Task 1 ADHD

Question 1

Combined presentation

Answer 1

If enough criterions for Inattention and Hyperactivity/Impulsivity are met

Question 2

Predominantly inattentive presentation

Answer 2

If only inattentive criterions are met

Question 3

Predominantly hyperactive/impulsive presentation

Answer 3

If only hyperactive/impulsive criterion are met

Question 4

Neurodevelopmental disorder

Answer 4

ADHD is a neurodevelopmental disorder that means that the onset is rather early in life

Question 5

Value of future events

Answer 5

Patients with ADHD discount the value of future events at a higher rate than other children (do not wait for higher reward)

Question 6

Heterogeneity

Answer 6

key characteristic of ADHD
o Symptoms can take many forms (e.g. inattention or hyperactivity)
o Might be caused by the different paths

Question 7

Path 1 (Dual-pathway model of ADHD)

Answer 7

dysregulation of thought and action and associated with diminished inhibitory control (dorsal fronto-striatal dysregulation/meso cortical control circuits)
 Context independent
 More severe cognitive impairment
 D1 receptor

Question 8

Path 2 (Dual-pathway model of ADHD)

Answer 8

motivational style (delay aversion) associated with fundamental alterations in reward mechanisms (ventral fronto-striatal circuits/Meso limbic reward circuit)
	Children are motivated to escape or avoid delay (Delay aversion)
	Associated with reduced task engagement (start to look out of window to avoid delay of other task)
	Is more variable in view of environmental factors (e.g. parenting)
	D2 receptor

Question 9

Developmental outcome

Answer 9

 Separated into behavioural symptoms (impulsiveness, inattention and overactivity) and task engagement

Question 10

Psychological processes

Answer 10

primary (deficient inhibitory control) and secondary (cognitive and behavioural dysregulation) process characteristics

Question 11

Temporal processing deficits

Answer 11

independent factor to the dual pathway mode
o Associated with reading problems
Working memory deficits

Question 12

Symptoms for inattention

Answer 12

o Often fail to give close attention, making careless mistakes when doing e.g. homework
o Often has difficulties sustaining attention in tasks or play activities
o Often does not seem to listen when spoken to directly
o Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
o Often has difficulty organizing tasks and activities (difficulty managing sequential tasks, disorganized work; poor time management)
o Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
o Often loses things necessary for tasks or activities (e.g. pens, phone, eyeglasses)
o Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts)
o Is often forgetful in daily activities

Question 13

Symptoms for Hyperactivity and Impulsivity

Answer 13

o Often fidgets with or taps hands or feet or squirms in seat
o Often leaves seat in situations when remaining seated is expected
o Often runs about or climbs in situations where it is inappropriate (Note: in adolescents or adults, may be limited to feeling restless)
o Often unable to play or engage in leisure activities quietly
o Is often “on the go,” acting as if “driven by a motor” (always going)
o Often talks excessively
o Often blurts out an answer before a question has been completed
o Often has difficulty waiting his or her turn
o Often interrupts or intrudes on others (for adolescents or adults, may intrude into or take over what others are doing)

Question 14

DSM-5 criteria for diagnose

Answer 14

o If six or more of the symptoms for Inattention and Hyperactivity and impulsivity are met and need to be impairing and consistent over at least 6 months
 For people older than 17 5 symptoms have to be met
o Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years
o Symptoms are present in two or more settings
o There is clear evidence that the symptoms impair normal functioning in school etc.
o The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder
 If the other disorder can’t explain the symptoms comorbidity is possible
o Age limit of 12 years

Question 15

Gender differences

Answer 15

o Boys are nearly twice as likely to develop ADHD in childhood in adolescence it gets less (1.6:1)
o Girls diagnosed with ADHD show more inattentive features than boys who also show disruptive behaviour

Question 16

Prevalence

Answer 16

o Affects 3 to 5% of school age children and 2.5% in adults

Question 17

Cormobidity

Answer 17

20-25% have also a specific learning disorder
 45-60% develop a conduct disorder, abuse drugs or alcohol, or violate the law
 Increases the risk for antisocial PD, substance abuse, mood and anxiety disorders, legal infractions and frequent job changes in adulthood

