Lecture 6 Flashcards
Externalizing Behavior Disorders
ADHD, conduct disorder, oppositional defiant disorder
Externalizing disorder- uncontrolled impulsive potentially aggressive behavior
Three main types
What is adhd
Persistent age-inappropriate symptoms of:
Inattention Hyperactivity Impulsivity
These symptoms cause impairment in major life activities
Umbrella term- categorize and diagnose persistent symptoms
Show all symptoms to some degree
Inattention- cant focus when expected- can result in mistakes and forgetful behaviour
Hyperactivity- what ppl think of when adhd- active, fidgeting, cant stay still, multitasking, restlessness- uncontrollable, difficulty engaging in relaxing and quiet tasks
Impulsivity- self control issues, act without thinking, more likely to interrupt conversations, ask irrelevant questions, make inappropriate comments, cant inhibit behaviours
Blanket term that refers to these behaviours- must cause impairment
Adhd history
Early 1900-Poor “inhibitory volition” and “defective moral control”
1917 to 1926- “Brain- injured child syndrome”
1940-1950-
“Minimal brain damage” and “minimal brain dysfunction”
Late 1950- Hyperkinesis “hyperactive child syndrome”
- hyperactivity
1970- Deficits in:
- attention
- impulse control
- hyperactivity
1980 Increased interest in ADHD and rise in stimulant use
Since 90s- inc interest in identifying symptoms and causes
Earliest descriptions-1902- George still said these behaviours caused my moral inhibition- couldn’t control behaviour but still intelligent
Throughout 1900s- more children in settings where these behaviours are more apparent- cat sit still, pay attention
More attention drawn to these behaviours
Following influenza epidemic- inc of children experiencing inphaliytis- swelling of brain causing adhd symptoms
1950- kids without brain trauma show symptoms, led to new disorders and terms
Beginning of biological cause of adhd
Not used anymore- doesn’t correlate with adhd
Hyperkinesi- focusing on hyper behaviours
In 1970- more research- more elements on attention and impulsivity and how it’s affects the disorder
1980- more interest in adhd and more treatment for adhd- medication
How we got to adhd today
Used to be called add
ADHD in the DSM-5
Neurodevelopmental disorder
Adhd- neuro developmental disorder
Early onset= start before age 12, may be noticeable at age 3, even earlier
Persistent course= persistent course for some individuals, persists through life, some out grow, some worsen symptoms
Differences in neural development = associated wth differences in neural development- delayed prefrontal maturation and activity differences= differences in thinking, behaviour, emotions
Associated with other neuro developmental disorders =adhd associated with delayed in language, motor development- linked with autism and learning disorders
CORE CHARACTERISTICS
Key symptoms fall under two well-documented categories:
I attention and hyperactivity- impulsivity
3- core groups of adhd fall into two categories
Highly correlated and interrelated- biut do predict differences
1- predicts school issues
2- peer rejection and impulsivity
Hyperactivity and impulsivity linked- because when display one often display the other
Using these dimensions can oversimplify the disorder- lots of variablity even with those who present the disorder textbook definition
Inattention
Inability to engage and sustain attention, and follow through on directions or rules while resisting distractions
Inattention can result from a failure in one or more cognitive processes:
Deficits in Attentional Capacity, selective attention and distracting Lott, sustained attention and alerting
Attentional capacity= numbers o items one can remember and attend to in short period- remember phone number- this is not a challenge associated with adhd- can hold same amount as those without adhd
Selective attention ability to focus on most important info while tuning out distractions
Distractibility= defecit in selective attention- adhd more likely to focus on salient info
Sustained attention/vigilance- ability to maintain concentration over long period of time- adhd struggle with this
Alerting- a deficit that happens before task has begun- ability to listen to instructions/prepare for task- have difficulty doing tasks cause miss instructions
Hyperactivity-Impulsivity
Undercontrol of motor behavior, challenge inhibiting behavior, inability to delay a response or defer gratification
Hyperactive behaviors
Activity is excessively energetic, intense, and not goal-directed
Impulsive behaviors
Inability to control immediate reactions or think before acting
DSM-V Diagnostic Criteria for ADHD
A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):
Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is
inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks of misses details,
work is inaccurate).
Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).
Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks: difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).
Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or home-work; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).
Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).
Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping
appointments).
Won’t expected to memorize
What are different dimensions and potential symptoms?
1st criteria- pattern of innattention or impulsive/hyperactivity that impairs functioning
Six or more symptoms- at least 6 months and inconsistent with development
Child fails to. Pay attention to details, make careless mistakes, difficult remaining focused
Hyperactivity and Impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
Often fidgets with or taps hands or feet or squirms in seat.
Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).
Often runs about or climbs in situations where it is inappropriate. Note: In adolescents or adults, may be limited to feeling restless.
Often unable to play or engage in leisure activities quietly.
