Week 4 Flashcards
Name the DSM-criteria for ADHD
A. Inattention (6/9 symptoms required)
- Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
- Often has difficulty sustaining attention in tasks or play activities
- Often does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish schoolwork, chores, or workplace duties
- Often has difficulty organizing tasks and activities
- Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
- Often loses things necessary for tasks and activities
- Is often easily distracted by extraneous stimuli
- Is often forgetful in daily activities
B. Hyperactivity and Impulsivity (6/9 symptoms required)
- Often fidgets with hands or feet or squirms in seat
- Often leaves seat in situations when remaining seated is expected
- Often runs about or climbs in inappropriate situations
- Often unable to play or engage in leisure activities quietly
- Is often ‘on the go’ or acts as if ‘driven by a motor’
- Often talks excessively
- Often blurts out an answer before a question has been completed
- Often has difficulty waiting their turn
- often interrupts or intrudes on others
C.
- Symptoms must be present before age 12
- Symptoms must be present in at least 2 or more settings
- Symptoms must interfere with or reduce quality of functioning in social, academic, or occupational areas
- Symptoms are not better explained by another mental disorder
Which 3 forms of ADHD are there?
- Inattentive (~30%)
- Mostly in girls
- These people are more quiet and have concentration problems
- You meet more symptoms in the Inattention Cluster - Hyperactive/Impulsive (~5%)
- More in Boys
- Mainly hyperactivity-impulsivity symptoms - Combined (~65%)
- Both inattention and hyperactivity-impulsivity symptoms are present
Which 4 domains in cognitive functioning are impaired in ADHD?
- Cognitive control
- switching between tasks
- Inhibition - Timing
- difficult estimating their own pace
- often too late/ early - Emotion dysregulation
- difficulties in reading other’s emotions
- difficulties regulating their own emotions - Reinforcement sensitivity
- difficulties too learn from the rewards and more sensitive for the reward
What is meant by heterogeneity in ADHD?
Not all people with ADHD experience the same symptoms. Some have impairments on all cognitive domains, some only in 1. Every person with ADHD is different.
What are the positive things about ADHD?
- Zit vol energie
- Enthousiast
- spontaan
- niet saai
- creatief; minder gestructureerd leidt tot creativiteit
origineel - Help iemand van wie ik houd altijd: they are not inhibited so they stand up for others and themselves easily
- hard werken
What is the prevalence of ADHD?
- in children: ~3-7%
— 1 in every school class
— more boys, than girls - Adults: ~2,5%
What is subthreshold ADHD? + prevalence
Children with subthreshold ADHD, don’t meet all the required criteria for ADHD (for example: 5/9 symptoms i.p.v. 6/9) or they have milder symptoms.
- 11-18% of children
- it is predictive for the onset of full threshold ADHD in adolescence
Refute the argument: ‘ADHD is something of our current time’
Maybe it looks like this because there is more attention for ADHD on social media, so people get more information about it and there is now less stigma about it. Because of this more people ask for an ADHD diagnosis, however the prevalence did not increase over the last 30 years. Eventhough more people ask for it, doesn’t mean that they also meet all the criteria.
Explain the high comorbidity in ADHD
There is high comorbidity with:
- ODD (oppositional Defiant Disorder) (21%)
- Anxiety Disorders (10%)
- Conduct Disorders (7%)
- Tic Disorders
- Mood Disorders
There is a high comorbidity because ADHD affects multiple brain functions, such as attention regulation, impulse control, and emotional regulation. This makes individuals with ADHD vulnerable for developing additional mental health and behavioural disorders.
- ADHD is linked to dysfunction in the prefrontal cortex, dopamine system, and executive function networks, which are also involved in other conditions like anxiety, depression, and conduct disorders.
- Poor impulse control can lead to aggressive behavior, conduct disorder (CD), or oppositional defiant disorder (ODD).
- Individuals with ADHD often experience intense emotions, making them more prone to mood disorders like depression and anxiety.
- Difficulties managing frustration can contribute to anger issues or explosive behaviors, which are seen in ODD and mood disorders.
- ADHD often leads to difficulties in school or work, increasing stress and making individuals more likely to develop anxiety or depression.
- Poor social skills and impulsive behavior can lead to peer rejection or bullying, contributing to social anxiety or low self-esteem.
- Impulsivity increases the likelihood of engaging in substance abuse, risky behaviors, and addiction.
Why is it difficult to distinguish ADHD from other disorders?
Because many conditions share overlapping symptoms. Examples:
- Bullying-related trauma
- Social Anxiety
- Psychosis
- Depression
- OCD
These conditions can also lead to inattention, hyperactivity, or impulsivity. This makes it difficult to determine whether ADHD is the primary condition or a secondary effect of another condition
What 3 factors play a role in ‘causing’ ADHD:
- Genetic Factors (high heritability) > vulnerability (genetic predisposition)
- Prenatal factors (e.g. Maternal stress, intoxication)
- Interactions with environment (diathesis-stress model)
Refute the argument: ‘ADHD is just the parents fauls’
ADHD is a neurodevelopmental disorder, meaning it originates from brain structure, function, and genetics, rather than parenting style.
