ADHD

Question 1

Atypical development

-describe typical development

Answer 1

We describe development as typical unless:

• there is a delay in the emergence of a particular behaviour
• a child presents differently
• Development may be following the correct pathway but taking longer than expected of ‘usual’
• Delayed and different are used interchangably to describe atypical development and depending on the area of development being investigated

Question 2

Developmental disorders

• definition?
• affects?
• continue or decline?

Answer 2

A developmental disorder is one that begins in early years

• it can affect one single developmental area (specific developmental disorder) OR several (pervasive developmental disorder)
• they can continue through adult life
• they can decline with age
• ADHD is a developmental topic as it begins in early years and can continue throughout adulthood

Question 3

ADHD

• definition?
• prevelance in UK?

Answer 3

Those who are hyperactive and impulsive
-prevelance:
UK, 5-15yrs : 3.62% boys and 0.85% girls had ADHD
Worldwide for children: 5%
-longitudinal:
by age 25 only 15% retained full ADHD diagnosis
but 65% fulfilled criteria for wither ADHD or partial ADHD in partial remission
(consistent with surveys that estimate prevelance in adults to be 3-4%)

Question 4

Classification of symptoms from DSM-V

Answer 4

• classified as either being inattention, hyperactivity or both
• several inattentive or hyperactive-impulsive symptoms before the age of 12
• symptoms present in more than one location
• symptoms interfere with quality of social, academic, or occupational functioning
• symptoms not exclusive to another disorder(SCZ) and not better explained by another disorder (mood/anxiety/personality/ substance or withdrawal from substance)

Question 5

Inattention

Answer 5

6 or more of the following symptoms have persisted for at least 6 months to a degree that is consistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
- often fails to give close attention to details or makes careless mistakes in schoolwork/at work/other activities
-often has difficulty sustaining attention in tasks
-often doesn’t seem to listen when spoken to directly
-often doesn’t follow through on instructions and fails to finish schoolwork
-often has difficulty organising tasks and activities
-often avoids engaging n tasks that require sustained mental effort
-often loses things necessary for tasks eg. money/ glasses etc.)
-often easily distracted by extraneous stimuli
-often forgetful in daily activities
(Note: the symptoms are not solely a manifestation of oppositional behaviour, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least 5 symptoms are required)

Question 6

Hyperactivity and impulsivity

Answer 6

6 or more of the following symptoms have persisted for at least 6 months to a degree that is consistent with developmental level and that negatively impacts directly on social and academic/occupational activities:

• often fidgets with or taps hands or feet or squirms in seat
• often leaves seat in situations when remaining seated is ecxpected
• often runs about or climbs in situations where it is inappropriate
• often unable to play or engage in leisure activities quietly
• often ‘on the go’
• often talk excessively
• often blurts out an answer before a question has been completed
• often has difficulty waiting his or her turn
• often interrupts or intrudes on others

Question 7

ICD 10 classification

Answer 7

international classification of diseases and health problems (10th revision)
-european equivalent of DSM

Question 8

Co-morbidity

• motor coordination
• IQ
• academic attainment
• sleep
• social issues

Answer 8

–motor coordination - children with ADHD are less coordinated than those without (Mariani and Barkley)
around 60% of kids with ADHD have some sort of developmental coordination disorder
– IQ -
Kids with ADHD often perform less well on IQ tests (Sonuga-Barke et al)
links are unclear but obvs inattention during learning acts as a barrier
–academic attainment -
younger children may be less ready for schooling and often perform less well at knowing numbers/colours/shapes (mariani and Barkley)
Unclear as to whether poor academic ability is linked to ADHD or conduct disorder or other factors
–sleep
ADHD kids have more sleep disturbances(Gruber et al) can occur twice as often
ADHD kids have more behavioural issues at bedtime, wake more frequently, and take longer to fall sleep (may require less sleep to function)
–social issues
ADHD kids are less likely to make friends (Hinshaw and Milnick)
they struggle with waiting and turn taking and may react negatively to losing
Their play may be less coordinated and involve much higher levels of aggression = these factors reduce their sustainability as playmates

Question 9

Causes?

• genes
• environment
• parents
• Diet
• neuropsychology

Answer 9

• • Genes
• highly heritable disorder (based on family, twin and adoption studies)
• Parents and siblings of children with ADHD have a 2 to 8-fold increased risk for ADHD (Biederman)
• • environment
• link between environment and genetics
• growing up in deprived and insitutional care may increase rates of inattention and over-activity
• children with ADHD have an atypical cortical response to stress – cortisol levels decrease following a stressor = could be linked to poor response inhibition in the hypothalamic-pituitary-adrenal axis (HPA)
• -parents
• chaotic and disorganised parenting can allow development of ADHD in predisposed individuals
• -diet
• no definitive link to consumption of sugar or additives in food
• -neuropsychology
• cognitive dysregulation (Nigg, 2001) - ADHD child’s behaviour stems from lack of planning, forethought, control
• delay aversion (Sonuga-Barke) -when child has control envrionment they can minimise delay by acting impulsively
• when they don’t have control or are expected to behave in a certain way they can pass the time by daydreaming (inattention) or fidgeting(hyperactivity)

Question 10

Treatment

Answer 10

Either:
-psychosocial or behavioural intervention
-drug treatment
(or combination of the two)

Question 11

Psychosocial interventions

• parent
• teacher
• cognitive training/ behavioural

Answer 11

-parent training:
1)New Forest Parent Training Programme (Sonuga-Barke et al)
-designed to address core symptoms of ADHD
-designed to target key parenting skills
-4 intervention components:
1=psycho-education, 2=parent child relationships, 3= behaviour training and limit setting, 4= attention training
2) Triple-P Positive Parenting Programme (Sanders et al)
-17 core child management strategies including:
1=10x competence and development
2= 7x limit setting and managing disruptive behaviour
– teacher training:
-work with child and parents to set structure
-set tone of what is expected behaviourally
-speaking to child:addressing by name, eye contact, saying what not why, clear instructions
-positive reinforcement for good behaviour
-keep focus with concrete learning techniques building on their creativity
– behavioural
-setting rules
-clear commands
-set reasonable expectations
-using when/then to encourage good behaviour
-reward system
-change disciplinary techniques as child gets older
(similar to teacher training as this system should be used at home and in school)

Question 12

Dopamine/ Norepinephrine levels

Answer 12

There is evidence to suggest that ADHD is due to an imbalance or lack of dopamine in the brain (less in synaptic cleft). There may also be a lack of norepinephrine

• these are related to rewards and control (dopamine) and stress (norepinephrine)
• both are related to happiness

Question 13

Methamphetamine

Answer 13

Stimulant of the CNS
2 uses:
1-to treat ADHD - stimulates the CNS to increase dopamine levels which increases stimulation allowing the person to concentrate more and reduces hyperactivity
2- recreational drug - dumps dopamine into synapse and makes the user feel strong sense of accomplishments (dopamine linked to rewards)

Question 14

Ritalin different to amphetamine

Answer 14

ritalin =
-slower release, sustained levels of stimulation, control over dopamine levels for long period of time
amphetamine =
-dumps all dopamine, surge of feeling great for short period of time, short half life

Question 15

Adult life

Answer 15

• structure - function better in jobs with structure and guidance (not as well in jobs with self-directed goals and targets)
• jobs - work well as artists and musicians due to increased creativity (thrive on the many different tasks)
• creaticity in work - work better when allowed to develop creative approaches to work
• decline in symptoms? How? - symptoms may decline with age (no clear explanation for this yet) This may be due to a function of age, or it could be constant structure in life. Symptoms may not decline if there is a lack of structure but no clear link