ADHD Flashcards
What is ADHD?
- attention deficit hyperactivity disorder
- deficiency in a set of psychological abilities… the deficiencies pose serious harm to most individuals possessing the disorder’
Psychosocial Consequences of ADHD
- teenage pregnancy
- multiple car accidents
- depressions and personality disorder
Medication for ADHD
- over 200 well-controlled studies have shown the effectiveness of stimulants (increase activity in the brain) in alleviating the symptoms of ADHD; works effectively in 70-80% of cases
- the effects confirm the role of dopamine and noradrenaline in executive functioning tasks and reward processing
- methylphenidate (Ritalin): increases dopamine (DA) and norepinephrine (NE) in PFC and basal ganglia (stimulant med)
- atomoxatine (Strattera): increases DA and NE in PFC, anterior cingulate cortex (ACC) and thalamus, but NOT in basal ganglia
Subtypes of ADHD
- 2 dimensions: inattention and hyperactivity/impulsivity
- subtypes:
- combined (meets criteria for both dimensions for 6 months)
- predominantly inattentive
- inattentive
- predominantly hyperactive/impulsive
- Chabildas et al (2001) compared neuropsychological profiles of children with inattention, hyperactive or combined subtypes
- showed the classic pattern of performance in ADHD participants was evident in only IA and combined subtypes = inattention the main cause of the cognitive profile of ADHD
DSM-V Symptoms and Criteria of ADHD
examples of symptoms:
- often fidgets/squirms
- runs/climbs in inappropriate situations
- trouble waiting for their turn
- (more so than what would be expected at age and Ievel)
criteria b: some symptoms must be present before 12 years old
criteria c: symptoms present in 2 or more settings e.g. school and home
criteria d: interfere with everyday life
criteria e: not exclusively during psychotic episode
Prevalence (According to DSM-V)
- around 3-5% children affected
- more common in boys (9:1 in clinically referred samples)
- research conducted mainly on boys so less known about girls with ADHD
- many studies on prevalence exclude just inattentive type as harder to detect
ADHD in Adults
- used to be thought that ADHD resolves itself with age
- DSM-V is just as effective for diagnosing adults but only 5 symptoms need to be met (6 in children)
Comorbidities of ADHD (Taylor, 2006)
- 60% oppositional defiant disorder (ODD)
- 30% learning disorders e.g. dyslexia
- 25% anxiety disorders
- 25% mood disorders
- 20% conduct disorders
adult comorbidities (Biederman, 2005)
- common mood and anxiety disorders
- drug and alcohol abuse
How is ADHD assessed in Children?
- school observations
- semi-structured interviews with parents
- clinical observations
- parent and teacher ratings of child’s behaviour
Scales for Assessing ADHD
- the parental account of children’s symptoms (Taylor et al, 1986) - semi-structured interviews
- conner’s rating scale (Conners, 1996)
Issues?
