Lecture 10 ADHD Flashcards
ADHD
- persistent pattern of inattention and / or hyperactivity-impulsivity
- Inattention
- can’t give attention to details, careless mistakes in schoolwork
- difficult to sustain attention in tasks
- doesn’t seem to listen when speaking to them
- won’t follow instructions
- has difficulty organising task, activity
- avoid, disliked, reluctant to do tasks that ask for sustained mental effort
- loses things necessary for task
- easily distracted
- forgetful in daily activities
attention in adhd kids
- actually don’t have fundamental problem of paying attention= can pay attention
- its about ability to sustain attention to attain future goal
future goals in adhd kids
goals motivate us to concentrate, so we can persist in task and avoid distractions (like study hard to become doc)–> but ADHD kids can’t do this
how do adhd kids perceive distractions
- don’t perceive distractions differently– rather, they
- respond to distractions MORE than other kids=
distracted more easily - react to events that are irrelevant to goal
- get off task much faster than others
- respond to distractions MORE than other kids=
inattention can…
impair woking memory
- Hyperactivity and impulsivity
- often fidgets
- often leave seat when you’re supposed to sit . and be quiet
- often runs to places where you’re not supposed to
- can’t play quietly
- on the go
- talks a lot
- blurts out answer before question completed
- hard to wait for turn
- interrupts others (ex. butts into convo)
ADHD= not mood disorder or emotional disorder
poor emotional control
- don’t know how to down-regulate emotions, express emotions that are socially acceptable
what type of disorder is adhd?
- neurodevelopmental disorders (autism, adhd, learning disorders)
- autism and adhd cause each other= thats why its grouped together
diagnostic criteria DMS-5
A. several symptoms present before 12 years old
B. several symptoms present in 2 or more settings (home, school, work, friends, relatives)
C. clear evidence that symptoms interfere with social, academic, occupational setting
D. not better explained by another condition
comorbidities
anxiety disorder (8-30%) conduct (8-25%) ODD (45-64%) affective (15-75%) tic (8-34%) mania / hypomania (0-22%) learning / academic problems (10-92%)
Developmental path of ADHD
hyperactivity symptoms–> inattention symptoms
hyperactivity symptoms
- can see as soon as kid can get up and walk (preschool)
- decline over time
- can’t diagnose w/ medication until 6 or 8 (school years)–> so help parent cope
inattention symptoms
- obvious with age
- maturation of prefrontal cortex–> as school demands intensify
whats the dual pathway model of adhd
2 diff processes: both shaped by env. processes
- deficits in inhibitory-based executive processes
- motivational dysfunction involving disruptive signaling of delayed reward
deficits in inhibitory-based executive processes
response inhibition: ability to stop inappropriate ongoing response in favour of a more appropriate alternative
- self control, emotional regulation
- underpinned by frontal striatal circuits
- dopamine= key neuromodulator of this circuit
motivational dysfunction involving disruptive signaling of delayed reward
neurobiological impairment in power with which contingency between present action and future rewards is signaled= so, can’t control current behaviour for future rewards
delay aversion hypothesis
if mums like don’t do this, don’t do that…
becomes aversive= more and more aversive= feel need to delay gratification
how can delay aversion be intensified
environment
- more you avoid delay= little opportunity to develop skills to manage delay effectively
valid diagnosis of adhd
- 1 test not enough to identify adhd
- “objective tests”= continuous performance tests
- diagnosis= must be multi-factorial
- clinical interview
- collateral interviews
- age effects
- symptoms in 1 or more than 1 setting
- rating scales
treatment
- psychosocial interventions (parent training, classroom programs)= improve functioning
- stimulant medication= acts on core features of ADHD–don’t cure adhd (side effects– might have to stop)
clinical interview
- look at psychiatric systems– ex. attention, mood, anxiety, trauma, tics, substance
- medical and developmental history
- fam and social history
- genetic vulnerability–> history of adhd
- if no genetic= look at env
- collateral interviews
- child
- primary caregivers (parents)
- teachers
- sunday school teachers
age effects
“some” symptoms by age 7yrs
symptoms in 1 or more than 1 setting
- never diagnose adhd in 1:1 interview
- depending on setting, could be diff– might focus well in some setting
rating scales
- for parents and teachers
- child beh. checklist
- beh assessment system for children
Gene x env interaction:
association between inconsistent parenting + ADHD symptoms stronger for those with…
long allele of DRD4 gene= dopamine
multi-modal treatment study for adhd (MTA)
- 7-9 yrs
assigned to 14 months of: - medical management (titrated stimulants)– get the medication reviewed, make sure it hits the sweet spot, male it just right for the child
- intensive beh therapy
- combined trt
- most effective= titrated– good to treat core symptoms
- combined treatments= superior for comorbid symptoms, normalised child behavour, improve functional outcomes like fam interactions, peer relationships, academic functioning
