B7.075 Attention Deficit Hyperactivity Disorder

Question 1

define inattention

Answer 1

6+ of the following symptoms have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

• fails to pay attention to details, makes careless mistakes
• difficulty sustaining attention
• does not listen when spoken to directly
• does not follow through on instructions and fails to finish tasks (not due to opposition or failure to understand)
• difficulty organizing tasks and activities
• avoids, dislikes, and is reluctant to engage in tasks that require sustained mental effort
• loses things necessary for tasks
• easily distracted
• forgetful

Question 2

define hyperactivity

Answer 2

multiple of following symptoms have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

• fidgets or squirms
• leaves seat when remaining seated is expected
• runs and climbs in inappropriate situations
• difficulty engaging in leisure activities quietly
• often “on the go” or “driven by a motor”
• often talks excessively

Question 3

define impulsivity

Answer 3

multiple of the following symptoms have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

• blurts out answers
• difficulty awaiting turn
• interrupts or intrudes on others

Question 4

diagnostic criteria for ADHD

Answer 4

A. either (1) or (2)
(1) inattention (as defined earlier)
(2) hyperactivity-impulsivity (as defined earlier)
B. some symptoms present before age 12
C. impairment present in 2 or more settings (home and school)
D. clinically significant impairment in social, academic, or occupational functioning
E. do not occur in context of other disorder

Question 5

subtypes of ADHD

Answer 5

ADHD combines type
ADHD predominantly inattentive type (A1 is met but A2 is not for the past 6 months)
ADHD predominantly hyperactive-impulsive type (A2 is met but A1 is not for the past 6 months)

Question 6

co morbid diagnoses in children with ADHD

Answer 6

conduct disorder (development of antisocial personality disorder)
substance abuse (alcohol, marijuana, cocaine) with comorbid conduct disorder

Question 7

co morbid diagnoses in adults with ADHD

Answer 7

generalized anxiety
alcohol abuse/dependence/ other drug abuse
MDD
OCD
antisocial personality disorder

Question 8

relationship between ADHD and cognitive function

Answer 8

prominence of executive dysfunction

• response inhibition (frontal lobe)
• vigilance (frontal lobe/parietal cortex and brainstem/midbrain)
• working memory (prefrontal cortex)
• planning

Question 9

locations of the brain that deal with conscious, focal attention

Answer 9

dorsolateral prefrontal cortex

parietal cortex

Question 10

dorsolateral prefrontal cortex

Answer 10

FEF focus eyesight to relevant targets

Question 11

parietal cortex

Answer 11

lateral intraparietal area “hub” with the FEF and sensory areas based on current task

Question 12

gamma band activity

Answer 12

attention processes
40-60 Hz
deficient in schizo and attention disorders

Question 13

locations of the brain that deal with nonconscious, nonfocal attention

Answer 13

subcortical regions

• superior and inferior colliculi
• tegmentum
• red nucleus
• substantia nigra

Question 14

function of colliculi

Answer 14

process sensory info as well as initiating “orienting behaviors” such as turning head towards origin of detected stimulus

Question 15

tegmentum

Answer 15

comprised of many nuclei

related to movements (e.g. eye movements)

Question 16

red nucleus

Answer 16

limb movements

Question 17

substantia nigra

Answer 17

initiation of movements; connection to forebrain (communicates motor plans)

Question 18

neurotransmitters implicated in attention function

Answer 18

typically addresses by ADHD meds:
-norepinephrine
-dopamine
other:
acetylcholine

Question 19

NE in attention

Answer 19

distributed throughout brainstem and cerebral cortex

also contributes to emotion-depression and mania

Question 20

dopamine in attention

Answer 20

some localization in brainstem, limbic system, and frontal cortex
also associated with motor movement- Parkinson’s

Question 21

acetylcholine in attention

Answer 21

diffuse distribution throughout the brain stem, limbic system, and cerebral cortex
also associated with neuronal excitability, learning and memory- AD

Question 22

what are ERPs

Answer 22

event related potentials
assessed using EEG
provides index of neural communication and information
multiple signals:
N100
N200
P300

Question 23

N100

Answer 23

frontotemporal regions
related to unpredictability
modified by top down influences originating in prefrontal cortex

Question 24

N200

Answer 24

seen in anterior regions
“mismatch negativity”
associated with stimulus ID, attention shifts, motor inhibition

Question 25

P300

Answer 25

seen in frontal, central, and parietal regions

P3a- orienting, novelty, engagement of attention, decision making

Question 26

psychotherapy in ADHD

Answer 26

may involve assistance with structure, organization, and strategy formation

• chores, lists, reinforcement, behavior modification
• assist dysfunctional frontal lobe systems

Question 27

pharm therapy in ADHD

Answer 27

typically involve “stimulant meds”

• amphetamine (and derivatives)
• methylphenidate (and derivates)

Question 28

cognitive models of ADHD

Answer 28

associated with multiple cognitive deficits

response inhibition, vigilance, working memory, planning/exec functioning

Question 29

psychophysiological models of ADHD

Answer 29

associated with poor inhibition and control/organization of attention within the CNS
brain activity features poor inhibition and inefficiency when responses are needed

Question 30

neurological models of ADHD

Answer 30

cerebral organization is implicated

• lower brain volumes correlated with deficits
• reduced right superior gyrus
• disruption and inhibitory networks

Question 31

treatment effects in ADHD

Answer 31

treatments can change neurophysiology in ADHD

• use of a cognitive strategy improves P300
• stimulant treatment improves selective attention