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Abnormal Psychology 3018 > ADHD > Flashcards

ADHD Flashcards

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1
Q

Which state has the highest rate of prescription medication for people with ADHD?

A

NSW

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2
Q

Although there has been an increase in prescription medication for people living with ADHD, is it enough?

A

No, many people are not getting help.

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3
Q

There was a statement concerning ADHD made in 2002, what was it titled, who said it, and what was said?

A

It was the International Consensus Statement on ADHD, made by leading scientists and Psychiatrists. It said, as a matter of science, the idea that ADHD doesn’t exist is simply wrong.

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4
Q

What is the history of ADHD? (timeline)

A

1900 - 1950: Minimal Brain Dysfunction (damage).
1950 - 1969: Hyperkinetic/Hyperactivity Syndrome (DSM-2)
1970 - 1979: First recognition of Attentional Impairment & Impulsivity
1980: ADD w or w/o Hyperactivity (DSM-3)
1994: ADHD (inattentive, hyperactive subtypes - DSM-4)

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5
Q

In the DSM-4, ADHD was created with inattentive and hyperactive specifiers/subtypes. What does this mean and what subtype is harder to identify?

A

The subtypes means that someone might present with only ONE specifier.
Presenting with only inattentiveness is harder to identify, as there are no behaviour problems but the person cannot complete tasks.

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6
Q

What is a DALY?

A

Disability-Adjusted Life Year, is a measure of overall disease burden expressed as the number of years lost due to ill-health, disability or early death.

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7
Q

How does the percentage of DALYs ADHD has compare with other mental disorders? What does this mean?

A

It is very low compared to other disorders.

It is a common disorder but does not cause a high amount of impairment over a lifetime.

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8
Q

Give the 2 reasons why ADHD has its DALY score:

A

ADHD has a low DALY score because:

  1. Medication works really well.
  2. People tend to grow out of/adapt their ADHD for adult life.
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9
Q

What are the two main symptom groupings within ADHD?

A

Hyperactivity/impulsivity and inattention.

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10
Q

In the DSM-5, what are some symptoms of Inattention? (a-i)

A

A. Fails to give close attention to detail or makes careless mistakes.
B. Has difficulty sustaining attention in tasks/play
C. Does not seem to listen when spoken to directly.
D. Does not follow through on instructions.
E. Has difficulty organising.
F. Avoids, dislikes, or is reluctant to engage in tasks that require mental effort.
G. Loses things.
H. Easily distracted.
I. Forgetful.

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11
Q

In ADHD, why is ‘inattention’ a misnomer?

A

Because ‘attention’ is related to neurological processes, and that is not the problem in ADHD.

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12
Q

If ‘inattention’ is a misnomer in the ADHD classification, what does it actually mean?

A

‘Inattention’ relates to the inability to SUSTAIN attention/action toward a goal/task.
It is the inability to persist toward a goal and avoid distractions.

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13
Q

The ‘inattention’ bracket of ADHD symptoms is not just about attention… what else is it about?

A

The inability to be motivated when there are no rewards.

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14
Q

Children with ADHD struggle to persist at tasks, why is this?

A

They are unable to resist distractions.

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15
Q

‘Inattention’ largely reflects what impairment in cognition?

A

The working memory.

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16
Q

What are some ways that the inability to ignore distractions might inhibit functioning? (5)

A
  • respond to distractions more than others.
  • react to events that are irrelevant to goal.
  • get off task much faster than others.
  • have difficulty re-engaging with tasks
  • skip from one incomplete task to another.
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17
Q

In the DSM-5, what are the symptoms of Hyperactivity/Impulsivity? (a-i)

A

a. Often fidgets, taps hands/feet, or squirms in seat.
b. Often leaves seat at times when remaining in expected.
c. Often runs/climbs in inappropriate situations.
d. Often unable to play/engage in activities quietly.
e. Often ‘on the go’, acting as if ‘driven by a motor’.
f. Often talks excessively.
g. Often blurts out an answer before questions are complete.
h. Often has difficulty waiting for turn.
i. Often interrupts or intrudes others.

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18
Q

Some people who do not believe in ADHD say that all kids have ‘inattentive’ and ‘hyperactive’ symptoms. Why is this wrong?

A

Because children with ADHD have symptoms that are so excessive, and persistent that they may fail school, have no friends, the family is distressed, etc.

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19
Q

In the Hyperactivity/Impulsivity group of symptoms, what symptom is missing?

A

Emotional impulsivity.