- Brain Differences: Research using brain imaging (MRI studies) shows that individuals with ADHD have differences in prefrontal cortex activity, dopamine regulation, and executive function networks. These areas are responsible for attention, impulse control, and emotional regulation.
- Genetic Basis: ADHD is highly heritable, with 75-80% of cases linked to genetics. If a parent has ADHD, their child has a significantly higher chance of developing it.
- Neurochemical Imbalances: ADHD is associated with dopamine and norepinephrine dysregulation, which affects motivation, attention, and self-regulation—issues that are not caused by parenting.
- If ADHD were purely a result of bad parenting, it would not appear consistently across different cultures, socioeconomic backgrounds, and family structures.
- Studies show that ADHD is diagnosed worldwide, with similar prevalence rates across countries, suggesting biological origins rather than cultural or parental influence.
- While parenting can affect how well a child manages ADHD symptoms, it does not create the disorder.
- For example, structured environments, positive reinforcement, and clear expectations can help manage symptoms, while inconsistency might make them more challenging—but this applies to all children, not just those with ADHD.
- Symptoms of ADHD are often noticeable by age 3-6, even in children with attentive, responsible parents.
If ADHD were solely caused by bad parenting, symptoms would not appear in young children who have had little exposure to different parenting styles. - ADHD is not just a childhood disorder; many individuals continue to experience symptoms into adulthood, affecting work, relationships, and daily life.
If ADHD were only due to parenting, individuals would “grow out” of it once they left their parents’ care, which is not the case.
Describe ADHD symptoms throughout the lifespan
- Preschool: Behavioural problems & hyperactivity
- School-age:
- Academic problems
- Social problems
- Low self-esteem
- Oppositional behaviour
- Accidents - Adolescent:
- Planning problems
- Social problems
- Low self-esteem
- Addiction
- Behavioural problems
- Antisocial behaviour - Student:
- Cognitive under-functioning
- Difficulty finding a job
- performance anxiety
- substance abuse
- accidents - Adult:
- Job-related problems
- Low self-esteem
- Substance abuse
- accidents
- relation problems
Describe the research about peer problems in school-age children with ADHD
Participants were shown a face for a brief duration and had to identify the emotion using a response system.
- The graph compares emotion recognition accuracy between ADHD (red) and Control (blue) groups.
- The x-axis represents expression intensity (from faint to clear emotions).
- The y-axis represents percentage of correct responses.
Findings: - Both groups improve as expression intensity increases.
- The ADHD group performs worse at lower expression intensities, indicating greater difficulty recognizing subtle emotional cues.
- However, at higher expression intensities, the performance gap narrows.
Children with ADHD often struggle to recognize emotional expressions, particularly subtle expressions.
This difficulty in reading social cues can lead to misunderstandings and social conflicts, contributing to peer problems.
Describe the research about student-teacher relationships in school-age children with ADHD
The researchers did an observation studies and looked if teachers gave children with ADHD more corrective feedback and what the consequences were for the student-teacher relationship.
- Children with ADHD Receive More Corrective Feedback:
- The slide states that children with (subthreshold) ADHD receive up to five times more corrective feedback than their peers.
- This means that teachers frequently correct or reprimand students with ADHD more often than those without ADHD.
- The frequent corrective feedback may negatively impact self-esteem and motivation, potentially straining the student-teacher relationship. - Teachers Give More Corrective Feedback in a Weak Student-Teacher Relationship:
- The second point highlights that when the relationship between the student and teacher is less close, teachers tend to increase the amount of corrective feedback.
- This suggests that a strained relationship could lead to more negative interactions, further reinforcing challenges in the classroom.
Name some factors for what childhood ADHD is a riskfactor for:
- traffic incidents
- substance abuse
- aggression
- sexual risk taking (teenage pregnancies)
- Gambling problems
- Financial risk taking (compulsive buying)
- food related risk taking (causing obesity)
Will you grow out of ADHD?/ is ADHD forever?
Some children ‘grow out’ of it but many do not:
- 20-45% meet full criteria as adults
- 25-48% have impairing symptoms
Research:
- ADHD children have a delay in reaching cortical thickness, especially in the PFC. This delay might explain why some children seem to “outgrow” ADHD symptoms as their brain catches up in development.
However, for many individuals, ADHD symptoms persist into adulthood, suggesting that while development might be delayed, it is not always fully resolved.
A meta-analysis of 19 studies found that 17 of them reported that the youngest children in a school year were significantly more likely to receive an ADHD diagnosis or medication.
This suggests that relative immaturity compared to classmates might be mistaken for ADHD, leading to overdiagnosis.
Explain the Functional Working Memory (WM) model
> ADHD symptoms are the result of overwhelmed demands on impaired working memory. The model suggests that ADHD is primarily a disorder of executive functioning, caused by impaired working memory. Working memory is the ability to hold, process, and manipulate information over short periods, which is crucial for tasks like planning, problem-solving, and impulse control.
- WM capacity in people with ADHD is lower. They seek therefore behavioural ways to compensate for this problem.
