Lecture 10 ADHD

Question 1

ADHD

Answer 1

• persistent pattern of inattention and / or hyperactivity-impulsivity

Question 2

1. Inattention

Answer 2

• 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

Question 3

attention in adhd kids

Answer 3

• actually don’t have fundamental problem of paying attention= can pay attention
• its about ability to sustain attention to attain future goal

Question 4

future goals in adhd kids

Answer 4

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

Question 5

how do adhd kids perceive distractions

Answer 5

• 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

Question 6

inattention can…

Answer 6

impair woking memory

Question 7

2. Hyperactivity and impulsivity

Answer 7

• 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)

Question 8

ADHD= not mood disorder or emotional disorder

Answer 8

poor emotional control

- don’t know how to down-regulate emotions, express emotions that are socially acceptable

Question 9

what type of disorder is adhd?

Answer 9

• neurodevelopmental disorders (autism, adhd, learning disorders)
• autism and adhd cause each other= thats why its grouped together

Question 10

diagnostic criteria DMS-5

Answer 10

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

Question 11

comorbidities

Answer 11

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%)

Question 12

Developmental path of ADHD

Answer 12

hyperactivity symptoms–> inattention symptoms

Question 13

hyperactivity symptoms

Answer 13

• 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

Question 14

inattention symptoms

Answer 14

• obvious with age

- maturation of prefrontal cortex–> as school demands intensify

Question 15

whats the dual pathway model of adhd

Answer 15

2 diff processes: both shaped by env. processes

1. deficits in inhibitory-based executive processes
2. motivational dysfunction involving disruptive signaling of delayed reward

Question 16

deficits in inhibitory-based executive processes

Answer 16

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

Question 17

motivational dysfunction involving disruptive signaling of delayed reward

Answer 17

neurobiological impairment in power with which contingency between present action and future rewards is signaled= so, can’t control current behaviour for future rewards

Question 18

delay aversion hypothesis

Answer 18

if mums like don’t do this, don’t do that…

becomes aversive= more and more aversive= feel need to delay gratification

Question 19

how can delay aversion be intensified

Answer 19

environment

- more you avoid delay= little opportunity to develop skills to manage delay effectively

Question 20

valid diagnosis of adhd

Answer 20

• 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

Question 21

treatment

Answer 21

• 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)

Question 22

clinical interview

Answer 22

• 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

Question 23

• collateral interviews

Answer 23

• child
• primary caregivers (parents)
• teachers
• sunday school teachers

Question 24

age effects

Answer 24

“some” symptoms by age 7yrs

Question 25

symptoms in 1 or more than 1 setting

Answer 25

• never diagnose adhd in 1:1 interview

- depending on setting, could be diff– might focus well in some setting

Question 26

rating scales

Answer 26

• for parents and teachers
• child beh. checklist
• beh assessment system for children

Question 27

Gene x env interaction:

association between inconsistent parenting + ADHD symptoms stronger for those with…

Answer 27

long allele of DRD4 gene= dopamine

Question 28

multi-modal treatment study for adhd (MTA)

Answer 28

• 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