ADHD Flashcards
ADHD is a persistent pattern of
inattention and or hyperactivity - impulsivity
how long must symptoms perist for?
at least 6 months
criteria
interfers with function or development, several symptoms noted prior to age 12
present in 2 or more settings
criteria for Inattention
- lack of attention to detail
- difficulty staying on task
- trouble listening
- problem with follow through
- poor organization
- avoids/dislikes tasks that require sustained mental effort
- trouble keeping track of things necessary for tasks/activities
- easily distracted
- forgetful in daily activities
hyperactivity-impulsivity criteria
- fidgets/squirms
- leaves seat when you should be seated
- runs/climbs when inappropriate
- unable to play quietly
- “on the go”
- talks excessivley
- blurts out answeres
- difficulty waiting turn
- interrupts or intrudes on others
diagnosis - innattentive
6/9 symptoms (5/9) if 17 or older
fewer than 6 hyperactivity
diagnosis - hyperactive/impulsive
6/9 symptoms (5/9) if 17 or older
fewer than 6 inattention
mostly preschoolers
contemporary model of ADHD
problem of executive functions of the brain
executive functions
higher cognitive process
involves communication and organization across multiple brain regions/pathways
executive function ROLE
plan and complete a task, multitask
keep track of time, differentiate among conflicting thoughts, filter out unimportant information, anticipate future consequences of current behavior/activities, work toward a defined goal, make mid-course corrections when thinking, reading, writing, inhibit impulses that could lead to socially unacceptable problems
problems when executive function isn’t working
significant problems learnign
cant get tasks done
difficulty controlling emotions
struggles with social functioning
what can cause executive function to be impaired
prenatal exposure to drugs, pregnancy complications, frontal lobe injury, stroke, Alzheimers, dementia, many medical conditions
ADHD represents and EXTREME in
inefficiency in executive function
common comorbitd contiditions in children
oppositional definat disorder conduct disorder anxiety depression autism learnign disabilites bipolar speech/languae
genetic factors
elevated risk of ADHD among biological relatives
twin studies suggest 60-80% heritability
abnormality with the DRD4 dopamine receptor gene
neurological factors
cerebral blood flow reduced in frontal lobes, striatum, cerebellum, reduced brain volumes of anterior frontal lobes, deficits in DA and NE
dopamine is predominately present in
hyperactive/impulsive
changes in DAT
reduces DA in brain
treatment? stimulant medications to block DAT and increase DA
NE is predominately present in
inattentive
changes in NET
reduces NE levels in brain
treatment? nonstimulant to block NE transporter so increases NE
Neuropsychological deficits
behavioral inhibition sustained attention resistance to distraction working memory internalization of language planning emotional self-regulation
comprehensive assessment
collect info from multiple settings (parent, teacher, child care)
assess for comorbid conditions
assess impact on family, social and academic functioning
rule out other causes
assessment should include
parent, child interviews, bio-psycho-social assessment interview including family history, parent and teacher rating scales and self-report
multidisciplinary assessment
rule out any unusual medical conditions that might produce ADHD like symptoms (standard pediatric exam, neurodevelopmental screening) + vision, hearing, speech and language assessment
psychological assessment tools - intelligence testing
Wechsler intelligence scale for children
psychological assessment tools - achievement testing
Wechsler individual achievement test
psychological assessment tools - some tests of executive functionings
wisconsin card sorting test, category test, trail making test
structure of assessment
- prior to meeting mail rating scales to parents and teachers
- session 1 test the child
- session 2 interview parent
- decision making, feedback, recommendations
questions to ask yourself
are there enough ADHD symptoms, do they cause impairment? present to age 12, any other explanation? comorbid conditions?
gender differences
gender differences
girls diagnosed later than boys
,silently suffer, more likely to have inattentive presentation and puberty is catastrophic because DA covaries with estrogen