- these types of assessment rely on externalisation of symptoms so likely to miss those with inattention style
Underlying Caused of ADHD
- problems with hyperactivity thought to reflect problems with behavioural inhibition and executive function
- not a modular disorder - these are higher levels of supervisory systems
3 Neuropsychological Theories of ADHD
- Problems with executive functioning (EF):
- ADHD is as a result of deficits in EF, poor inhibitory control being the core deficit (Barkley, 1997) - Problem with state regulation:
- poor state regulation results in problems in regulating effort, arousal and affect - underpins poor EF (Sergeant, 2005) - Problems with delay aversion:
- children with ADHD choose small immediate rewards over larger delayed rewards (Sonuga-Barke, 2005)
Barkley’s (1997) EF Theory of ADHD
- suggests core impairment of those with ADHD is a deficit in inhibitory control of behaviour which results in:
1. poor working memory
2. poor self-regulation of affect, motivation and arousal
3. difficulty internalising speech
4. reconstitution
Assessing the EF Theory of ADHD
Willcutt et al, 2005: - looked at 83 studies that did tests relating to various EF constructs: - vigilance - set shifting - planning - verbal working memory - spatial working memory key findings? ADHD groups showed significant impairments in all EF tasks
however… only 35-50% of ADHA participants exhibit a significant impairment on any specific EF task (Nigg, Willcutt Doyle and Sonuga-Barke, 2005)
Conclusions of Assessing the EF Theory of ADHD
- EF difficulties are one of several important weaknesses in the neuropsychology of ADHD
- Willcutt et al (2005) marks a shift to models that include multiple neuropsychological deficits rather than one core deficit
Problems with the EF Account of ADHD
- there is evidence for deficits in some EF tasks but not others
- when deficits are found the effect sizes are typically small or medium (Willcutt et al, 2005) and normally in small proportion of participants with ADHD
- EF deficits are also found in other developmental disorders e.g. autism and dyslexia
ADHD and Delay Aversion (Sonuga-Barke et al, 2003, 2005)
- delay aversion hypothesis: characterises children with ADHD as having a ‘delay aversive’ motivational style
- formed as a negative emotional response and expressed behaviourally in attempts to escape delay
- Sonuga-Barke et al (1992) - children with ADHD preferred 1-point reward with 2s delay over 2-point reward with 30s delay
- evidence to show relationship with ADHD and delay aversion found in clinical (Solanto et al, 2001) and non-clinical sample (Thorell, 2007)
- but not as studied as the relationship between ADHD and EF, and some studies found no link (Scheres et al, 2006)
Delay Aversion when Controlling for Conduct Disorder
- Kuntsi et al (2001) carried out same choice delay task but when co-morbid conduct disorder was controlled for the group difference disappeared
The Cognitive Energetic Model of ADHD
- Sergeant (2005) states that single deficit models of ADHD are not sufficent
- argues that efficiency of info processing is determined by:
- computational resources e.g. working memory
- state regulation e.g. effort
- management of resources (executive functioning)
- poor state regulation gives rise to slower and more variable reaction times (RT variability) in EF tasks
- RT variability is one of the most consistent findings for ADHD patients across range of tasks, countries and research groups (Sergeant, 2005)
- event rate manipulation shows that EF impairment is only apparent at slow or fast but not medium presentation rates = impairment related to state regulation
Issues with The Cognitive Energetic Model
- not well specified
- complicated model
- testing it depends on identifying satisfactory measures of arousal, activation and effort
IFC and Response Inhibition Summary
- wide spread regions of frontal cortex activity needed to inhibit a prepotent response - predominantly right hemisphere frontal activation
- children and adults with ADHD have response inhibition deficits
- longer duration of stopping process on ‘stop signal’ task, more errors on ‘no go’ task
- significant structural and functional differences in the right IFC are related to problems with response inhibition
Managing ADHD in Educational Settings: Medication
- improves abilities in:
- handling general tasks and demands
- academic productivity e.g. scores on quizzes, homework completion
side effects:
- sleep disturbances
- anxiety
- bladder probs etc…
Managing ADHD in Education Settings: Training Executive Functions
- becoming more of a focus in research
- reported that working memory can be improved in children with ADHD (Klingberg et al, 2005)
Managing ADHD in Education Settings: Behaviour Management
- ADHD is not the result of being lazy and naughty!!
- change context and create unique strategies:
- be structured and consistent
- set expectations
- breakdown instructions
- one question at a time
etc. ..
Managing ADHD in Education Settings: Social and Emotional Issues
- a lot of peer rejection (Hoza et al, 2005)
- immature behaviour - pressure to control impulsiveness and hyperactivity
- self-confidence issues - reinforces self-perception of being ‘defective’ or ‘a failure’
Managing ADHD in Education Settings: Stress
- ADHD people have ineffective coping strategies to deal with stress
Impact of Reciprocal Friendships Predict:
- poorer adjustments in adulthood
- lower self worth
- more depressive symptoms
- poorer family relationships
Educational Strategies for Social and Emotional Issues:
- ignore unintentional behaviour
- praise positive behaviour
- keeps parents involved
- private reminders on behaviour
