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ADHD Flashcards

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1
Q

What is ADHD?

A
  • attention deficit hyperactivity disorder
  • deficiency in a set of psychological abilities… the deficiencies pose serious harm to most individuals possessing the disorder’
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2
Q

Psychosocial Consequences of ADHD

A
  • teenage pregnancy
  • multiple car accidents
  • depressions and personality disorder
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3
Q

Medication for ADHD

A
  • 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
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4
Q

Subtypes of ADHD

A
  • 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
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5
Q

DSM-V Symptoms and Criteria of ADHD

A

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

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6
Q

Prevalence (According to DSM-V)

A
  • 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
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7
Q

ADHD in Adults

A
  • 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)

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8
Q

Comorbidities of ADHD (Taylor, 2006)

A
  • 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
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9
Q

How is ADHD assessed in Children?

A
  • school observations
  • semi-structured interviews with parents
  • clinical observations
  • parent and teacher ratings of child’s behaviour
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10
Q

Scales for Assessing ADHD

A
  • 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

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11
Q

Underlying Caused of ADHD

A
  • problems with hyperactivity thought to reflect problems with behavioural inhibition and executive function
  • not a modular disorder - these are higher levels of supervisory systems
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12
Q

3 Neuropsychological Theories of ADHD

A
  1. Problems with executive functioning (EF):
    - ADHD is as a result of deficits in EF, poor inhibitory control being the core deficit (Barkley, 1997)
  2. Problem with state regulation:
    - poor state regulation results in problems in regulating effort, arousal and affect - underpins poor EF (Sergeant, 2005)
  3. Problems with delay aversion:
    - children with ADHD choose small immediate rewards over larger delayed rewards (Sonuga-Barke, 2005)
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13
Q

Barkley’s (1997) EF Theory of ADHD

A
  • 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
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14
Q

Assessing the EF Theory of ADHD

A 
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)

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15
Q

Conclusions of Assessing the EF Theory of ADHD

A
  • 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
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16
Q

Problems with the EF Account of ADHD

A
  • 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
17
Q

ADHD and Delay Aversion (Sonuga-Barke et al, 2003, 2005)

A
  • 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)
18
Q

Delay Aversion when Controlling for Conduct Disorder

A
  • Kuntsi et al (2001) carried out same choice delay task but when co-morbid conduct disorder was controlled for the group difference disappeared
19
Q

The Cognitive Energetic Model of ADHD

A
  • 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
20
Q

Issues with The Cognitive Energetic Model

A
  • not well specified
  • complicated model
  • testing it depends on identifying satisfactory measures of arousal, activation and effort
21
Q

IFC and Response Inhibition Summary

A
  • 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
22
Q

Managing ADHD in Educational Settings: Medication

A
  • 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…
23
Q

Managing ADHD in Education Settings: Training Executive Functions

A
  • becoming more of a focus in research

- reported that working memory can be improved in children with ADHD (Klingberg et al, 2005)

24
Q

Managing ADHD in Education Settings: Behaviour Management

A
  • 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. ..
25
Q

Managing ADHD in Education Settings: Social and Emotional Issues

A
  • 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’
26
Q

Managing ADHD in Education Settings: Stress

A
  • ADHD people have ineffective coping strategies to deal with stress
27
Q

Impact of Reciprocal Friendships Predict:

A
  • poorer adjustments in adulthood
  • lower self worth
  • more depressive symptoms
  • poorer family relationships
28
Q

Educational Strategies for Social and Emotional Issues:

A
  • ignore unintentional behaviour
  • praise positive behaviour
  • keeps parents involved
  • private reminders on behaviour

Educational Psychology (9 decks)

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