Problem 4 Flashcards
1
Q
ADHD in the DSM-V
A
- three presentations: combined (most prevalent), hyperactive, inattention
- inattention (9 symptoms)
- hyperactivity/impulsivity (9 symptoms)
- 6/9 symptoms per cluster, pervasiveness ( more than 1 setting), impairment, symptoms present before 12 yrs
- substantial phenotypic heterogeneity within ADHD
2
Q
Domains impaired with ADHD
A
- cognitive control
- emotion dysregulation
- reinforcement sensitivity
- some children do not show any neurocognitive impairments, there is heterogeneity in neurocognitive profiles
3
Q
Why are problems often first recognised at school?
A
- higher demands placed on neurocognitive functions
4
Q
Prevalence ADHD
A
- children = 3.7%
- adults = 2.5%
-more boys than girls
5
Q
Prevalence subthreshold ADHD
A
- 11-18% of children
-similar but milder problems and impairments - predictive for the onset of full threshold ADHD in adolescence
- treatment guidelines prescribe the same treatment for ADHD and subthreshold ADHD because of this
6
Q
Has ADHD prevalence increase
A
- no increase in prevalence over the last 30 years
7
Q
ADHD and comorbidity
A
- high comorbidity with other disorders
- differentiation between other disorders can be difficult
- DSM 5: symptoms could not be explained by another disorder
8
Q
Causes of ADHD
A
- genetic factors (high heritability): vulnerability
- prenatal factors (i.e. maternal stress, intoxication)
- interactions with the environment (diathesis-stress model)
9
Q
ADHD in pre-schoolers
A
- behavioural problems
- hyperactivity
10
Q
ADHD at school age
A
- academic problems
- social problems
- low self-esteem
- oppositional behaviour
- accidents
11
Q
ADHD in adolescence
A
- planning problems
- social problems
- low self-esteem
- addiction
- behavioural problems
- antisocial behaviours
12
Q
ADHD at university age
A
- cognitive under functioning
- difficulty finding a job
- performance anxiety
- substance abuse
- accidents
13
Q
ADHD in adulthood
A
- job related problems
- low self-esteem
- substance abuse
- accidents
- relation problems
14
Q
Study: ADHD at school age
A
- sample had full threshold and subthreshold ADHD
- both groups of children completed an emotional expression test where they were shown different expressions for a short period of time
- looked at peer problems: difficulties recognizing emotional expressions, in particular subtle expressions
- ADHD: weaker emotional recognition was correlated with more peer problems
- also looked at student teacher relationship: children with ADHD receive up to 5 times more corrective feedback, teachers provide more corrective feedback when the student-teacher relationship is less close
15
Q
ADHD as a developmental risk factor
A
- traffic incidents
- substance abuse
- aggression/delinquency
- sexual risk-taking (i.e. STDs and teenage pregnancy)
- gambling problems
- financial risk taking
- food related-risk taking
- many more negative outcomes
16
Q
ADHD brain development
A
- children with ADHD have delayed cortical development
17
Q
Birthdate effect
A
ADHD more often diagnosed in the youngest children in class
18
Q
Functional WM Model
A
- ADHD symptoms are the result of overwhelmed demands on the WM
1. WM demands are too high for children with ADHD
2. children with ADHD seek for behavioural ways to compensate
3. hyperactivity stimulates their brain: activates brain-based arousal mechanisms that support the executive/supervisory attentional component of working memory
19
Q
Empirical Evidence for functional WM model
A
- better WM performance in children with ADHD when the activity level was higher
- the more difficult the task, the more children with ADHD move
- all children show hyperactivity when difficulty level increases (idk double check all of this)
20
Q
Motor movement
A
- not all motor activity may be functional
- studies showed that fidget spinners were more distracting than functional
21
Q
Delay Aversion Theory
A
- ADHD symptoms as a choice to avoid delay because delay is aversive
- ADHD is associated with problems dealing with delayed reward
- delay discounting: 50 euros today or 100 next month?
