ADHD Flashcards
Majority of kids have ____________, but can just have __________
combined hyperactivity-inattentive subtype, inattentive
Is ‘inattention’ a misnomer?
- kids with ADHD do not have a problem with perception/filtering/ processing
- their difficulties are primarily with persistence - ie the capacity to sustain action/attention towards a goal/task
ADHD is a failure to direct behaviour forward in time - to persist towards delayed end points
Persistence (attention) relies on the ability to…
resist distractions.
Children with ADHD do not perceive/encode distractions differently but rather
- respond to distractions more than other children
- react to events that are irrelevant to the goal
- have difficulty re-engaging in tasks following interruption
- skip from one incomplete task to another
This ‘inattention’ may largely reflect…
impaired working memory
What’s missing from current DSM criteria?
Emotional impulsivity.
While ADHD is not a mood disorder or emotional disorder, it is nonetheless associated with poor emotional control.
Children with ADHD have difficulties self-soothing, down-regulating, in order to express emotions in ways that are socially acceptable, or consistent with longer-term goals
ADHD is ____ comorbid with ODD and ___ comorbid with CD
50, 20
ODD can be differentiated from ADHD how?
ODD is not about attention but rather deliberately annoying others, blaming others, and arguing with authority figures. There is an inability to not be angry
In DSM-5, ADHD is currently conceptualised as a _____ disorder
neurodevelopmental
ADHD clusters with autism, motor coordination, reading/learning disabilities
Despite DSM-5’s criterion of a cut-off date of 12 years, a true ADHD case would show symptoms since
mid-primary school
____ of children with ADHD are comorbid with at least one Axis 1 disorder
2/3
What is the developmental trajectory of ADHD?
Hyperactivity symptoms are most pronounced in preschool and decline over time.
Inattention symptoms become increasingly apparent with age, as peers undergo rapid maturation of prefrontal cortex, and as school demands intensify
What are some non-genetic possible causes of ADHD?
Exposure to Teratogens and toxins during critical phases of pregnancy
- household, outdoor pesticides
- prenatal nicotine
- lead
- paracetamol?
Synthetic food colours - probably fake
Quantitative genetics refers to…
Twin studies research
Average genetic contribution of ADHD based on twin studies is ___, which is higher than ________
0.8, schizophrenia
High levels of parental involvement associated with…
reduced hyperactivity/inattention during early childhood
The more inconsistent the parental discipline, …
the more ADHD increased over time
What are some alternative explanations (other than that bad parenting causes ADHD) for the link between parenting and ADHD?
- ADHD may elicit negative responses from parents and family members
- Gene-environment correlation (rGE)
ADHD Children treated with stimulants not only showed improvements in their symptoms but also…
the quality of parenting improved
What is evocative rGE and passive rGE?
evocative rGE: Child characteristics that are genetically based evoke negative responses from parents
passive rGE: The same genes that underlie ADHD in the child underlie parenting problems in their parents
How was evocative rGE and passive rGE in ADHD able to be tested?
A longitudinal study looking at genetically unrelated mothers and offspring (adoption-at-birth)
What were the main findings of the adoption-at-birth longitudinal study?
- Biological mother’s ADHD symptoms predict impulsivity in the child… child’s impulsivity predicts adoptive mother’s hostility towards the child… this in turn increases child’s ADHD
In other words, the child’s biological inheritance is driving the quality of parenting they receive. This quality of parenting exacerbates/reduces the child’s ADHD symptoms over time
The idea = genetic loadings drive the environments we are exposed to
The ______ system is disturbed for kids with ADHD
dopamine
The Dual Pathway Model of ADHD (Sonuga-Barke, 2005) argues that there are two distinct processes, involving distinct but overlapping neural architecture, with both shaped by environmental processes. What are they?
- Deficits in inhibitory-based executive processes
- — ie find it very difficult to inhibit their responses towards extraneous distractive stimuli
this deficit leads to a
- Motivational dysfunction involving disruptive signalling of delayed reward
- — ie unable to be motivated to engage in correct behaviour of delaying gratification
Response inhibition is the ability to…
inhibit an inappropriate prepotent or ongoing response in favour of a more appropriate alternative
Response inhibition is a prerequisite for…
self-control, emotional regulation, cognitive flexibility
Response inhibition is underpinned by the _______, which is modulated by _______.
frontal striatal circuit, dopamine
ADHD arises from neurobiological impairment in the ____________ with which the contingency between ________ and _________ is signalled.
power and efficiency
present action
future rewards
The motivational dysfunction is based in the ___________, modulated by _________.
frontal limbic circuitry (incl. amygdala)
dopamine
The delay aversion hypothesis:
Demands from teachers/environment to delay gratification become….
really aversive –> lose control emotionally
environment becomes increasingly hostile —> escalates ADHD
How can environments amplify the ‘delay aversion’?
negative/punitive parenting reactions to hyperactive behaviour
inconsistent parenting
The critical thing when establishing a valid diagnosis is…
Collateral interviews (multi-informant data)
- child
- parents
- teachers
- sports coaches etc
Cannot diagnose ADHD if it only occurs in one setting
What were the main findings of the Multi-Modal Treatment Study for ADHD (MTA)?
- On primary outcome measure (ADHD symptoms), medication alone and combined treatment did better than behavioural treatment alone and TAU
- Combined treatment was better than TAU when kids had comorbid problems
Only ________ really addresses the core symptoms of these kids
stimulant medication
