostic criteria - how we interpret and measure girls and boys behaviour?
  • there are key different in how we interpret behaviour
  • are girls misdiagnosed as a result?!?!?!?
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8
Q

Polancyzk et al (2014) - Prevalence of ADHD

A
  • found that estimates of ADHD prevalence are significantly variable

Geographical location and year of study - not associated with variability of prevalence estimates!

Variability was instead accounted for by:
- methodological characteristics of studies, specifically diagnostic criteria used, source of information and requirement of impairment of diagnosis

Examined studies from the past 3 decades
- no evidence suggesting that there was an increase in the number of children in the population who meet criteria for ADHD when standardised diagnostic procedures are followed

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9
Q

ADHD - defining difficulties?

A

There are differences between the classification criteria:
- DSM V - over diagnosing; ICD-10 - under diagnosing

Key differences between self-reports and parents reports

Child needs to demonstrate the behaviours across contexts

Difference between teacher’s reports based on the child’s ethnicity
- making assumptions about cultures?

> Could we be making assumptions about genders too?

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10
Q

ADHD - differences between parents reports?

A

Fathers - maybe reporting fewer problems - WHY?
Mothers - maybe spending more time due to father’s work commitments OR is it just the way that females view/regard the behaviour?

Demonstrating the behaviour across contexts:

  • normally the mother who comes out of employment to look after the child!
  • SO mother gets 24/7 of the ADHD child, father doesn’t get as much
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11
Q

DSM-IV to DSM-V - changes?

A
  • same 18 symptoms divided into the 2 domains - Inattention and Hyperactivity/Impulsivity
  • diagnosis - need at least 6 symptoms in one domain

KEY change - changes to reflect adult experiences!

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12
Q

DSM-V - ADHD

A

Now appropriate for adults!

DSM-IV - devised mainly on childhood samples
- not really valid then diagnosing pre-schoolers and adults with the same measures - quite a difference!

  • Farone (2000) - DSM-IV is developmentally insensitive
  • children and young adults - learn to control their symptoms and have freedom to choose non-constructive environments

Getting older:

  • lots of ADHD begins/becomes apparent when children are put in structures like pre-school etc
  • only really / it is easier to see when the child is put in an environment which demands some form of order?
  • then we can see the ADHD emerge?
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13
Q

ADHD - Adulthood

A

Adult ADHD - many of the same characteristics
BUT now it is in adults contexts - work, love etc

  • same patterns but developmentally appropriate contexts
  • life span disorder, not a childhood disorder!
  • same neuropathology as childhood ADHD
  • also has similar responses to drug treatments!
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14
Q

Changes in criteria from DSM-IV to DSM-V….

A
  • examples have been added to help with the application across the lifespan
  • cross-situational requirement - has been strengthened to “several” symptoms in each setting
  • onset criterion has been changed from “symptoms…present before age 7 years” to “symptoms were present prior to age 12”
  • hyperactive earlier onset; inattention later onset
  • co-morbid diagnosis with autism spectrum disorder - now allowed!
  • symptom threshold changes has been made for adults, with the cut off for ADHD of 5 symptoms instead of 6 which is required of younger persons
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15
Q

Some criticisms of DSM-IV - Inattention and Hyperactivity-Impulsivity

A

Inattention and Hyperactivity-Impulsivity

  • separate elements within a complex disorder
  • OR are they arbitrarily divided elements of a continuous-trait dimension

> the current subtype structure addresses neither position!

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16
Q

Some criticisms of DSM-IV - existence of subtype entities….

A

Implies that they exist!

- HOWEVER there is little empirical evidence to support their differentiation as classified

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17
Q

Some criticisms of DSM-IV - manifestation of adult ADHD

A

Not well represented in the criteria!

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18
Q

Some criticisms of DSM-IV - criteria themselves

A

Vaguely described!