- many risk taking behaviours are rewarding in the short term and long term harmful
22
Q
Abberant reward sensitivity
A
- ppl with ADHD need more and longer rewards to learn
- they struggle with motivation so they need more extrinsic motivation to keep going
23
Q
Dual Pathway Model
A
ADHD is characterized by problems in executive
functioning and motivational differences
- Executive pathway:
Diminish demands: - Divide tasks in multiple steps
- Provide structure (fixed places, rituals)
- Use to-do lists
- Keep instructions short and repeat them
- Ignore motor activity
- Prevent distraction (e.g. no window-
seat)
From dual-pathway model to treatment
Motivational pathway:
Increase motivation: - Use reward systems
- Reinforce desired behavior immediately
- Make desired behavior explicit
- Create attractive tasks (e.g. gamification)
- Anticipate for problems
- Praise:correct 5:1
24
Q
ADHD symptom categories
A
- inattentive symptoms
- impulsive-hyperactive symptoms
25
ADHD presentations
- primarily inattentive presentation
- primarily hyperactive-impulsive presentation
- combined presentation
26
ADHD diagnostic requirements
- symptoms must be evident before age 12
- symptoms must be pervasive across situations and interfere with performance
27
Inattentive presentation symptoms
- forgetfulness
- careless attention to detail
- difficulty sustaining attention over time
- distraction
28
Impulsive-hyperactive symptoms
- excessive motion
- incessant talking
- fidgety/squirmy behaviour
- impatience
- intrusiveness
- issues with inhibition (blurting out comments or answers)
29
Diagnostic requirements by age
- for either hyperactive or inattentive ADHD, six symptoms is required for those under 17 and five symptoms for those 17 and older
- for combined presentation, 12 symptoms is required for those under 17 and 10 (5 from each category) for those aged 17 and older
30
Precursors for hyperactive-impulsive presentation (early childhood)
- difficult temperaments
- excessive activity
- poor sleep patterns
- irritability in early childhood
- underregulated behaviours (i.e. self control issues) and demandingness
31
Precursors Hyperactive-impulsive presentation (ages 6-12)
- challenges in meeting increased academic and social demands (likely related to impulsivity and inhibition of responses)
- demonstrate low frustration tolerance and tend to abandon tasks that do not have an immediate solution
- impulsivity places this group of children at higher risk of injury accidentally
32
Precursors Hyperactive-impulsive presentation (ages 12-19)
- reckless driving accidents
- participation in other high risk behaviours (substance use, risky sex)
- academic problems due to impulsivity and concentration issues
33
ADHD prevalence
- 3-7% in school aged children
- 90% are diagnosed with hyperactive (but this may be due to the fact that inattentive symptoms might go undiagnosed/wrongly diagnosed as they are subtle)
- more males than females have been diagnosed (2:1 to 9:1)
- females may be more impaired than males in areas of psychosocial functioning (i.e. higher depression, anxiety, worse self esteem, higher stress)
34
ADHD and comorbidity
- comorbidity with specific learning disorders is between 16-21%
- 70% of depressed children have comorbid ADHD
- 90% of prepubescent children and 30% adolescents referred for bipolar disorder have ADHD
- high rates of other anxiety disorders, somatic complaints, sleep issues
- children with ODD and conduct disorder are more seriously maladjusted and have worse outcomes
- 35/60% of children with ADHD have ODD and 50% go on to develop conduct disorder
- childhood diagnosis of ADHD can be a strong predictor of substance use issues
35
Etiology of ADHD
- less activity in frontal brain regions (in charge of executive functioning)
- reduction of dopamine in basal ganglia and dysfunction of parietal lobe (altered perception of time and issues with time management)
- low levels of catecholamines which has been associated with attention and motor activity (pharmacological interventions can increase these levels)
- 50% have a parent with ADHD and 75% of aetiology is attributed to genetic factors
36
Barkley's model of ADHD
- understanding ADHD through executive functions (Does not explain inattentive variant)
- the child's degree of success in behavioural inhibition is central to determining the outcome of 4 central executive functioning tasks
1. WM (sequential ordering, planning)
2. self-regulation (sustained effort, goal directed behaviour)
3. internalization of speech (slower reactivity, promotion of inner reflection)
4. reconstitution (analysis and synthesis of info)
- deficits in behavioural inhibition result in poor problem solving strategies based on an inability to integrate and coordinate information generated by there 4 central processes
37
Assessment of ADHD
- semi structured interview: developmental history and parental expectations and impressions of the child's problem - ASEBA or BASC can be used
- BRIEF scale can be used
- academic assessments can be used to rule out other diagnostics or comorbid disorders
- cognitive assessments: cognitive efficiency, processing speed, WM
38
Treatment: Pharmacological Interventions
- mostly stimulant medication
- positive effects of controlling the core symptoms in areas of hyperactivity-impulsivity, inattention as well as reduction of aggressive behaviours
- improve child parent interactions
- side effect is reduction in heigh gains over time
39
