Task 1 - ADHD Flashcards
neurodevelopmental disorders
= a group of disorders that typically arise first in childhood
- dysfunction in the brain
–> attention-deficit/hyperactivity disorder
–> autism spectrum disorder
–> intellectual disability
–> learning, communication, and motor disorders
neurocognitive disorders
= disorders that typically rise in older age
DSM-5 Criteria ADHD
A persistent pattern of inattention and/or hyperactivity that interferes with functioning or development, as characterized by inattention and/or hyperactivity and impulsivity
Inattention:
1. Careless mistakes in schoolwork, at work, or during other activities; no close attention
2. Difficulty sustaining attention in tasks (lectures, conversations, lengthy reading) or play activities
3. Does not seem to listen when spoken to directly
4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties
5. Often has difficulty organizing tasks and activities
6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
7. Often loses things necessary for tasks or activities
8. Is often easily distracted by extraneous stimuli
9. Is often forgetful in daily activities
Hyperactivity/Impulsivity:
1. Often fidgets or taps hands or feet squirms in seat
2. Often leaves seat in situations when remaining seated is expected
3. Often runs about or climbs in situations where it is inappropriate
4. Often unable to play or engage in leisure activities quietly
5. Is often “on the go”, acting as if “driven by a motor”
6. Often talks excessively
7. Often blurts out an answer before a question has been completed
8. Often has difficulty waiting for his or her turn
9. Often interrupts or intrudes on others
B several inattentive or hyperactive-impulsive symptoms were present prior to age 12
C several inattentive or hyperactive-impulsive symptoms were present in two or more settings
Subtypes of ADHD
combined presentation: six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity
predominantly inattentive presentation: six or more symptoms of inattention but less than six symptoms of hyperactivity-impulsivity are present
predominantly hyperactive/impulsive presentation: six or more symptoms of hyperactivity-impulsivity but less than six symptoms of inattention are present
Gender differences
- boys are 2x more likely than girls to develop ADHD in childhood
- girls with ADHD are primarily presented with inattentive features
Effects on Life
- children with ADHD often do poorly in school
- 20-25% of children with ADHD have a specific learning disorder
- children with ADHD have poor relationships with other children and are often rejected
- they show intrusive, irritable, and demanding behaviors when interacting with their peers
Comorbidities
- ADHD symptoms worsen during their development
- 40-60% are diagnosed with conduct disorder –> violation of social and cultural norms; acting unsocial
- increased risk for antisocial personality disorder, substance abuse, mood/anxiety disorders
Causes: Biological
- abnormal activity in the prefrontal cortex, striatum, cerebellum, and cerebral cortex
Immaturity hypothesis:
Children with ADHD are neurologically immature leaving them unable to maintain attention and control their behavior at an age-appropriate level –> their brains are slower to develop than the brains of unaffected children
- dopamine and norepinephrine function abnormally
- parental and birth complications
- specific diets (synthetic food colorings) and lead to ADHD
Causes: Psychological and Social
- families that experience frequent disruptions
- parents are prone to aggressive and hostile behavior and substance abuse
Dual Pathway Model of Behavior and Cognition
Pathway 1:
ADHD is predominantly a disorder of the regulation of thought and action resulting from inhibitory dysfunction
- DTAP = dysregulation of thought and action pathway
- core dysfunction in inhibitory control associated with the meso-cortical branch of the dopamine system which projects to cortical control centers
- severe cognitive and behavioral dysregulation
- context-independent
Pathway 2:
ADHD is predominantly a motivational style mediated by the emergence of delay aversion during childhood
- ADHD children are motivated to escape or avoid delay
- inattentive overactive, and impulsive behaviors
- MSP = motivational style pathway
- preference for immediacy
- reward circuits associated with the meso-limbic branch of the dopamine system
- varies as a function of environmental context
“Triple” Pathway Model
Pathway 1:
Temporal Processing (Timing)
- the most common deficit
- reading problems
Pathway 2:
Inhibitory Control (Inhibition)
- least common deficit
Pathway 3:
Delay
- low IQ
- reading problems
- impaired processes: time anticipation; waiting for a desired outcome
–> 71% of ADHD participants displayed just one neuropsychological deficit
Four “Pathways”
Pathway 1:
Dorso frontostriatal pathway –> cognitive control
Pathway2:
Ventral Frntostriatal pathway –> reward processing
Pathway 3:
Frontocerebellar pathway –> temporal processing
Pathway 4:
Vigilance
- possibly related to attention networks
- slow responding and low target detection
- inattentive subtype
–> Pathways 1-3 belong to the Neurobiological framework of ADHD
–> 80% of patients had deficits in only one of the components
Treatment: Stimulant Drugs
- most children with ADHD are treated with stimulant drugs (Ritalin, Dexedrine, Adderall)
- 70-85% respond to these drugs –> only 30% symptom reduction
- they work by increasing levels of dopamine in the synapses of the brain, enhancing release and inhibiting reuptake of this neurotransmitter
- inhibit dopamine and norepinephrine transporters
positive:
- increases in positive mood
- higher quality of relations
- ability to be goal directed
negative:
- reduced appetite
- insomnia
- risk of abuse
- increased frequency of tics
–> most effective available treatment for ADHD, but only short-term
–> medication stopped - symptoms return
Treatment: Second Line Medications
- atomoxetine (ATX): inhibits a norepinephrine transporter
- guanfacine (GFC): stimulate noradrenaline receptors in the CNS
- clonidine (CLO): same as GFC
–> add-on treatments to psychostimulants
–> particularly for hyperactivity
Treatment: Antidepressants
- effects on cognitive performance
- not as effective for ADHD as the stimulants
- bupropion affects dopamine levels and seems more effective than other antidepressants –> norepinephrine enhancer
–> medication stopped - symptoms return