  • this enhances criterion variance
  • this is a significant problem in everyday use
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19
Q

Some criticisms of DSM-IV - 6 month time span

A
  • too short - particularly for young children!
  • school attention problems may be transient
  • 12 months would be more appropriate time
  • gives a bit longer to assess
  • may just be that children need to settle
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20
Q

Issues affecting diagnosis fo ADHD - children’s abilities to sustain and control impulses

A

More problematic:

  • later in the day
  • with more complex tasks
  • when behavioural restraint is required
  • when levels of stimulation are low
  • where there is a deal in feedback / reward
  • when there is an absence of adult supervision
  • when the task requires persistence
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21
Q

Issues affecting diagnosis fo ADHD - children’s abilities to sustain and control impulses

(thoughts behind this)

A
  • children - still developing
  • higher brain structures - e.g. PFC - still not developed
  • are we rushing sometimes to put a label on?
  • needed if the behaviour is really really bad / deviant from the norm
  • also have to realise that children are just growing and we cannot expect them to constantly be ready and available to test etc
22
Q

ADHD - DSM-V

- adult observations

A

“in children and found adolescents, the diagnosis should be based on information obtained from parents and teachers…..for older adolescents and adults, confirmatory observations by third parties should be obtained wherever possible”

> who are these 3rd party observers?
someone who knows them or who is a total stranger?

23
Q

DSM-V vs ICD-10

A

DSM-V - can be diagnosed mainly on inattention symptoms
ICD-10 - a P has to show symptoms of inattention, impulsivity and hyperactivity to be diagnosed

DSM-V - will more people be diagnosed?
ICD-10 - people being diagnosed with hyperkinetic disorder?
—> problems of over- and under-diagnosis?!?!

DSM = US; ICD-10 = UK

ICD-10 - diagnoses fewer kids with more severe symptoms
- so those who could be diagnosed with ADHD using DSM won’t get treatment?

OR are too many people being diagnosed with ADHD using DSM-V?

24
Q

ADHD under 5 years old?

A

How do we diagnose and identify?

  • really young - can we justify the use of labels to certain behaviours that early on in development?
  • is it just natural childhood behaviour rather than being disruptive ADHD behaviour?

BUT under 5’s do:

  • present the same symptoms and developmental impairment
  • do show similar neuropsychological deficits
25
Q

ADHD under 5 years old? - Pierce et al (1999)

A

Symptoms of ADHD found in under 5 boys predicted the same problems in middle childhood

Hyperactivity scores - extremely high in under 5’s at risk for ADHD
- looking at the criteria - difficult as some of the behaviours are natural to those under 5!

Genetically predisposed? - is the genetic risk predisposed by parental responses???

26
Q

ADHD under 5 years old - genetically predisposition by parental responses???

A

REMEMBER Bronfenbrenner’ model

  • those within the child’s system shape their responses etc
  • bidirectional relationships too!
  • child’s behaviour shapes parent’s behaviours which in turn feeds into the child’s behaviour!
27
Q

What are some of the suggested causes of ADHD?

A
  • Genetics
  • Biological Risks
  • Environment
  • Neuropsychology
28
Q

Causes of ADHD - Genetics

A
  • large body of research on genetics
29
Q

Causes of ADHD - Genetics

- Thapar et al (1999)

A
  • ADHD is highly heritable

- convincing evidence that hyperactivity, defined as a trait, is highly heritable

30
Q

Causes of ADHD - Genetics

A
  • approximately 70% of the risk of having ADHD can be explained through genetics
  • 20% of parents of children with ADHD have ADHD (Farone et al, 2000)

The exact nature of the interaction is still contested
- complex, individually unique, gene by gene interaction

31
Q

Cause of ADHD - Genetics

- Greven et al (2011)

A
  • family, twin, adoption studies - heritability for symptoms range from 0.75 to 0.97
32
Q

Causes of ADHD - Genetics

- Joseph (2000)

A

Not in their genes - a critical view of the genetics of ADHD

33
Q

Causes of ADHD

- DeGrandpere (1999)

A
  • the result of some children’s problems with impulse control in our increasingly “rapid-fire culture” leading to children’s “rapid fire consciousness”
  • emergence of a phenomenological experience of unsettledness characterised by feelings of restlessness, anxiety and impulsivity
  • hyperactivity / inability to attend to mundane activities - exemplifies the type of escape behaviour that the “sensory addicted” child or adult uses in order to maintain their needed stream of stimulation
  • continuing growth to stigmatise individuals and groups and to support the use of psychotropic drugs to treat problems caused by social and psychological factors
34
Q

Causes of ADHD - Biological Risk

- Maternal smoking

A
  • nicotine influences the development of NT systems
  • PROBLEM - correlation and causation!
  • do get some people who smoke during their pregnancy AND there are no problems
  • is it more of a risk factor?
35
Q

Causes of ADHD - Biological Risk

- Maternal smoking - Thapar et al (2003)

