LECTURE 3: ADHD Flashcards
Disorders of Childhood Origin
• Disorders which are typically diagnosed in
the developmental period are called
neurodevelopmental disorders.
• Neurodevelopmental disorders include:
o Intellectual disabilities
o Communication disorders
o ASD
o ADHD
o Specific learning disorders
o Motor disorders
o Tic disorders
• Children can experience adult-associated
disorders like anxiety, depression, bipolar, or
schizophrenia but the onset typically doesn’t
occur during the developmental period.
Three Most Common Neurodevelopmental Disorders: (often comorbid)
Disorder
Core Features
Pharmacological Agent
ADHD • Deficits in attention, impulse control, and/or hyperactivity • Stimulants • Non-stimulants
Tourette’s Disorder
• Presence of both vocal and motor tics
• Antipsychotic
• Adrenergic alpha-2 medications
ASD
• Persistent deficits in social communication
and social interactions, and a pattern of
restricted and repetitive behaviors
• Antipsychotic medication
- Pharmacological interventions can treat
(modulate the expression) symptoms but
not cure these conditions.
Prevalence
General
One-fourth of children worldwide have experienced a mental disorder in the past year (25%) and one-third in their lifetime.
1. Anxiety disorders (most common)
2. Behavior
3. Mood
4. Substance use disorders (least
common)ASD Rate in 2020: USA
- 1 in 34 among boys (or 2.97 percent)
- 1 in 145 among girls (or 0.69 percent)
- Boys > Girls
SES
• 50% of children in the child welfare system
meets the criteria for a mental disorder
1. Neurodevelopmental behaviour
disorders (i.e., conduct and oppositional
defiant disorder and ADHD)
2. Neurodevelopmental Anxiety and Mood
disorders (i.e., depressive disorders)
• Low SES > High SES
Cross-cultural Studies
• Higher rates of internalizing disorders
(anxiety) among girls
• Higher rates of externalizing disorders
among boys (behavior disorders)
• Australia, China, Israel, Jamaica,
Netherlands, Turkey, and United States
*Gender difference found worldwide
*Girls > Boys in internalizing anxiety
prevalence
*Boys > Girls in external behaviour disorders
Attention Deficit Hyperactivity Disorder (ADHD)
Definition
• Persistent pattern of inattention and/or
hyperactivity and impulsivity
o Impairment in settings such as school and
work
o Onset of symptoms occurs in childhood
o According to the DSM-5 several
inattention and hyperactivity-impulsivity
symptoms need to occur prior to age 12.
(3) ADHD Subtypes
• Predominately inattentive (40% of cases;
more common in girls > boys)
• Predominately hyperactive-impulsive (very
small percentage; boys > girls)
• Combined presentation (50-55%; boys >
girls)
*Three common symptoms of ADHD are
Attentional Deficits and
Hyperactivity/Impulsivity.
Symptoms emerge in childhood and disrupt
schooling (student-teacher interactions,
disruptive behaviour, poor academic
performance) but by adulthood the
symptoms become more manageable.
ADHD behavioural symptoms are modifiable
but the disorder is not curable.
*Women more likely to be diagnosed in
adulthood than men (more likely to be
diagnosed with other internalizing disorders
first; anxiety or depression)
Prevalence
ADHD
• ADHD occurs worldwide!
• Affects ~5% of children and ~2.5% of adults
• The disorder is more frequently diagnosed
in males than females but the male to
female ratio ranges from 2:1 to 9:1
depending on subtype.
• ADHD is the most common
neurodevelopmental disorder and most
commonly studied.
Percent of children with a parent-reported ADHD diagnosis
• The prevalence of ADHD is increasing 5%
annually with 6.4 million children in the US
meeting the criteria for ADHD.
• ADHD is becoming more common,
prevalence rates is increasing, upwards
trend.
• Why? Many theories exist. Difference in
diagnosis criteria, becoming more aware of
the condition, how to spot it and more
people getting assessed by child
psychologists. Environmental factors? It
could be many things; the jury is still out on
a firm conclusion.
Comorbidity (disorders)
Comorbidity (outcomes)
ADHD
Comorbidity (disorders) *High comorbidity (ADHD doesn’t present alone; makes diagnosis and treatment more complicated) • Conduct disorder • Oppositional defiant disorder • Tourette’s disorder • Mood disorders • Learning disabilities
Comorbidity (outcomes)
• Children and adults with ADHD have a
greater risk of:
o Academic deficits
o School-related problems
o Social skill deficits
o Peer rejection
• Adolescents with ADHD have a greater risk
of:
o Antisocial behavior
o School dropout
o Small percentage of adolescents with
ADHD pursues higher education
• College students with ADHD do not differ
in intelligence
o However, more likely to have a lower
GPA
o Report greater difficulty paying
attention in lectures
o Greater risk of depression and/or
anxiety disorders
o Have lower quality of life
• Adults with ADHD report problems with:
o Employment
o Sexual Relationships
o Driving
o Illegal activities
o Depression or personality disorders
*ADHD symptoms linked to these poorer
outcomes (not due to intelligence! It’s the
consequence of in attention or hyperactivity
impair school engagement, and being
different from other kids impairs social
relationships)
*GPA lower due to engagement not
intelligence!
