L18 - Attention-Deficit/Hyperactivity Disorder Flashcards
What has been the development of Attention-Deficit/Hyperactivity Disorder from past definitions?
1900-1950: - Minimal Brain Dysfunction (damage). 1960-1969: - Hyperkinetic/ Hyperactivity Syndrome (DSM-II). 1970-1979: - Recognition of Attentional Impairment and Impulsivity (DSM-III). 1980: - 'ADD' with or without hyperactivity. 1994: - ADHD (inattentive, hyperactive, combined subtypes) (DSM-IV).
What type of disorder is ADHD currently categorised as?
- ADHD is classified under ‘Externalising Disorders’ in DSM-5.
- Currently conceptualised as a ‘neurodevelopmental’ disorder.
What is the DSM-5 criteria for ADHD?
A) Several symptoms present prior to age 12.
B) …… across ≥ settings.
C) Interference with social, academic, or occupational functioning.
D) Not better explained by other condition.
What are some common comorbidities of ADHD?
- 2/3 of patients present with at least one comorbid condition.
- ~50% ODD, 20% CD.
- Anxiety.
- Depression.
- Tic disorder.
- Autism.
- Learning disabilities.
What is the developmental trajectory of ADHD?
- Most pronounced in pre-school, decline over time (“6yr old acts like 2yr old”).
- Inattention symptoms increasingly apparent with ageing.
- 2:1 M:F.
What are some environmental factors which have been said to potentiate the biological risk of ADHD?
Teratogens and toxins:
- exposure during critical periods in pregnancy
- e.g. pesticides, nicotine, lead, paracetamol.
Dietary factors:
- synthetic food colours.
- may account for about 8% of ADHD.
Is there a genetic influence on ADHD?
- ADHD shows strong concordance rates in twin studies.
- Less heritable than height.
- More heritable than schizophrenia, breast cancer, asthma.
What did Hawes et al. (2013) show regarding ADHD and parental involvement?
- 976 males between 4-10 years old.
- Found that high levels of parental involvement was associated with reduced hyperactivity/inattention.
- Early parental involvement may protect against ADHD.
- Inconsistent discipline increases chance of ADHD.
Who is said to drive the parent-child problems in ADHD?
- Children’s ADHD symptoms elicit negative responses from parents and drive the problems.
What did Dadds et al. (2016) identify as a potential biologic/genetic influence on ADHD?
- Epigenetic regulation of DRD4 gene.
- Methylation of dopamine receptor gene is higher in children with ADHD symptoms (gene is switched off more).
What did Harold et al. (2013) show after measuring the ADHD of children, biological mothers, and adopted mothers?
- Significant effect of inherited impulsivity.
- Inherited impulsivity predicts ADHD later in life via adopted maternal hostility.
- Vicious cycle where parent responds to early symptoms, leading to negative parent exacerbating symptoms.
What is the Dual Pathway Model of ADHD (Sonuga-Barke, 2005)?
- 2 distinct processes, involving overlapping neural architecture and shaped by environment.
Pathway 1: - Deficits in inhibitory-based executive processes: response inhibition, self control.
Pathway 2: - Motivational Dysfunction: can’t delay gratification.
What is the Delay Aversion Hypothesis?
- Parent attempts to get child to delay reward and inhibit responses.
- This becomes aversive when parent uses negative tactics.
- Negativity becomes associated with situations that signal need to delay gratification.
- Leads to the child attempting to avoid delaying gratification.
How is ADHD diagnosed?
- There is no single ADHD assessment tool.
- Involves the incorporation of data from multiple informants (parents, school).
- Rarely diagnosed under 7yrs.
How is ADHD treated?
- The Multimodal Treatment Study (1999) looked at 579 children aged 7-9 assigned to 14 months of treatment.
- Treatment was either, medication, behavioural therapy, combined treatment, or treatment as usual.
- Found that all treatments showed a reduction over time.
- Found that combined treatment was not significantly better than medication only.