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20
Q

ADHD is not a mood disorder or an emotional disorder BUT, nonetheless -

A
  • it is associated with poor emotional control.
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21
Q

Children with ADHD may experience rapid and unmoderated emotional expression, what in particular

A
  • impatience.
  • low frustration tolerance.
  • quickness to anger.
  • prone to emotional excitability/arousal.
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22
Q

What type of disorder is ADHD? And what did it used to be?

A

ADHD is now classified as a Neurodevelopmental Disorder and an Externalising Disorder. It used to be considered a Disruptive Behaviour Disorder.

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23
Q

Externalising Disorders:
Neurodevelopmental Disorders:
Disruptive Behaviour Disordes:

A

ED: ADHD, ODD (oppositional defiant disorder), CD (conduct disorder).
ND: ADHD, ASD (autism), learning disorders.
DBD: ODD, CD.

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24
Q

Why is ADHD now classified as a different disorder than ODD and CD?

A

Because it is a neurodevelopmental disorder, not a functional behaviour problem.

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25
Q

ADHD is now considered similar to what disorder? Why?

A

Autism. Most kids with Autism have ADHD and many kids with ADHD have features of Autism.

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26
Q

ADHD is still* considered to be a(n) _____ disorder. What are its comorbid rates with the two other disorders in this group?

A

Externalising Disorder.

  • Oppositional Defiant Disorder: 50% comorbid with ADHD.
  • Conduct Disorder: 20% comorbid with ADHD.
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27
Q

What is the ratio of male to female diagnosis in ADHD?

A

2:1

28
Q

There is a phenotypic overlap with ODD/CD and ADHD, which symptoms/features in particular?

A

Hyperactive/impulsive features.

29
Q

Although there are similarities between ADHD and ODD, what are some differences?

A

ADHD:
- often unable to play or engage in leisure activities quietly.
- often interrupts/intrudes on others.
ODD:
- often deliberately annoys others.
- often blames others for own mistakes.
- often argues with authority figures/adults.

30
Q

ADHD clusters with the features of what disorder?

A

Autism.

31
Q

What is the DSM-5 Diagnostic Criteria for ADHD? (A - D)

A

A. Several symptoms present prior to age 12 years.
B. Several symptoms present in two or more settings.
C. Clear evidence that the symptoms interfere with social, academic, or occupational functioning.
D. Not better explained by another condition.

32
Q

In DSM-5 the Diagnostic Criteria B. is very important, why?

A

(B. Several symptoms present in two or more settings.)
Because the child must be assessed in many different setting (2+) to understand that it is the child, NOT the setting/specific people that trigger the issues.

33
Q

How many people with ADHD also have another mental disorder?

A

2/3.

34
Q

In ADHD, what in the comorbidity percentage for Anxiety Disorders and Affective Disorders?

A

Anxiety: 8-30%.
Depressive: 15-75%.

35
Q

To be diagnosed with ADHD, symptoms must present before what age?

A

12 but if a child has ADHD, they have always had it, since the time they could walk.

36
Q

In the development of a child with ADHD, which symptoms present first? And what is the course of the symptoms in school?

A

Hyperactivity presents first, it tends to decline over time. Inattention appears a while later and becomes increasingly apparent with age.

37
Q

When a young child presents with symptoms of ADHD, what treatment must be done?

A

Medication cannot be used until the child is 7 or 8, so at first it is just behavioural treatments and coping strategies for the parents.

38
Q

List some biological but non-inherited factors that may contribute to the cause of ADHD.

A

Exposure during pregnancy to:

  • pesticides (household/outdoor).
  • prenatal nicotine.
  • lead.
  • paracetamol?
  • alcohol.
39
Q

Do dietary factors cause ADHD?

A

No, there is little evidence. Research shows that only 8% of children with ADHD have symptoms increased by food.

40
Q

What biological (but non-inheritable) factor is considered a massive cause of ADHD?

A

Lead. Ingesting it causes learning problems, a lot of kids diagnosed with ADHD were in fact lead poisioned.
(Also, as lead came down in population studies, violent crime was reduced).

41
Q

What is the twin concordance/genetic loading of ADHD?

A

0.8

42
Q

What is the genetic loading of ADHD comparable to?

A

Height.
ADHD: 0.8
Height: 0.85-0.9

43
Q

What is the Missing Heritability Problem?

A

We know genetics greatly influence certain disorders, yet when we look at the genome, we can’t find anything (there are no specific genes that mark any disorder).

44
Q

What parenting styles are associated with a reduction in ADHD?

A

Warm, caring parental styles with healthy routines in place.

45
Q

What is the correlation with ADHD and high parental involvement, compared to inconsistent discipline?

A

High parental involvement - reduced hyperactivity/inattention.
Inconsistent discipline - increased hyperactivity/inattention.