Question 18

Brain parts involved

Answer 18

o	Prefrontal cortex (control of cognition, motivation and behaviour)
o	Striatum (Working memory and planning)
o	Cerebellum (motor activities)

Question 19

Neurotransmitter

Answer 19

o Dopamine and norepinephrine

Question 20

Immature brain hypothesis

Answer 20

Children with ADHD have slower development of the brain

Question 21

Genetics

Answer 21

o Are strongly tied to ADHD

Question 22

Nurture

Answer 22

o Triggering ADHD
o ADHD is often caused by prenatal and birth complications
o Heavy drinking or smoking during pregnancy can also cause ADHD

Question 23

Dorsal frontostriatal pathway

Answer 23

involved in cognitive control (basal ganglia)

Question 24

Ventral frontostriatal pathway

Answer 24

involved in reward processing (motivational deficit) (reinforcement)

Question 25

Frontocerebellar pathway

Answer 25

related to temporal processing o Shares neuro components (e.g. basal ganglia) with the other two pathways (correlation between them) but is still an own pathway

Question 26

Impairments in timing, inhibition or delay

Answer 26

 Overlap between different deficits was uncommon and never greater than expected by chance – 70% of those affected showed just one deficit.

Question 27

Stimulants treatment (e.g. ritalin)

Answer 27

 70-85% of the patients respond positively  Neuro level: enhances release and inhibiting reuptake of Dopamine  Side effects: reduced appetite, insomnia, edginess and gastrointestinal upset  Is often misprescribed for children that are hard to control without actual ADHD

Question 28

Atomoxentine, clonidine and guanfacine

Answer 28

 Neuro: affects norepinephrine levels |  Can reduce tics and increase cognitive performance

Question 29

Antidepressants

Answer 29

 Used in older age when people are also diagnosed with depression

Question 30

Behavioural therapy

Answer 30

o Children learn to anticipate the consequences of their behaviour to make less impulsive choices, and less disruptive behaviour o Highly effective in reducing symptoms

Question 31

Most efficient treatment

Answer 31

• Combination of Drug treatment and behavioural therapy is most effective

Question 32

Working memory training

Answer 32

o Increases activity in DLPFC and parietal association cortices o Increases laboratory measures of attention o Works also for preschool children (with no diagnosed ADHD) o Decreases symptoms of ADHD based on parental ratings o Attention training has no significant effects on WM o Adaption of the difficulty level based on performance

Question 33

Visuo-spatial WM

Answer 33

is more clearly associate with ADHD compared to verbal WM |  Has transfer effects on verbal WM

Question 34

Practice effects

Answer 34

getting better in one trained task (accounts for WM and inhibition)

Question 35

Training effects

Answer 35

due to training one task you are better in another task of the same domain ( accounts for WM)

Question 36

Transfer effects

Answer 36

training in one domain can enhance performance of others (accounts for WM on attention)

Question 37

Inhibitory control

Answer 37

task did not improve performance on non-trained tasks  Might be caused by using it less often then WM as well it is a much faster neuronal process so actual training was short

Question 38

Study

Answer 38

used children age from 7-12 and gave them a computer program that adjusted the difficulty to their WM level (control group had no adjustment)  Treatment affect for every executive task and the parents mentioned improvement  Positive change for response inhibition (Stroop task) but no transfer effects, verbal WM (digit-span) , complex reasoning (ravens task)

Question 39

Conduct disorder

Answer 39

A disorder that impairs others and owns life as well as violates general norms.

Question 40

Cognitive energetic model

Answer 40

 Information processing is influenced by both computational (process) factors and state factors such as effort, arousal and activation.  Effort – Related to motivation, energy necessary to meet demands of tasks. If children have deficit in effort, performance may be poor due to non-optimal energetic state. Reinforcement will induce necessary energy to meet task demands and thus improve performance on cognitive tasks.  Computer Assisted Instruction (CAI) – Computerization of tasks has shown to increase child’s interest and motivation. These programs include clear goals and objectives, highlights important materials and provides immediate feedback regarding response accuracy. o Most effective CAI program has game-like format – It uses multiple sensory modalities (color, sounds, movement). It also includes animated characters, narratives, colorful interactive environments and player advancement through levels.