ADHD

Question 1

When do we NOT describe development as typical?

Answer 1

When there is a delay in the emergence of a particular behaviour
OR
A child presents differently

Question 2

Outline the term developmental disorder

Answer 2

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

Question 3

What is ADHD?

Answer 3

Those who are hyperactive or impulsive

Question 4

What is the prevalence for ADHD?

Answer 4

The worldwide prevalence is 5%
More common in boys
People who were diagnosed as children found that by age 25 only 15% retained the full ADHD diagnosis
However 65% fulfilled criteria for either ADHD or ADHD in partial remission

Question 5

What are individuals with ADHD classified as?

Answer 5

Either inattention, hyperactivity or both
It is required that:
- They have several inattentive or hyperactive-impulsive symptoms before the age of 12
- They have symptoms present in more than one location
- They have symptoms that interfere with quality of social, academic or occupational functioning

Question 6

For inattention, list the symptoms that require 6 to persist for at least 6 months

Answer 6

• Often fails to give close attention to details
• Often has difficulty sustaining attention in tasks
• Often does not seem to listen when spoken to directly
• Often does not follow through on instructions
• Often has difficulty organising tasks and activities
• Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort
• Often loses things necessary for tasks or activities
• Is often easily distracted by extraneous stimuli
• Is often forgetful in daily activities

Question 7

For hyperactivity, list the symptoms you need 6 or more of

Answer 7

• Often fidgets with or taps hands or feet or squirms in seat
• Often leaves seat in situations when remaining seated is expected
• Often runs about or climbs in situations where it is inappropriate
• Often unable to play or engage in leisure activities quietly
• Is often on the go acting as if driven by a motor
• Often talks 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 8

Outline the co-morbidity with motor coordination

Answer 8

Children with ADHD are less coordinated than those without

Around 60% of children with ADHD have some sort of developmental coordination disorder

Question 9

Outline the co-morbidity with IQ

Answer 9

Children with ADHD often perform less well on IQ tests

Links are unclear but obviously inattention during learning acts as a barrier

Question 10

Outline the co-morbidity with academic attainment

Answer 10

Younger children may be less ready for schooling

Unclear as to whether poor academic ability is linked to ADHD or Conduct disorder or other factors

Question 11

Outline the co-morbidity with sleep

Answer 11

Children with ADHD have more sleep disturbances than those without
May have more behavioural issues at bedtime, wake more frequently, take longer to fall asleep
They may require less sleep to function

Question 12

Outline the co-morbidity with social issues

Answer 12

Children with ADHD are less likely to make friends
Struggle to take turns and may react negatively to losing
They may be more aggressive

Question 13

Outline genes as a cause of ADHD

Answer 13

It is a highly inheritable disorder

Parents and siblings of children with ADHD have a 2 to 8-fold risk for ADHD

Question 14

Outline environment as a cause of ADHD

Answer 14

There is a link between environment and genetic factors for causality
Growing up in deprived institutional care may increase rates of inattention and over-activity
Children with ADHD have an atypical cortisol response to stress, their levels decrease following a stressor
This could be linked to poor response inhibition in the HPA axis

Question 15

Outline parents as a cause of ADHD

Answer 15

Chaotic and disorganised parenting can allow development of ADHD in predisposed individuals

Question 16

Outline diet as a cause of ADHD

Answer 16

No definitive link to consumption of sugar or additives in food

Question 17

Outline neuropsychology as a cause of ADHD

Answer 17

Cognitive dysregulation - ADHD child’s behaviour stems from lack of planning, forethought and control
Delay aversion - when child has control over environment 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 or fidgeting

Question 18

What are three types of psychosocial interventions for ADHD?

Answer 18

1. Parent training
2. Teacher training
3. Behavioural training

Question 19

Outline parent training as an intervention

Answer 19

New Forest Parent Training Programme
- Designed to address core symptoms and target key parenting skills
- Has 4 intervention components
- Psycho-education
- Parent child relationships
- Behaviour training and limit setting
- Attention training
Triple-P Positive Parenting Programme
- 17 core child management strategies including:
- 10 for competence and development and 7 for limit setting and managing disruptive behaviour

Question 20

Outline Teacher training as an intervention

Answer 20

They work with child and parents to set structure
Set the tone of what is expected behaviourally
When speaking to the child
- Address by name
- Make eye contact
- Saying what not why
- Clear step by step instruction
Positive reinforcement of good behaviour

Question 21

Outline behavioural as an intervention

Answer 21

Setting rules and giving clear commands
Setting reasonable expectations
Using when/then to encourage good behaviour - reward system
Change disciplinary techniques as child gets older
Similar to teacher training

Question 22

How are dopamine/norepinephrine levels related to treating ADHD

Answer 22

There is evidence that suggests that ADHD is due to an imbalance or lack of dopamine in the brain and also possibly a lack of norepinephrine
These are related to rewards and control (dopamine) and stress (norepinephrine)
Both are related to happiness

Question 23

How is methamphetamine related to treating ADHD?

Answer 23

Stimulant of the CNS
Two uses:
1. To treat ADHD by stimulating CNS and increasing dopamine levels, which allows the person to concentrate more and reduces hyperactivity
2. Recreational drug which dumps dopamine into the synapse (speed)

Question 24

What is the difference between Ritalin and amphetamine?

Answer 24

Ritalin:
- Slower release
- Sustained levels of stimulation
- Control over dopamine levels for a long period of time
Amphetamine:
- Dumps all dopamine
- Surge of feeling great for a short period of time
- Short half life

Question 25

How does ADHD affect adult life?

Answer 25

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.
Decline in symptoms? How?
- Symptoms may decline with age, this may be a function of age or it could be constant structure in life.