ADHD Flashcards
Attention
Construct of attention is multidimensional
Vigilance: the ability to sustain attention/orientation to a task for the length of time to complete the task or persistence of effort
Distractibility: likelihood that a child responds to the occurrence of extraneous events unrelated to the task
Executive Functioning (e.g., planning & organization) & Working Memory
Can be apparent in both free-play settings, but most commonly with situations requiring child to sustain attention to dull, boring, & repetitive tasks
Difficulties with attention sustained throughout developmental years
Inattention
Children with inattention tend to have:
Poor persistence of responding
Impaired resistance to distraction
Deficient task re-engagement following disruption
Impulsivity
Deficiency in inhibiting behavior especially ones that obtain immediate reinforcement
Impaired motor inhibition
Poor sustained inhibition
Hyperactivity
Excessive and often task irrelevant motor and verbal behavior
Restlessness decreases with age, becoming more internal, subjective by adulthood.
Developmentally inappropriate levels of activity, restlessness, and fidgetiness
Course: Infancy to Age 6
Infancy
difficult temperament, negative mood
High activity level
Irregular sleeping & eating habits
Age 3
Start to show behavioral problems
Over activity & impulsivity
May have difficulties with toilet training
Complaints of restlessness, inattention, & oppositionality
Age 6 Continued problem behaviors including aggression Social skills lacking Struggle with consequential thinking Experience strong emotionality
ADHD Adolescent
Common and Associated Problems
Common Characteristics:: Hyperactivity may decrease Disruptive classroom behaviors Failure to be compliant (homework) Poor organization Poor social skills Clumsy Inattention becomes more disabling Academic underachievement School disciplinary action May be perceived as lazy or unmotivated Occupational difficulties
Associated Problems:: Conduct Disorder Mood Disorders Anxiety Disorders Substance Abuse Risk for automobile accidents & traffic violations
ADHD in Adulthood
Common
Associated
Common Characteristics
More likely to drop out of college, complete less education
Riskier driving
Internal restlessness
Greater risk of having another mental disorder
Poor sense of time management
Difficulty organizing, planning and completing tasks
Lower socio-economic status
Frequent changes in employment
More likely to be a small business owner than a professional
Higher rates of divorce and multiple marriages
Higher self-report of interpersonal problems
Associated Problems
Anxiety
Substance Abuse
Antisocial personality disorder
Comorbidity and Associated Problems, Continued
Associated Problems
Medical issues (sleep)
Academic underachievement
Motor coordination & adaptive functioning
Family functioning- parent stress and psychopathology
Behavioral difficulties (i.e. noncompliance, aggression)
Peer relations or acceptance especially with children who display aggression
Etiology of ADHD
or Cause of ADHD
Disorder arises from multiple causes (true of all developmental disabilities)
All currently recognized causes fall in the realm of biology (neurology, genetics)
There is NO EVIDENCE that ADHD is causes by environmental causes (e.g. diet, watching violent TV, etc).
Little-no support for Feingold method (dietary sugar ingestion that cause ADHD)
Some correlation studies between maternal smoking & low birth weight
Social factors moderate types & degrees of impairment
Etiology of ADHD
Final common pathway for disorder appears to be the fronto-striatal-cerebellar circuits in the brain.
Some areas implicated: right frontal lobe: Orbital frontal area is smaller in children with ADHD, striatal basal ganglia, right side of the cerebellum
These structures are 10 – 15 % less active
Neurochemical Deficits Dopamine dysregulation: Drugs (stimulants) that help ADHD are dopamine regulators Norepinephrine dysregulation (strattera affects this)
Neurobiology
Smaller, less active, less developed brain regions
Oribital-Prefrontal Cortex (primarily right side)
Basal Ganglia (Mainly striatum and globus pallidus)
Cerebellum (central vermis area, more on right side)
Size of network is correlated with degree of ADHD symptoms, particularly inhibition
No gender differences
Differences largely persist with age
Results are not due to taking stimulant medications.
Neurochemical imbalances: abnormalities in one or more of the monoaminergic systems (dopamine or norepinephrine) within the prefrontal limbic areas of the brain (prefrontal cortex–which is believed to be related to the inhibition of behavior)
Dopamine & dopamine receptor gene & transmitter gene- Stimulant medication temporarily increases the dopamine & norepinephrine in the synaptic cleft
Genetics
ADHD is one of the most highly heritable of all psychiatric disorders
- Most studies reporting heritability estimates between 0.60 and 0.95, indicating that 60%-95% of the variance in the presentation of the disorder can be accounted for by genetic factors
- Higher rate of ADHD symptoms in first-degree relative of children with ADHD
- Evidence from twin studies .7-.97
- More heritable than height
- Important to keep in mind when working with parents of children with ADHD
Etiology: Acquired Cases: Prenatal
Drinking & smoking during pregnancy increases chance by 5
Maternal smoking in pregnancy (odds ratio 2.5)
Maternal alcohol drinking in pregnancy (odds 2.5)
Prematurity of birth, especially if brain is bleeding (45 %+)
Etiology: Acquired Post-natal
Head trauma, brain hypoxia, tumors or infection
Lead poisoning in preschool years
Survival from acute lymphoblastic leukemia. Treatments for ALL cause brain damage, affects frontal lobe
Streptococcal Bacteria infection triggers auto-immune antibody attack of basal ganglia (rare)
Post-natal elevated phenylalanine (dietary amino acid related to PKU)
Etiology: Psychosocial
Excessive TV/ Videogames (No evidence of causation- People with ADHD tend to watch more TV, read less, talk more on the phone
No evidence for “fast paced society”
Family Stressors (Linked to ODD/ CD/ MDD)
Poor Child Management (Parental ADHD/ ODD/ CDD)
Learning Disabilities (Comorbid but not causal)
No evidence for Intolerant teachers/ parents as causing ADHD
Diets: Not causal but some new research coming out that may indicate sensitivities in children with ADHD to certain foods (may exacerbate but not cause symptoms)