Is often “on-the-go and acting as if “driven by a motor” (e.g., is unable to be or is uncomfortable being still for extended time, as in restaurants, meetings; may be seen by others as being restless or difficult to keep up with).
Often talks excessively.
Often blurts out answers before a question has been completed (e.g., completes people’s sentences; cannot wait for a turn in conversation).
Often has difficulty waiting his or her turn (e.g., while waiting in line).
Often interrupts or intrudes on others (e.g., butts into conversations, games or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).
Specify if:
In partial remission: When full criteria were previously met, fewer than the full criteria have been met for the past 6 months, and the symptoms still result in impairment in social, academic, or occupational functioning.
Specify current severity:
Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and symptoms result in no more than minor impairments in social or occupational functioning.
Moderate: Symptoms or functional impairment between “mild” and “severe” are present.
Severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present, or the symptoms result in marked impairment in social or occupational functioning.
Adhd presentation types
Presents- inattention only= inattentive type adhd- predominantly inattentive presentation Inattentive, easily distracted, slow-moving, spacey, easily confused, disorganized, daydreamy
Hyperactivity and impulsivity= hyperactive impulsive type Hyperactivity, fidgeting, excessive talking, impulsivity, argumentative
All =combined
Hyperactive, restlessness, disorganized, inattention, impulsivity
Most commonly referred for treatment
This is newly added to dsm- newer area needs more research on accuracy
Some suggests it may not be the best- 50% were reclassified to a type depending on methods, how info was combined and amount of symptoms needed
Additional DSM-5 Criteria For Diagnosis
Appears prior to age 12
Occurs across two or more settings (e.g., home, school, or work, with friends or relatives, in other activities)
Symptoms interfere with or reduce the quality of social or academic performance
Symptoms are not better explained by another disorder
In addition to the 6 symptoms present for 6+ months
Rely on retrospective reporting for those who come for treatment older
Limitations of DSM Criteria for ADHD
Limitations in developmental sensitivity
Categorical view of ADHD
DSM criteria shape our understanding of ADHD
DSM criteria are also shaped by, and in some instances lag behind, new research findings
1- the criteria are used across lifespan- for older adults= 5 symptoms, the symptoms decline over age but this is only adjustments ,age. Concerns about using this approach across lifespan- older ppl
2- these symptoms exist o dimension- see these behaviours in regular population- those who present 5 symptoms- may be the same as those with 6- why the cut off
Associated characteristics
Children with ADHD often have additional challenges:
Cognitive Deficits
Deficits in executive functions
Intellectual and academic deficits
Learning disorders
Distorted self-perceptions
Problems in executive functioning 50%- show deficits in one or more areas of EF
Refers to cognitive processes- integrate and manage other brain functions
Involves their ability to control, plan and organize
Organizing- have trouble starting planning, organizing work and likely to misunderstand instructions
Focus- loose focus, reread and forget what they read
Regulating alertness- procrastination, drowsiness
Manage frustration- easily frustrated, cant regulate emotions
WM- forgetting to do task, cant follo instructions
Regulate action- interrupting, blurting out
Intellectual and academic cognitive deficits Do not differ in levels of intelligence- difficulty applying intelligence- loss of potential to suceed
Can impact iq performance and intelligence task- cant focus, inattention
Poorer academic outcomes- lower grades imp
Difficulty in academic settings
Intellectual deficits and impaired academic functioning
Cognitive Deficits: Learning Disorders
Challenges with reading, spelling, and math
45% have specific learning disorder
Self perception- distorted self perception Some linking to distorted self perception
How diffferent factors present can predict this
Mood disorders make tis more likely
Hyperactive and conduct problem– show positive illusory bias- exaggerated self perception in relation to behaviour and abilities – show more agression- serve as self protective mechanisms- cope with symptoms- may not recognize what successful behavior/performance is
Speech and language impairments
Challenges with formal speech
Co-occurring language disorder
In some cases- these interrelated with other symptoms- impulsivity, inattention
~30–60% of children with ADHD
have a speech and/or language impairment
Difficulty understanding others speech
Formal speech and language disorders
Speech production errors
Excessive and loud talking
Inability to listen
Medical and physical conditions
Health-related problems
Accident-proneness and risk-taking behaviors
Over 50% of parents of a child with ADHD describe their child as being accident-prone
At higher risk for health related problems- asthma and bed wetting, poor fitness, eating disorder sleep disturbance- may be because of stimulant medication
More accident prone- more likely to show up in hospitals with broken bones, bruising- experience accidents due to impulsive behaviour
Inc risk or car accidents and substance abuse
Social problems
Family problems
Peer problems
Close friendships may buffer negative outcomes
Sibling conflict- may feel that one with adhd is victimizing them or getting more attention
Parents more likely to be stressed, maternal depression, father substance abuse
Family concern about outside perception and stigma of mental disorders
Peer difficulties- cant apply experiences to interactions, friends= protective factor
