Day 7-8 - ADHD Flashcards
What are 3 common arguments for why ADHD isn’t “real”?
- product of western culture
- unrealistic expectations regarding children’s behaviour
- pharmaceutical industry (money making scheme)
What are 2 arguments that counter suggestions that ADHD isn’t real?
- ADHD prevalence is similar worldwide
- presence of ADHD is associated w marked impairments (problems w peers, school failure, mortality)
Use of stimulants to treat ADHD is __x higher in NA than in the rest of the world
5x
(T/F) there is a global inattention problem in ADHD
FALSE (sometimes only inattention for less enjoyable tasks)
Distinguish hyperactivity and impulsivity
Hyperactivity: inability to inhibit dominant or ongoing behaviour
Impulsivity: inability to control immediate reactions or thinking before acting
What are the 9 inattention symptoms of ADHD?
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities
- Often has difficulty sustaining attention in tasks or play activities
- Often does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
- Often has difficulty organizing tasks and activities
- Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
- Often loses things necessary for tasks or activities
- Is often easily distracted by extraneous stimuli
- Is often forgetful in daily activities
What are the 9 hyperactivity/impulsivity symptoms of ADHD?
- Often fidgets with or taps hands or feet or squirms in seat.
- Often leaves seat in situations when remaining seated is expected
- Often runs about or climbs in situations where it is inappropriate (In adolescents or adults, may be limited to feeling restless)
- Often unable to play or engage in leisure activities quietly.
- Is often “on the go,” acting as if “driven by a motor”
- Often talks excessively.
- Often blurts out answers before a question has been completed
- Often has difficulty waiting his or her turn
- Often interrupts or intrudes on others
What are the 3 subtypes of ADHD?
- Primarily Inattentive (ADHD-PI)
- Primarily Hyperactive (ADHD-HI)
- Combined (ADHD-C)
How many symptoms does one need to display to be diagnosed with ADHD?
- 6 in one category or 6 in both for ADHD-C
- 5 for ages 17+
For ADHD to be diagnosed, what are 4 additional criteria required beyond symptoms?
- symptoms continue for at least 6 months
- persistence, impairment, and non-normative
- several symptoms present before age 12
- several symptoms present in at least 2 settings
(T/F) ADHD diagnosis with the DSM-5 is only categorical
FALSE(ish) - specifiers for severity are kinda dimensional
WHy do we often not ask young children for self-reports when conducting an ADHD assessment?
- not reliable
- they will underreport symptoms
The K-SADS is a ______ method for assessing ADHD
semi-structured interview
The SNAP-IV is a _____ method for assessing ADHD
parent/teacher rating scale
When you look at parent or teacher reports of ADHD alone, which subtypes are most often diagnosed?
ADHD-PI and ADHD-HI
ADHD is mainly assessed using ___ and ___
interviews and rating scales
Newer research has suggested that about 50% of those with ADHD-PI who have never displayed HI symptoms might actually have _____
cognitive disengagement syndrome (sluggish cognitive tempo)
Cognitive disengagement syndrome symptoms are:
- (more/less) correlated w each other than with symptoms of other disorders like ADHD
- have (high/low) internal reliability
- have (good/poor) test-retest reliability
- are evident (cross-culturally/only in NA)
- MORE correlated w each other than with symptoms of other disorders like ADHD
- have HIGH internal reliability
- have GOOD test-retest reliability
- are evident cross-culturally
Research inspired by RDOC looking at how neurobiology and temperament are associated w ADHD has suggested a ____ subtype of ADHD
irritable subtype
- The point prevalence of ADHD in school-age children in NA -is between __ and __%
- The 6 month prevalence of ADHD in 4-11y/o in Ontario study was ____%
- The national comorbidity survey found that the lifetime prevalence for ADHD in adolescents was ___%
- 5-9%
- 10.5%
- 8.7%
What is the overall prevalence of ADHD-C, ADHD-HI, and ADHD-PI? How do these numbers change if we use the “or” vs the “and” rule?
- ADHD-C: 3.4% (“or”: 5.1%, “and”: 0.8%)
- ADHD-HI: 0.8% (“or”: 2.1%, “and”: 1.9%)
- ADHD-PI: 1.8% (“or”: 6.7%, “and”: 2.1%)
(T/F) ADHD is more prevalent among children living in poverty
TRUE, slightly more prevalent
In the community, rates of ADHD have a __ boys:__girls ratio
In clinics, rates of ADHD have a __ boys:__girls ratio
- community: 3:1
- clinics: 6:1
How does ADHD symptom presentation vary by gender?
