Externalising Disorders - ADHD

Question 1

ADHD, by looking at the DALY index, is one of the ______ impactful disorders for kids. This is attributed to them not having to go to _______ anymore.

Answer 1

least

school

Question 2

Characteristic of ADHD in the ATTENTION dimension is that the child:
6+ 6m (1-9)

Answer 2

• fails to give close attention, often making careless mistakes
• difficulty sustaining attention
• reluctant to engage in activities that require sustained attention
• easily distracted by extraneous stimuli
• fails to listen when spoken to directly
• does not follow through on instructions, failing to finish school work, chores, duties, etc
• often loses things
• forgetful
• Difficulty organising tasks, activities

Question 3

In what sense is attention affected in ADHD?

Answer 3

There is nothing wrong with the children’s ability to pay attention, but there is an issue with them not being able to ignore distractions. They cannot persist with the attention in the real world.

Question 4

Attention is often _____-orientated. Kids with ADHD often can’t project themselves into the ______, and strive for certain ______.

Answer 4

future, future, goals

Question 5

Children with ADHD respond to distractions _______ than other children. They react to events that are _______ to the goal, and get off task _____ than others. They then have difficulty ________ in tasks. And some studies have shown deficits in their _____ _____ capacity.

Answer 5

more, irrelevant, faster, re-engaging, working memory

Question 6

For hyperactivity 1, children with ADHD

1. ______ often,
2. have difficulty staying in their _____,
3. ______ or ______ when it is inappropriate to do so. 4. generally ________ sitting still for long periods
4. Is often ___ _____ ____ as if driven by a motor

Answer 6

fidget, 
seat, 
run or climb
uncomfortable
on the go

Question 7

For hyperactivity 2: children with ADHD are

6. unable to play ______,
7. often talk ________, 8. _________ out answers before questions are completed.
8. They find it _______ to wait their turn, and often ________ others.

Answer 7

quietly, excessively, blurting, wait, interrupts

Question 8

What kind of impulsivity is ADHD commonly associated with and elaborate on this?

Answer 8

commonly associated with emotional impulsivity. Exhibit rapid and unmoderated emotional expression - quick to anger, prone to emotional excitability, difficulties self-soothing, down-regulating and generally expressing emotion in ways that are socially acceptable. This is NOT part of DSM criteria.

Question 9

ADHD is an externalising disorder, highly co-morbid with what?

Answer 9

50% ODD
20% CD
Also with learning difficulties, tics, mania/hypomania, anxiety disorder
2/3 have co-morbidities - 66%

Question 10

Is ADHD more common in males or females?

Answer 10

males - potentially more implusive? More testosterone, etc?

Question 11

Whilst ADHD is an externalising disorder, it also clusters with _______, and _______ difficulties. So it’s somewhere between a functional ______ problem and neurological _________ problem. Hence, it is classified as a ____________ disorder in the DSM.

Answer 11

autism, learning, behaviour, learning, neurodevelopmental

Question 12

What other criteria is required for a diagnosis of ADHD (criteria B-D)?

Answer 12

B. Symptoms present before age 12 (aka childhood)
C. Symptoms present across multiple settings (if child is only exhibiting symptoms at home it could be a functional disorder - issue with parenting)
D. Clear evidence that it is interferring with social, academic or other functioning

Question 13

Describe the developmental trajectory of ADHD

Answer 13

Hyperactivity symptoms develop first, in all children, then decline. Attention capacity begins later and increases slowly, but then children with ADHD stay at that early stage, never maturing in this capacity.

Question 14

Can adults have ADHD?

Answer 14

Yes, but they are often in activities they enjoy, not confined to school. Hence, it is often unnoticed and not a problem.

Question 15

Name the causal factors of ADHD

Answer 15

Environmental factors - teratogens and toxins - lead, pesticides, nicotine potentially paracetamol in the womb. Dietary factors - only attributes for 8% (processed foods). Also, could exacerbate this, but not cause it…

Genetics - huge genetics component, according to quantitative genetics (h2=0.8)

Parental Involvement - low involvement is associated with ADHD.

BUT - it’s complicated - child’s ADHD can drive the parenting style?

Question 16

Describe the evidence for child-driven ADHD impacting parenting. Does this indicate a causal role? How do genes and the environment interact in ADHD?

Answer 16

• shown in studies that there’s a correlation - ADHD is predictive of parental hostility at time 2
• treating kids with medication has a positive effect on the parenting (as a good side effect)
• but genes and environment are very complicated
• longitudinal adoption at-birth design sheds light onto this. Found biological mother impulsivity predictive of child impulsivity (TICK). Then how impulsive the child is predicts how hostile the mother is down the path to that child (TICK - child characteristics driving the parental hostility). BUT the more hostile the mother was the more it exacerbates the ADHD symptoms at 6 years of age.

Question 17

Genes are a _________ for ADHD, unless the child is exposed to a _______ such as ______.

Answer 17

pre-requisite, toxin, lead

Question 18

Describe the Dual Pathways Model for ADHD

Answer 18

1. Deficits in inhibitory-based executive processes - cannot inhibit responses to extraneous stimuli - to noises, chocolate cake, etc. This is important for self-control, emotion regulation, etc
2. Motivational dysfunction - with delayed reward - DA system. Impairment of the power in the contingency between current behaviour and future reward. The pull of future rewards has limited power on current behaviour. Future rewards discounted.
   –> the delay aversion hypothesis - this delay is very
   aversive to them. So this manifests in attempts to
   avoid/escape the delay by attending to what is most
   interesting in their environment OR acting on that
   environment (hyperactivity) to make it interesting.
   –> Environments can exacerbate this “delay aversion”.
   E.g negative reactions from parents that make the
   delay even more aversive.

BUT the more the child avoids dealing with this aversive delay the worse it will be.

Question 19

Diagnosis must be ________. Must be collateral evidence from ______, to prove symptoms are in _______ ________.

Answer 19

Multi-factorial, school, multiple settings

Question 20

It is important that age effects are taken into account. Only ____% of parents report symptoms by age 7. ____% are reported by age 12, and _____% by age 16.

Answer 20

50, 95, 99

Question 21

Currently, the most robust treatment studies indicates that…

Answer 21

medication, behavioural, combined, etc. Medication shown to be the most effective on ADHD symptoms, with combined not adding much to effectiveness. However, combined did show effectiveness in other areas…school, child-parent relationship, social skills, etc. AND higher medication doses were needed when the child wasn’t given the combined treatment (aka medication alone).

However, only medication is effective for the core symptoms. Does not “cure” it. Only manages the symptoms.