PPT 9

Question 1

Attention-Deficit/Hyperactivity Disorder (314.xx) Under Neurodevelopment Disorders

Answer 1

DSM-5 Three Subtypes:
1. Predominantly Inattentive type (.00)
2. Predominantly Hyperactive-Impulsive type (.01)
3. Combined type (.01 also)

Plus an “Other” and an “Unspecified”

Question 2

A. 1. Inattentive type

Answer 2

1. 6 or more inattentive sx persisting at least 6 mo to maladaptive degree

Question 3

A. 2. Hyperactive-Impulsive type

Answer 3

2. 6 or more hyperactivity-impulsivity sx persisting at least 6 mo to maladaptive degree

Question 4

Prevalence of ADHD

Answer 4

One of the most common chronic disorders of childhood

Found across social classes, racial and ethnic groups, and countries but with different prevalence rates

Onset often around 3 to 4 years old (but indications earlier)

Question 5

Adult ADHD

Answer 5

Disrupts sustained effort, planning, and organization important for effective functioning

Diagnosis in adults relies on establishing sx at the age of 12 and earlier

Question 6

Attention and Hyperactivity can be confused with or comorbid with a lot of conditions

Answer 6

Anxiety
Depression
Dyslexia
Family dysfunction
Conduct disorder
Tourette’s syndrome
Language impairment
Bipolar disorder
Brain injury
Even intellectual giftedness (boredom)

Question 7

Comorbidity

Answer 7

More than half of children who qualify for ADHD (67% in one study) have a comorbid diagnosis

Question 8

Developmental Course

Answer 8

Sx are often present in infancy-high activity, emotional lability, irregular sleep patterns, reduced need for sleep

Preschool years-add short attention span, proneness to tantrums, difficulties with groups

Often remains into adulthood

Question 9

Summary

Answer 9

1. Multiple deficits are needed to explain ADHD
2. Even with multiple deficits, the majority of sx variance in ADHD remains unexplained
3. There may be an emotional dysregulation subtype of ADHD
4. Our theoretical models of the development of ADHD are less adequate than are our theoretical models of some of the other learning disorders…

Question 10

Diagnosis and Treatment

Answer 10

Diagnosing ADHD relies more on converging evidence arising from observations and developmental/school histories than testing alone

Question 11

Diagnosis

Answer 11

Take care in diagnosing
- Vulnerable to misdiagnosis
- Lots of rule outs
- In adults, dx rests heavily on childhood symptoms

Question 12

Assessment of ADHD

Answer 12

Because it is important to distinguish ADHD from other possibilities, the assessment needs to be thorough. It can include:

• Interview, history, school records
• School visit
• Tests WAIS/WISC, WJA/WIAT
• Continuous performance test (CPT)
• MMPI/PIY
  Collateral information

Question 13

However….

Answer 13

Latest research suggests cognitive assessment may not be necessary for ADHD diagnosis, rather behavioral assessment through rating scales (self and vicarious observation) along with thorough consideration of history may be sufficient (Peterson, 2021)

Question 14

Continuous Performance Tests

Answer 14

But these are only one piece of evidence
- Performance can be impaired for reasons other than ADHD
- And performance can be unimpaired in ADHD

Question 15

Collateral Information

Answer 15

These are a number of behavioral rating scales that can be useful in assessment

1. Multi-dimensional or broad band
2. Unidimensional or focal

Useful BUT use intelligently

Question 16

Multi-behavior Rating Scales

Answer 16

Child Behavior Checklist (CBCL)
(Achenbach)
- Parent forms
- Teacher forms
- Self-report forms
- !!Select form for correct age range

Behavior Assessment System for Children (BASC)
- Parent form
- Teacher form

Question 17

ADHD Rating Scales for Children

Answer 17

Conners 3 - Parent
Conners 3 - Teacher
Conners-Wells Adolescent Self-Report Form

Question 18

ADHD Rating Scales for Adults

Answer 18

Child forms BUT rated as if 12 yo.
CAARS
- Self-Report form
- Observer form

Question 19

ADHD in Adults

Answer 19

History is central to dx
- Have parents or teacher rate them on child form as they were at 6-7/12 y.o.

Bottom Line: Look for converging evidence

Question 20

Treatment

Answer 20

1. Educate the client (and those close to them)
2. Medicate
   Enhances the inhibition mechanism
   - Increases resistance to the urge to act
   - Increases ability to stop in midstream if course is ineffective
   - Increases resistance to distraction
3. Accommodations
   - Modify the environment where problems occur
4. Therapy
   - Address the effects on self

Question 21

Medication

Answer 21

Medication is generally not enough by itself
- “Pills don’t give skills” (Dobson)
- Meds make you able to learn, but there is often a deficit of skills

Question 22

Educational Intervention

Answer 22

Often have missed some aspect of normal educational development

Modify the environment where problems occur
- Shorten delay between response and outcome
- Structure the task, make smaller steps, more immediate reinforcement
- Bridge time by breaking task down into manageable intervals

Less able to use internal cues, so increase external cues (Clocks, Tokens)

Minimize distractions

Question 23

Creativity

Answer 23

Plays a role in problem solving, innovation, artistic expression, and overall advancement across fields

Sternberg considered it a fundamental aspect of intelligence - but this has not panned out

Emphasis has shifted from seeing it as an inherent ability to how to improve an individual’s creativity
- Evidence that if you pretend to be more creative you can be more creative

• Effort to remove constraints of creativity that are self-imposed or socially-imposed

Question 24

Tasks of Divergent Thinking

Answer 24

Fluency - number of ideas one can generate - BUT this only reflects quantity and not originality

Novelty - efforts to get at creative quality have led to better measures of creativity involving semantic distance using Latent Semantic Analysis

Question 25

Fluency and Novelty

Answer 25

Studies show both can be improved (meditation, diet, walking, music, mood, travel, new experiences)

So divergent thinking seems to have plasticity rather than being a stable trait