A

Maternal smoking during pregnancy and ADHD disorder symptoms in offspring

  • questionnaire assessing child’s ADHD symptoms (parent and teacher rated), maternal smoking during pregnancy, conduct disorder symptoms and family adversity
  • genetic influences did account for most of the variance in offspring ADHD
  • BUT….maternal smoking during pregnancy was still found to show a significantly environmentally mediated association
  • also remained a significant influence when other potential confounds were taken into account
36
Q

Causes of ADHD - Low Birth Weight

- Eric et al (2002)

A
  • ADHD cases were 3x more likely to have been born LBW than were non-ADHD controls after attending to potential confounders
  • if this association was causal, 13.8% of all ADHD cases could be attributed to LBW
  • these results converge with prior studies documenting similar associations
  • also indicate that LBW is an independent risk factor for ADHD
  • HOWEVER, children with LBW make up a relatively small proportion of children with ADHD
37
Q

Causes of ADHD - Low Birth Weight

- Hack et al (2004)

A
  • behavioural outcomes and evidence of psychopathology among VLBW infants at age 20 years
  • no differences in the young adult SR of ADHD
  • no differences either in the SR rates of the subtypes of ADHD according to clinical criteria
  • HOWEVER - parents of VLBW men reported significant higher mean scores of inattention for their sons vs parents of control P’s
  • BUT not higher rates of ADHD according to clinical criteria
  • 20 years - increases in parental reports of attention problems or inattention for VLBW men on the ADHD scale and VLBW women

More attention related rather than hyperactivity symptoms!

38
Q

Causes of ADHD - Foetal Distress

A
  • can cause significant developmental delays

- causing problems - difficult to associate them though!

39
Q

Causes of ADHD - Environment

- Stevens et al (2008)

A
  • higher rates of inattention / over activity among children raised in deprived institutional care
40
Q

Causes of ADHD - Environment

- Johnston and Mash (2001)

A
  • chaotic or disorganised parenting can enhance genetic predisposition –> parental psychopathology, including ADHD
41
Q

Causes of ADHD - Environment

- Sonuga-Barke et al (2001)

A
  • improvements in ADHD when parents are taught alternative parenting programmes
42
Q

Causes of ADHD - Environment

- Kummel et al (1996)

A
  • literature review - concluded that there was no relationship between sugar consumption and ADHD
43
Q

Causes of ADHD - Environment

- McCann et al (2007)

A
  • adverse effects of food additives and food colours DO NOT cause ADHD BUT actually make all children hyperactive!!!
44
Q

Causes of ADHD - Neuropsychology

- Nigg (2001)

A

ADHD is a result of cognitive dysregulation

  • insufficient forethought, planning and control?
  • leads to hyperactive behaviour?
  • lack of attentional control?
45
Q

Causes of ADHD - Neuropsychology

- Sonuga-Barke et al (1996)

A
  • NOT cognitive dysregulation BUT instead it is delay aversion hypothesis?
  • engage because of your aversion to delay?
46
Q

Causes of ADHD - Neuropsychology

- Paloyelis et al (2009)

A

Are ADHD symptoms associated with delay aversion or choice impulsivity?

47
Q

ADHD plus associated difficulties

A

Rarely found on its own - high co-morbid levels

  • oppositional defiant disorder
  • conduct disorder
  • depression
  • anxiety
  • substance abuse

Motor coordination - frequently have physical needs to!

  • need to be active BUT have to help them moderate risks
  • Kadesjo et al (2001) - 60% of children with ADHD have a developmental coordination disorder
48
Q

ADHD plus associated difficulties

- Intelligence

A
  • children with ADHD have lower IQ test scores than control groups
  • IQ tests - assume a lot of focus

ADHD - stopping them from demonstrating a high intelligence due to the methods of IQ testing that have been established???

49
Q

ADHD plus associated difficulties

- Academic functioning

A
  • struggle with school work and social interaction
50
Q

ADHD plus associated difficulties

- social problems

A
  • higher levels of aggression, less coordinated play, less conversation
  • peer rejection and less friends
  • tendency to talk over, not stop talking
51
Q

ADHD plus associated difficulties

- accident proneness

A
  • consequence of impulsivity (fearlessness) and poor motor coordination
  • more likely to put themselves in these kinds of situations?
52
Q

ADHD plus associated difficulties

- sleep problems

A
  • twice as many sleep problems

Atypical Development (4 decks)

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