Chapter 8- Attention-Deficit/Hyperactivity Disorder Flashcards
Definition of ADHD
Attention-deficit/hyperactivity disorder (ADHD) is exhibited as persistent age-inappropriate symptoms of inattention, hyperactivity, and impulsivity that are sufficient to cause impairment in major life activities
Characteristic behaviors ___ ___ from child to child
Vary considerably
Different ___ ___ may have ___ causes
behavior patterns
different
ADHD in the early 1900s
Children who lacked self-control and showed symptoms of overactivity/inattention in school were said to have poor ___ and ____
“inhibitory volition” and “defective moral control”
“Brain-injured child syndrome”
Following the worldwide influenza epidemic from 1917-1926
1940s-1950s labels -2
“minimal brain damage” and “minimal brain dysfunction”
Late 1950s label which led to
ADHD was called hyperkinesis
led to definition of hyperactive child syndrome
By the 1970s what sympotoms were seen as primary
Deficits in attention and impulse control, in addition to hyperactivity
what years was there an increased interest in ADHD
Why?
1980’s
Rise in stimulant use generated controversy
the key symptoms of ADHD fall under _____
what are they?
two well-documented categories
Inattention
Hyperactivity-impulsivity
using __ to define ADHD ____ the disorder
dimensions
oversimplifies
____ and ____ are closely connected developmentally
Attention and impulse control
what is inattention
Inability to sustain attention, particularly for repetitive, structured, and less enjoyable tasks
Deficits may be seen in one or more types of attention- 4
Attentional capacity
Selective attention
Distractibility
Sustained attention/vigilance (a core feature)
what is hyperactivity
Inability to voluntarily inhibit dominant or ongoing behavior
Hyperactive behaviors include
Fidgeting and difficulty staying seated
Moving, running, touching everything in sight, excessive talking, and pencil tapping
Excessively energetic, intense, inappropriate, and not goal-directed
what is Impulsivity
Inability to control immediate reactions or to think before acting
Cognitive impulsivity includes- 3
disorganization, hurried thinking, and need for supervision
Behavioral impulsivity includes- 1
difficulty inhibiting responses when situations require it
Emotional impulsivity includes- 5
impatience, low frustration tolerance, hot temper, quickness to anger, and irritability
what are the 3 ADHD Presentation Types
Predominantly inattentive presentation (ADHD-PI)
Predominantly hyperactive–impulsive presentation (ADHD-HI)
Combined presentation (ADHD-C)
Predominantly inattentive presentation (ADHD-PI) symptoms
Inattentive, drowsy, daydreamy, spacey, in a fog, and easily confused
May have learning disability, process information slowly, have trouble remembering things, and display low academic achievement
Often anxious, apprehensive, socially withdrawn, and may display mood disorders
Predominantly hyperactive–impulsive presentation (ADHD-HI)
Primarily symptoms of hyperactivity-impulsivity (rarest group)
Primarily includes preschoolers and may have limited validity for older children
May be a distinct subtype of ADHD-C
Combined presentation (ADHD-C)
Children who have symptoms of both inattention and hyperactivity-impulsivity
Most often referred for treatment
Additional DSM Criteria -6
age, length, who it appears in, interferes with
Appears prior to age 12
Persists more than 6 months
Occurs more often and with greater severity than in other children of the same age and sex
Occur across two or more settings
Interferes with social or academic performance
Not explained by another disorder
What DSM Criteria Don’t Tell Us
there are limitations of criteria
-Developmentally insensitive
-Categorical view of ADHD
DSM criteria shape our understanding of ADHD
-DSM criteria are also shaped by, and in some instances lag behind, new research findings
Children with ADHD often display other problems in addition to their primary difficulties -5
Cognitive deficits
Speech and language impairments
Developmental coordination and tic disorders
Medical and physical concerns
Social problems
Cognitive Deficits: Executive Functions -4
Cognitive processes
Language processes
Motor processes
Emotional processes
Cognitive Deficits: Intellectual and Academic
Most children with ADHD have at least ___ intelligence- the difficulty lies in ____
normal
applying intelligence to everyday life situations
Children with ADHD frequently have ___ productivity, grades, and scores on achievement tests
lower
Cognitive Deficits: Learning Disorders
Learning disorders are common for children with ADHD
Problem areas: reading, spelling, and math
Cognitive Deficits: Self-Perceptions
Distorted self-perceptions
Positive bias: exaggeration of one’s competence
Self-esteem in children with ADHD may vary with the subtype of ADHD
Distortions in perceptions of quality of life
what are the speech and language impairments that people with ADHD may experience -7
Formal speech and language disorders
Difficulty understanding others’ speech
Excessive and loud talking
Frequent shifts and interruptions in conversation
Inability to listen
Inappropriate conversations
Speech production errors
As many as ___-___% of children with ADHD display motor coordination difficulties
examples? -3
Clumsiness, poor performance in sports, or poor handwriting
Overlap exists between ADHD and ____
developmental coordination disorder (DCD)
Marked motor incoordination and delays in achieving motor milestones
Tic disorders occur in ___% of children with ADHD
Characterized by?