ADHD in prisoners
• ADHD is common among Norwegian
prison inmates
• ADHD is a risk factor for substance abuse
in adults and individuals with ADHD tend to
become addicted more rapidly and
severely
• ADHD is positively associated with
persistent cigarette smoking
• Greater internal restlessness and more
likely to have executive function deficits
(not unique to ADHD)
*Prisoners have ADHD (links to the illegal
activity points; problems with MH since
childhood led to poorer life outcomes like
prison)
*Pre-frontal cortex impairments, impulse
control disorders and risk of addiction (one
reason for ADHD but not the only factor).
Is ADHD Advantageous?
• There is a popular myth that ADHD is
beneficial.
• There is no evidence to support that
children with ADHD have superior divided
attention skills
• ADHD is a chronic disorder that causes
impairment in social, occupational, and
academic functioning
*Some people say ADHD is an advantage.
They argue that they can do so many tasks
because they can split their attention
between them. This is NOT true. For almost
everyone, there is evidence to support that
splitting attention between tasks impairs
performance. People with ADHD do not do
better at multitasking than HC’s
Genetics Family Studies (ADHD
• ADHD is more common in individuals with
first or second degree relatives with ADHD
(5-10x risk)
• More frequent among siblings who shared
the same mother and father (increased risk
between biological relative to step siblings)
• Individuals with ADHD are more likely to
have siblings with ADHD, having one
biological parent with ADHD their children
had an increased risk of 57%
• Adoptive relatives are less likely to have
ADHD than biological relatives (nature not
nurture)
Twin Studies (ADHD)
• ADHD is more common in identical twins
compared to fraternal twins
• Correlation of 0.78 (monozygotic) and 0.45
for (dizygotic)
• Despite girls with ADHD showing less
behavioural problems than boys their
heritability estimates are similar
• The overall heritability rate for ADHD is
0.70-0.80 which is substantially higher than
other psychiatric disorders
In-Class Discussion
Is ADHD binary?
Are labels good?
Why short term use of stimulants?
• Huge genetic component.
• Very high genetic risk between identical
twins (monozygotic) which tells us it is due
to nature rather than nurture.
• There are some important environmental
risk factors (mother that smoked while
pregnant, low birth weight, pollution during
prenatal development).
• There is no single cause, multiple causes or
origins can lead to the same
symptomology. TBI can result in ADHD (less
common cause).
• It doesn’t typically manifest in adulthood,
the symptoms are typically present in
childhood but not diagnosed.
• Awareness of ADHD symptoms through
tiktok can help women stop internalizing
symptoms, discrediting them, blaming
themselves for being lazy. Still should not
self-diagnose but need to go to a
psychologist.
• ADHD is a spectrum disorder
(high/moderate/low; heterogenous
presentation of symptoms) not binary (have
It or don’t; categorical; DSM-5). Diagnosis
requires 6 symptoms in the one category.
• What’s misunderstood about ADHD?
Education perspective think MH labels are
harmful for kids, stigma, impact how
teachers treat students, should frame it in
terms of strengths and areas of need
without the labels. In contrast, people with
ADHD really liked the label, removed self-
blame and guilt about not being able to do
certain tasks. With or without the label the
teacher would respond differently to
children with ADHD, labels help educate
teachers that there is biological reasons for
their different behaviour and not the child’s
fault. More empathetic, give better support
to the child.
• Medication (from neuroscience view; from
brain perspective illegal and Adderall are
the same effect on the brain) her view the
effectiveness of riddelliine is effective in
increasing attentional focus, academic
achievement (positive effects) there is also a
lot of research on long-term effects being
limited (immediate short-term benefits on
academic performance but it wanes over
time over the first couple of years; there are
side effects of stunted growth/shorter
height, apatite suppression and weight loss,
emotional outburst). For students with
severe symptoms behavioural interventions
are not effective without stimulants to help
them regulate their attention, without
behavioural intervention to teach them to
manage their symptoms long-term what is
the point of providing stimulants? There is a
tolerance build up with developmental
changes where dosage needs to be
adjusted. These medications are not as
easily accessible worldwide (stimulant
prescribed in NZ but not Japan; non-
stimulants are more tolerable than
stimulants but is not as impactful and ess
symptoms)