- in community, boys more likely to be diagnosed for all subtypes, but wider gap for ADHD-C and ADHD-HI
- don’t see same diffs in clinically referred samples
How early can we detect ADHD?
- no reliable and valid measures for younger than 3
- if symptoms last about a year at preschool age, child is likely to continue having challenges
Describe Klein’s 2012 study on adult outcomes of ADHD
- 207 boys btw 1970-1978 who were referred to clinic for behaviour problems (rated as hyperactive by psychiatrist OR teacher+parent)
- when boys (probands) were 18, recruited comparison Ps
- followed up w both groups when they were 41
- 135 probands and 136 comparisons participated
- much higher # of probands not finishing high school (17 vs 1)
- more comparisons completed graduate degree (40 vs 5)
- median annual salary was 40k lower in proband group
- probands more often divorced, incarcerated, and deceased
Up to __% of children w ADHD have a co-occurring psychological disorder
80%
What is the most common co-morbidity for ADHD?
- ODD and CD
- 50%+ of kids/teens w ADHD meet criteria for ODD
- early-onset ADHD is strong predictor of later CD and ODD
What are 3 other common comorbidities for ADHD?
- Anxiety disorders (25-50%)
- Depression (20-30%)
- Tic Disorders (20%)
(T/F) ADHD is ass w decreased intellectual ability
FALSE (only decreased academic functioning)
(T/F) ADHD symptoms impact language abilities
TRUE (speech production errors)
(T/F) ADHD is linked to deficits in interpersonal functioning
TRUE (exacerbated by co-occurring ODD/CD)
Based on twin studies, heritability for ADHD is estimated to be about ___%. What does this mean?
- 75%
- twins are 75% concordant for ADHD
(T/F) ADHD is only caused by genetics
FALSE, mostly biology/genetics but maintained and exacerbated by environmental influences
Stimulants have been used to treat ADHD since the ___
1930s
How do stimulants work?
- increase activity in prefrontal cortex
- increase dopamine in blood which allows for greater behavioural inhibition
What are some issues with treating ADHD w medication?
- side effects
- 20% of children may not improve (non-responders)
- may not help w academic performance or relationships
- effects might not be maintained over time or if meds stopped
- tolerance can occur (reduced efficacy of same dosage over time)
What is parent management training to treat ADHD?
- involved contingency management
- results in improved behaviour!
- effects might not be as large as for meds
- also used for conduct problems
What is behavioural classroom management to treat ADHD?
- contingency management in the classroom
- involves structuring environments that are conducive to desirable behaviours
What are behavioral peer interventions to treat ADHD? Are they effective?
- social skills training traditionally done in clinic/office
- not effective for kids w ADHD
- BUT does work in recreational settings!!
Organizational skills training for ADHD targets ___ rather than ____
targets impairment rather then symptoms themselves
What were the 3 key objectives of the multimodal treatment of ADHD study (MTA)?
- compare long-term medication and behavioral treatments
- determine if there are additional benefits id meds and behavioral treatments are combined
- compare systematic administration of treatment to treatment as delivered in community settings
What were the participant characteristics for the MTA study?
- 579 kids ages 7-9
- 80% male
- ADHD-C diagnosis (parent and teacher report)
In the MTA study, participants were randomly assigned to one of __ groups and treated for ____ months and assessed for ___ years
4 groups; 14 months; 2 years
What were the 4 groups of the MTA study?
- Medication management (stimulants)
- Psychosocial treatment (parent training, educational interventions, summer treatment program)
- Combination treatment
- Community treatment as usual
In the MTA study, which group(s) had a more significant decrease in core symptoms?
medication and combination
In the MTA study, which group(s) had a more significant decrease in parent-child conflict?
psychosocial and combined
In the MTA study, which group(s) did better at 2y follow-up?
combined and medication (did not differ)
What did an additional, 8y follow up of MTA participants show?
- no differences btw any of treatment groups of any outcomes assessed
- showed gains relative to baseline but functioning still worse than community control without ADHD
In the MTA study, what moderators were identified for the relationship between tx group (meds/combined) and responsiveness to treatment? Who were the best responders, and who were the worst?
- Parental depression, symptom severity, IQ
- best responders: low parental depression, low symptom severity (73% ER)
- worst responders: high parental depression, high symptom severity, lower IQ (10% ER – lower than social/community treatment group who had 30%)
What is the current best practice in terms of ADHD treatment?
- combined meds and psychosocial!