20
Sudden, repetitive, nonrhythmic motor movements or sounds such as eye blinking, facial grimacing, throat clearing, and grunting
Health-related problems
Higher rates of asthma and bedwetting
Sleep disturbances may be related to use of stimulant medications and/or co-occurring conduct or anxiety disorders
Accident-proneness and risk taking
Over ___% are described as being accident-prone
50
At higher risk for traffic accidents
At risk for early initiation of cigarette smoking, substance use disorders, and risky sexual behaviors
Reduced life expectancy
Higher medical costs
Social Problems
Family problems include: -7
Negativity, child noncompliance, excessive parental control, sibling conflict, maternal depression, paternal antisocial behavior, and marital conflict
Family difficulties may be due to _____
co-occurring conduct problems
Peer problems
ADHD children can be bothersome, stubborn, socially awkward, and socially insensitive
They are often disliked and uniformly rejected by peers, have few friends
They are unable to apply their social understanding in social situations
Up to ___% of children with ADHD have a co-occurring psychological disorder
80
2 common co-occurring psychological disorders
why?
Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)
Role of COMT gene (Catechol-O-methyltransferase) – alters levels of neurotransmitters, increased agitation, impulsivity - A common genetic contribution for ADHD, ODD, and CD
About ___% of children with ADHD experience excessive anxiety
25
Co-occurring anxiety worsens symptoms or severity of ADHD
Children with co-occurring ADHD and anxiety: -3
Display social and academic difficulties
Experience greater long-term impairment and mental health problems
ADHD at 4-6 years is a risk factor for future ___ and ____ behavior
depression and suicidal behavior
___-___% of children with ADHD experience depression
20-30
Controversy regarding relationship between ADHD and ____
pediatric bipolar disorder (BP)
Prevalence rates for ADHD ___ ____ with sampling methods
% of school aged children with ADHD in North America
and worldwide
Vary widely
6-7% of school-age children and adolescents in North America
5% worldwide have ADHD
ADHD is one of the most common ____
referral problems seen at clinics
ADHD occurs more frequently in ___
boys
Overall rates ___ in adolescence for both sexes - ratio remains the same
decrease
what is a reason that ADHD is diagnosed more in one sex than the other
DSM criteria (cutoffs and symptoms) may be more appropriate to boys than girls
Girls with ADHD who display impulsive-hyperactive behaviors are more likely to develop
eating disorder symptoms
Signs of ADHD may be present at ___ - no reliable or valid methods exist to identify it
birth
Hyperactivity-impulsivity symptoms become more visible and significant at ages ___
3-4
Children with symptoms for at least ___ year(s) are likely to continue to have difficulties later in middle childhood and adolescence
one
Symptoms are especially evident when ___
the child starts school
By age ___-___, defiance and hostility may take the form of serious problems
8-12
At least ___% of clinic-referred elementary school children continue to suffer from ADHD into ___
50
adolescence
Explanations for ADHD -3
Trait from evolutionary past as hunters
ADHD is a myth fabricated because society needs it
Some theories
Theories to explain ADHD -4
Cognitive functioning deficits
Reward/motivation deficits
Arousal level deficits
Self-regulation deficits
ADHD runs in ___
___% ____estimates for hyperactive-impulsive and inattentive behaviors
families
75% heritability
Factors that _____ before and after birth may be related to ADHD
compromise development of the nervous system
factors that are associated with ADHD
Mother’s use of cigarettes, alcohol, or other drugs during pregnancy
Neurobiological Factors
Research shows differences on:
Psychophysiological measures- Diminished arousal or arousability
Measures of brain activity during vigilance tests- underresponsive to stimuli
Decreased Blood flow to prefrontal regions and pathways connecting them to limbic system
Abnormalities primarily in the ___ are implicated in ADHD
This region includes the __ and ___
frontostriatal circuitry
prefrontal cortex and the basal ganglia
ADHD children have smaller total and right ____ (by 3-4%), smaller ____, and delayed brain ___
cerebral volumes
smaller cerebellum
delayed brain maturation
Some neurotransmitters may be involved in ADHD
Dopamine, norepinephrine, epinephrine, and serotonin may be involved
Some neurotransmitters may be involved in ADHD
Dopamine, norepinephrine, epinephrine, and serotonin may be involved
Low levels of ___ may be associated with ADHD symptoms
Lead
____may lead to ADHD symptoms or to a greater severity of symptoms
Family influences
how many children with ADHD recieve treatment
less than half
The primary treatment approach combines: -3
Stimulant medication
Parent management training
Educational intervention
___ have been used to treat ADHD since the 1930s
stimulants
what are the 2 most effective stimulants used to treat ADHD
What do they do?
dextroamphetamine and methylphenidate
May help normalize frontostriatal structural abnormalities and functional connections
Parent Management Training (PMT) provides parents with a variety of skills like -4
Managing the child’s oppositional and noncompliant behaviors
Coping with emotional demands of raising a child with ADHD
Containing the problem so it does not worsen
Keeping the problem from adversely affecting other family members
what is Educational Intervention
teacher and children set realistic goals and objectives
Response-cost procedures are used to reduce disruptive or off-task behaviors
