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PSYC 412 > Day 7-8 - ADHD > Flashcards

Day 7-8 - ADHD Flashcards

1
Q

What are 3 common arguments for why ADHD isn’t “real”?

A
  • product of western culture
  • unrealistic expectations regarding children’s behaviour
  • pharmaceutical industry (money making scheme)
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2
Q

What are 2 arguments that counter suggestions that ADHD isn’t real?

A
  • ADHD prevalence is similar worldwide
  • presence of ADHD is associated w marked impairments (problems w peers, school failure, mortality)
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3
Q

Use of stimulants to treat ADHD is __x higher in NA than in the rest of the world

A

5x

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4
Q

(T/F) there is a global inattention problem in ADHD

A

FALSE (sometimes only inattention for less enjoyable tasks)

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5
Q

Distinguish hyperactivity and impulsivity

A

Hyperactivity: inability to inhibit dominant or ongoing behaviour
Impulsivity: inability to control immediate reactions or thinking before acting

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6
Q

What are the 9 inattention symptoms of ADHD?

A
  • 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
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7
Q

What are the 9 hyperactivity/impulsivity symptoms of ADHD?

A
  • 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
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8
Q

What are the 3 subtypes of ADHD?

A
  • Primarily Inattentive (ADHD-PI)
  • Primarily Hyperactive (ADHD-HI)
  • Combined (ADHD-C)
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9
Q

How many symptoms does one need to display to be diagnosed with ADHD?

A
  • 6 in one category or 6 in both for ADHD-C
  • 5 for ages 17+
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10
Q

For ADHD to be diagnosed, what are 4 additional criteria required beyond symptoms?

A
  • 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
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11
Q

(T/F) ADHD diagnosis with the DSM-5 is only categorical

A

FALSE(ish) - specifiers for severity are kinda dimensional

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12
Q

WHy do we often not ask young children for self-reports when conducting an ADHD assessment?

A
  • not reliable
  • they will underreport symptoms
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13
Q

The K-SADS is a ______ method for assessing ADHD

A

semi-structured interview

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14
Q

The SNAP-IV is a _____ method for assessing ADHD

A

parent/teacher rating scale

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15
Q

When you look at parent or teacher reports of ADHD alone, which subtypes are most often diagnosed?

A

ADHD-PI and ADHD-HI

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16
Q

ADHD is mainly assessed using ___ and ___

A

interviews and rating scales

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17
Q

Newer research has suggested that about 50% of those with ADHD-PI who have never displayed HI symptoms might actually have _____

A

cognitive disengagement syndrome (sluggish cognitive tempo)

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18
Q

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)

A
  • 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
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19
Q

Research inspired by RDOC looking at how neurobiology and temperament are associated w ADHD has suggested a ____ subtype of ADHD

A

irritable subtype

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20
Q
  • 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 ___%
A
  • 5-9%
  • 10.5%
  • 8.7%
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21
Q

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?

A
  • 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%)
22
Q

(T/F) ADHD is more prevalent among children living in poverty

A

TRUE, slightly more prevalent

23
Q

In the community, rates of ADHD have a __ boys:__girls ratio
In clinics, rates of ADHD have a __ boys:__girls ratio

A
  • community: 3:1
  • clinics: 6:1
24
Q

How does ADHD symptom presentation vary by gender?

A
  • 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
25
Q

How early can we detect ADHD?

A
  • 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
26
Q

Describe Klein’s 2012 study on adult outcomes of ADHD

A
  • 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
27
Q

Up to __% of children w ADHD have a co-occurring psychological disorder

A

80%

28
Q

What is the most common co-morbidity for ADHD?

A
  • ODD and CD
  • 50%+ of kids/teens w ADHD meet criteria for ODD
  • early-onset ADHD is strong predictor of later CD and ODD
29
Q

What are 3 other common comorbidities for ADHD?

A
  • Anxiety disorders (25-50%)
  • Depression (20-30%)
  • Tic Disorders (20%)
30
Q

(T/F) ADHD is ass w decreased intellectual ability

A

FALSE (only decreased academic functioning)

31
Q

(T/F) ADHD symptoms impact language abilities

A

TRUE (speech production errors)

32
Q

(T/F) ADHD is linked to deficits in interpersonal functioning

A

TRUE (exacerbated by co-occurring ODD/CD)

33
Q

Based on twin studies, heritability for ADHD is estimated to be about ___%. What does this mean?

A
  • 75%
  • twins are 75% concordant for ADHD
34
Q

(T/F) ADHD is only caused by genetics

A

FALSE, mostly biology/genetics but maintained and exacerbated by environmental influences

35
Q

Stimulants have been used to treat ADHD since the ___

A

1930s

36
Q

How do stimulants work?

A
  • increase activity in prefrontal cortex
  • increase dopamine in blood which allows for greater behavioural inhibition
37
Q

What are some issues with treating ADHD w medication?

A
  • 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)
38
Q

What is parent management training to treat ADHD?

A
  • involved contingency management
  • results in improved behaviour!
  • effects might not be as large as for meds
  • also used for conduct problems
39
Q

What is behavioural classroom management to treat ADHD?

A
  • contingency management in the classroom
  • involves structuring environments that are conducive to desirable behaviours
40
Q

What are behavioral peer interventions to treat ADHD? Are they effective?

A
  • social skills training traditionally done in clinic/office
  • not effective for kids w ADHD
  • BUT does work in recreational settings!!
41
Q

Organizational skills training for ADHD targets ___ rather than ____

A

targets impairment rather then symptoms themselves

42
Q

What were the 3 key objectives of the multimodal treatment of ADHD study (MTA)?

A
  • 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
43
Q

What were the participant characteristics for the MTA study?

A
  • 579 kids ages 7-9
  • 80% male
  • ADHD-C diagnosis (parent and teacher report)
44
Q

In the MTA study, participants were randomly assigned to one of __ groups and treated for ____ months and assessed for ___ years

A

4 groups; 14 months; 2 years

45
Q

What were the 4 groups of the MTA study?

A
  • Medication management (stimulants)
  • Psychosocial treatment (parent training, educational interventions, summer treatment program)
  • Combination treatment
  • Community treatment as usual
46
Q

In the MTA study, which group(s) had a more significant decrease in core symptoms?

A

medication and combination

47
Q

In the MTA study, which group(s) had a more significant decrease in parent-child conflict?

A

psychosocial and combined

48
Q

In the MTA study, which group(s) did better at 2y follow-up?

A

combined and medication (did not differ)

49
Q

What did an additional, 8y follow up of MTA participants show?

A
  • 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
50
Q

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?

A
  • 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%)
51
Q

What is the current best practice in terms of ADHD treatment?

A
  • combined meds and psychosocial!
52
Q
A

PSYC 412 (9 decks)

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