PPT 9 Flashcards
Attention-Deficit/Hyperactivity Disorder (314.xx) Under Neurodevelopment Disorders
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”
A. 1. Inattentive type
- 6 or more inattentive sx persisting at least 6 mo to maladaptive degree
A. 2. Hyperactive-Impulsive type
- 6 or more hyperactivity-impulsivity sx persisting at least 6 mo to maladaptive degree
Prevalence of ADHD
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)
Adult ADHD
Disrupts sustained effort, planning, and organization important for effective functioning
Diagnosis in adults relies on establishing sx at the age of 12 and earlier
Attention and Hyperactivity can be confused with or comorbid with a lot of conditions
Anxiety
Depression
Dyslexia
Family dysfunction
Conduct disorder
Tourette’s syndrome
Language impairment
Bipolar disorder
Brain injury
Even intellectual giftedness (boredom)
Comorbidity
More than half of children who qualify for ADHD (67% in one study) have a comorbid diagnosis
Developmental Course
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
Summary
- Multiple deficits are needed to explain ADHD
- Even with multiple deficits, the majority of sx variance in ADHD remains unexplained
- There may be an emotional dysregulation subtype of ADHD
- Our theoretical models of the development of ADHD are less adequate than are our theoretical models of some of the other learning disorders…
Diagnosis and Treatment
Diagnosing ADHD relies more on converging evidence arising from observations and developmental/school histories than testing alone
Diagnosis
Take care in diagnosing
- Vulnerable to misdiagnosis
- Lots of rule outs
- In adults, dx rests heavily on childhood symptoms
Assessment of ADHD
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
However….
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)
Continuous Performance Tests
But these are only one piece of evidence
- Performance can be impaired for reasons other than ADHD
- And performance can be unimpaired in ADHD
Collateral Information
These are a number of behavioral rating scales that can be useful in assessment
- Multi-dimensional or broad band
- Unidimensional or focal
Useful BUT use intelligently
Multi-behavior Rating Scales
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
ADHD Rating Scales for Children
Conners 3 - Parent
Conners 3 - Teacher
Conners-Wells Adolescent Self-Report Form
ADHD Rating Scales for Adults
Child forms BUT rated as if 12 yo.
CAARS
- Self-Report form
- Observer form
ADHD in Adults
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
Treatment
- Educate the client (and those close to them)
- 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 - Accommodations
- Modify the environment where problems occur - Therapy
- Address the effects on self
Medication
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
Educational Intervention
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
Creativity
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
Tasks of Divergent Thinking
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
Fluency and Novelty
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
