Week 3- ADHD Flashcards by Mairead Murphy

ADHD prevalence

1-2% in adults
Higher in children

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ODD

Behaviour disorder
Often violate rules and boundaries

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To diagnose ADHD

18 potential symptoms
Inattention presentation: For diagnosis need at least 6 (5 for adults)
Hyperactive-impulsive presentation: Need at least 6
Combined presentation: 6+6

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3 neuropsychological pathways to ADHD

Executive functions
Reward sensitivity
Timing/motor functions

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Inattentive presentation of ADHD

a. Attention to details/ careless
b. Sustaining attention
c. Seems not to listen
d. Follow through instructions
e. Organizing tasks/activities
f. Avoids mental effort
g. Looses things
h. Easily distracted
i. Forgetful

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Hyperactivity/impulsivity presentation of ADHD

a. Fidgeting / squirming
b. Leaves seat
c. Runs / climbs
d. Unable to play quietly
e. On the go / driven by motor
f. Talking excessively
g. Blurts out answer
h. Waiting turn
i. Interrupting / intruding

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Lifespan symptom changes in adhd

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Things that contribute to the heterogeneity of adhd

Age
Mental comorbidity

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Mental comorbidity in Adhd

33%- 0 comorbid disorders
33%- 1 comorbid disorder
16%- 2 comorbid disorders
18%- 3 comorbid disorders

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Criteria for normal behaviour in diagnosing developmental disorders

-Is behaviour age appropriate?
-Does it fit the context?
-Frequency/ duration of behaviour (needs to be persistent pattern in time)
-Developmental trajectory
-Effect of interventions
-Functional impairments because of behaviour

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Diagnostic cycle of ADHD and tools

Signalling/ screening- Behaviour questionnaire
Medical history (parent/caretaker)- Interview
Medical history (teacher/ sports instructor)- Interview
Observation of the child- Interview/ observe play

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Role of observation in ADHD assessment

-In a medical setting: Exclude other mental disorders
-Signals genetic/neurologic disorders

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Defining the severity of ADHD symptoms is based on 3 aspects:

-Frequency
-Impairment
-Comparison to peers

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IQ in ADHD

ADHD can be found in both low and high IQ
On average people with ADHD score 7-12 pts lower

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Executive function pathway of ADHD relates to problems with

-Response inhibition
-Dysregulation of action and thought
-Meso-cortical branch
-Off-task behaviour
-Consistent behaviour symptoms
-Cognitive training can compensate

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Reward sensitivity pathway of ADHD relates to:

Delay aversion
Different motivational style
Meso-limbic branch
Disruptive behaviour
Symptoms depend on environment
Cognitive strategies can compensate

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ADHD medication

Stimulants
-MPH
-dexMPH
-dexAMP
-MAS-XR

Non-stimulants
-ATX
-Clonidine HCL extended-release
-Guanfacine extended-release

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Stimulant medication effects in ADHD

-Restores neural transmission of dopamine and noradrenaline in the prefrontal brain
-Large effects on behavioural symptoms of ADHD
-Effects on cognition are considerably smaller
-Lower doses are cognition-enhancing
-Higher doses are behaviourally activating but cognition impairing
-Only very small improvements in academic achievement but still lower than non ADHD peers

promising neuropsychology based interventions for ADHD

-Exercise/ physically active lessons
-Strategy instruction
-Cognitive training
-Neuro-feedback

Common referral reasons for a SNP evaluation

Children with:
-Past or recent head injury who is having academic or behavioural difficulties
-History of acquired or congenital brain damage
-Neuromuscular disease
-Brain tumour
-CNS infection or compromise
-History of a neurodevelopmental risk factor
-Returning to school after a head injury or neurological insult
-Documented rapid drop in academic achievement that cannot be explained by social-emotional or environmental causes

Intellectual disability

Permanent condition originating sometime between birth and age 18
General intellectual functioning significantly below average (IQ of 70 or below)
Concurrent deficits in adaptive behavior
Need for neuropsychological assessment is rare

Diagnostic criteria of ASD

-Persistent deficits in social communication and social interactions
-Restricted, repetitive patterns of behaviour, interest or activities
-Symptoms must be present in the early developmental period
-Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning
-Disturbances are not better explained by ID or global developmental delay

TBI and deficits

-Alertness and orientation
-Attention and concentration
-Intellectual functioning
-Language skills
-Academic achievement
-Adaptive behaviour and behavioural adjustment

Anoxia

Absence of oxygen supply to organ tissues, including the brain

Hypoxia

Decreased supply of oxygen to organ tissues

Causes of anoxia/ hypoxia

Near drowning, strangulation, smoke/carbon dioxide inhalation, poisoning

Anoxia/hypoxia can cause

Loss of consciousness, coma, seizures, death

Symptoms of anoxia/hypoxia

mental confusion, personality regression, parietal lobe syndromes, amnesia, hallucinations, memory loss

Meningitis

Inflammation of the lining around the brain and spinal cord

Early symptoms of meningitis

Severe headache Stiff neck Dislike of bright lights Fever/vomiting Drowsiness Less responsive Rash Possible seizures

Encephalitis

Inflammation of the brain usually caused by viruses

Acute symptoms of encephalitis

fever altered consciousness seizures disorientation memory loss

Etiology of epilepsy

Structural direct-29% Genetic-32% Electrophysical-35%

Cerebral palsy

-Heterogeneous group of chronic movement disorders -Caused by faulty development in the brain structures that help control movement and posture (pyramidal or extrapyramidal tract)

Symptoms of cerebral palsy

Ataxia Spasticity Weakness in one or more arm or leg Walking on toes, crouched gait or scissored gait

Causes of CP

Congenital brain malformations Genetic abnormalities Infections High fevers in the mother during pregnancy Injury to the fetus

Congenital muscular dystrophy

A group of disorders in which infants show muscle weakness at birth or shortly thereafter

6 subtypes of CMD

Myotonic MD (steinerts disease) Duchenne MD (Pseudo-hypertrophic) Limb-girdle MD Facioscapulohumeral MD (LandouzyDejerine) Spinal MD

Test battery modifications for children with visual impairments

-Administer verbal portions of standardized tests -Administer nonverbal tests that require spatial manipulation and problem solving but not sight -Administer a standardized or criterion-referenced test specifically designed to evaluate visually impaired children

Test battery modifications for children with hearing impairments

-Have an interpreter use ASL if possible for verbal tasks -Substitute written for oral language -Give directions through pantomime, signing or gesture -Use standardized nonverbal test

Test battery modifications for children with receptive and expressive language impairments

-Establish that an adequate output channel exists (eg. pointing) -Document expressive language deficits on standardized tests -Use nonverbal tests Give directions through pantomime and gesture

Test battery modifications for children with motor impairments

-Assess overall cognitive ability with verbal and motor-free tasks -Avoid speeded motor tasks -test motor abilities without time constraints

Strategies to address culturally different clients

-Test in clients language -Test validated with clients population -SNP's should be aware of the tests reference population -SNP's should be aware of limitations of assessment practices and tests for a culture, including test bias, test fairness and cultural equivalence