46
Q

Although parenting styles correlate with rates of ADHD, what is important to understand?

A

That they are just correlations, there is no indication of causation (what causes what).

47
Q

Parenting styles correlate with levels of ADHD, some data even suggest that…?

A

ADHD symptoms may ELICIT bad parenting styles/negative responses from family members.

48
Q

Research shows that when children with ADHD are treated with stimulants, there are improvements not only in symptoms of ADHD but also…?

A

There are also improvements in quality of parenting.

49
Q

Explain the Gene-Environment Interplay Study, what did it find?

A

Adoption study.

  • Looked at biological Mum (gene-loading).
  • Looked at rearing Mum (parental style).
  • Measured child’s ADHD symptoms.

Found that, biological Mum’s gene-loading predicted child’s ADHD symptoms.
Found that, more impulsivity in child predicted rearing Mum’s hostility.

Thus, the child’s genes produced the environment/parenting style.
And the parenting style exacerbates their symptoms.
A causal loop.

50
Q

The Gene-Environment Interplay Study showed a child’s genes predicts what two things?

A
  • parenting.

- ADHD symptoms (by age 6).

51
Q

The Missing Heritability Problem is a nightmare for geneticists. Only less than 1% of genes have been found in the genetic loading for ADHD. What is the 1% found?

A

The Dopamine Receptor Gene (DRD4).

52
Q

What is the gene/environment interaction that has been found in ADHD?

A

The association between inconsistent parenting and ADHD symptoms are stronger for those with the long allele of DRD4 gene (dopamine).

53
Q

What are the two underlying biological impairments outline in the Dual Pathway Model of ADHD?

A
  1. Deficits in inhibitory-based executive function:
    - cannot inhibit on-going responses for better alternatives (self-control, cognitive flexibility, emotional regulation, etc).
  2. Motivational dysfunction involving disruptive signalling of delayed reward:
    - impairment in the contingency between present action and future reward (future reward has no control over current behaviour).
54
Q

The two underlying biological impairments outlined in the Dual Pathway Model of ADHD are connected in what way?

A

They have overlapping neural architecture (dopamine system) and are both shaped by the environment.

55
Q

In the Dual Pathway Model of ADHD, what is the Delay Aversion Hypothesis?

A

The two impairments (unable to inhibit response & motivational dysfunction) start to create failure in certain areas. The person is then reprimanded for failures, creating a negative association with tasks that involve delaying gratification. Over time, the person develops an aversion to tasks involving delayed gratification.

56
Q

In children, untreated ADHD can manifest into what disorder?

A

Conduct Disorder, because they are unable to regulate behaviour/emotions, they are then reprimanded for behaviour/emotions, exacerbating the symptoms.

57
Q

How might negative parenting amplify ‘delay aversion’ in the Dual Pathway Model of ADHD?

A

Negative parenting in response to hyperactive behaviour makes the delay experience even more aversive.

58
Q

How might inconsistent parenting amplify ‘delay aversion’ in the Dual Pathway Model of ADHD?

A

If a reward is promised but not delivered, ‘delay’ might begin to signal uncertainty/disappointment.

59
Q

When establishing a diagnosis of ADHD, what test can be used to identify the disorder?

A

No single test, diagnosis must be multi-factorial.

60
Q

A clinical interview is helpful in establishing a valid diagnosis of ADHD, what should it involve? (5)

A

Interview should include:

  • assessment of primary complaint
  • review of symptoms
  • medical/psychiatric/developmental history
  • educational history
  • family/social history
61
Q

What are Collateral Interviews?

A

Interviews of people from at least 2 or more settings, including:

  • the child.
  • primary caregivers.
  • teachers.
62
Q

When establishing a diagnosis of ADHD, it is important to find the symptoms occurring in multiple settings. Are there exceptions to this rule? Which settings are most important?

A

Individuals with ADHD can often function well in certain settings where they are interested and can maintain focus (e.g. video games, watching TV, etc.)
However, the symptoms must be present in group settings.

63
Q

What scale is the most validated scale (across the world) for diagnosing ADHD?

A

Connors.

64
Q

In the Multi-Modal Treatment study for ADHD (MTA), which treatment was deemed the most effective?

A

Medication.

65
Q

Which medication is the most effective for treatment of ADHD? How must they be handled?

A

Titrated stimulants. They must be measured and monitored closely until the perfect dosage is found.

66
Q

Is combined treatment better than medication alone for the treatment of ADHD?

A

No, but combined treatment is better for comorbid symptoms/disorders (family interactions, peer relationships, academic functioning).

Abnormal Psychology 3018 (29 decks)

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