- people with ADHD are less able to mentally represent past experiences, visual images, or future goals. They can’t learn from past rules and situations
- People with ADHD are less capable to use internal speech to guide actions and problem-solving. So the are not that good in plan and organize tasks, think before acting, follow multi-step instructions
- People with ADHD are less capable to regulate emotions using WM. So they are quickly frustrated, have difficulty waiting or handling disappointment, and have increased impulsivity in emotional responses
- People with ADHD are less cabable to mentally manipulate information to create new solutions. So they have difficulty planning ahead, and managing time, and organizing ideas.
Explain the Functional Working Memory (WM) model according to the lecture
- WM demands are too high for children with ADHD
- Working memory deficits are a core issue in ADHD.
- Tasks that require holding multiple steps in mind, such as “finish math exercises 3-6, then continue with reading chapter 5”, are challenging.
- Children with ADHD struggle with multi-step instructions because their working memory capacity is limited, leading to forgetfulness, disorganization, and difficulty completing tasks. - Children with ADHD use behavioral compensation strategies
- Because of their working memory difficulties, children with ADHD seek external ways to compensate.
- Examples include:
— Asking for frequent reminders.
— Writing down instructions.
— Skipping steps or improvising when they forget.
- This aligns with research showing that children with ADHD often develop coping strategies to deal with cognitive challenges. - Hyperactivity helps stimulate their brain
- Hyperactivity is not just random behavior; it may serve a functional purpose.
- According to Dekkers et al. (2020), movement (e.g., fidgeting, pacing, tapping) activates arousal mechanisms in the brain.
- This arousal increases attention and working memory function, meaning hyperactivity may be a self-regulation mechanism.
- This aligns with research showing that allowing movement (e.g., using fidget tools, standing desks) can help children with ADHD maintain focus.
A study found that:
- Children with ADHD showed a better WM performance when they were more active. While the performance of TP children decreased when they were more active.
- The more difficult the task, the more children with ADHD move. Also TD children, but less than ADHD children
— But no evidence yet
Explain the Delay aversion theory:
- ADHD symptoms as a response to avoid waiting:
- According to this theory, individuals with ADHD do not simply have a deficit in attention or impulse control.
- Instead, they actively avoid situations that involve waiting or delayed rewards because these are emotionally distressing (aversive).
- Hyperactivity, impulsivity, and inattention may serve as coping mechanisms to escape delay.
- People with ADHD struggle with delayed gratification—they prefer immediate, smaller rewards over larger, delayed ones.
- This difficulty is referred to as delay discounting, where future rewards lose value because they require waiting.
- This preference for immediate gratification increases the likelihood of engaging in impulsive, risk-taking behaviors, even when they come with long-term negative consequences.
— Substance use
— Unsafe sex
— Spending a lot of money at once
— Reckless driving
— Gambling
— Binge-eating
- But there is a positive side to this, people with ADHD are more likely to show prosocial behaviour. voluntary actions intended to benefit others. For example: lending money to a friend even if you might not getting it back.
Empirical evidence:
A study shows that all children, but especially children with ADHD are more hyperactive during idle-time (a moment when nothing is going on).
Explain the dual pathway model:
ADHD is a result from two independent but interacting impairments:
1. Executive Functioning Deficits (related to cognitive control).
- Neurobiological Basis: Dysfunction in the prefrontal cortex (executive circuit).
- Psychological Process: Leads to inhibitory deficits (poor impulse control, weak working memory).
- Behavioral Expression: Results in inattention, disorganization, and impulsivity.
- Motivational/Reward System Deficits (related to delay aversion and impulsivity).
- Neurobiological Basis: Dysfunction in the reward circuit (linked to dopamine regulation).
- Psychological Process: Individuals with ADHD have a shortened delay reward gradient, meaning they are less willing to wait for rewards.
- Parental response and reinforcement patterns can strengthen delay aversion behaviors (e.g., impulsivity, preference for immediate rewards).
- Behavioral Expression: Leads to hyperactivity, impulsivity, and avoidance of delay-based tasks.
What EF’s are impaired in ADHD?
- attention
- inhibition
- working memory
- flexibility/ switching
- organization/ planning
- emotion-regulation
All these functions are needed to process info and guide goal-directed behavior
How is reward sensitivity affected in ADHD?
- they need more and longer reward to get their brain activated and learn from the reward
- they also have difficulties to motivate themselves
study 1:
ADHD individuals require a higher reward threshold to reach their optimal performance.
Controls reach optimal performance at lower reinforcement levels, while ADHD individuals need stronger incentives.
This supports the idea that ADHD is linked to dopamine dysregulation, making external rewards more necessary to sustain effort.
study 2:
- A working memory task (grid-based task with rewards) was used.
- Different reward conditions were tested:
— No reward
— Small monetary reward
— Large monetary reward
— Gamified reward (game elements as motivation)
- The goal was to determine how different reinforcement conditions impact working memory performance in ADHD.
- Controls performed better than ADHD individuals across all conditions.
- Controls reached optimal performance with feedback only, whereas ADHD individuals needed additional incentives to improve.
- Higher rewards led to more improvement in ADHD, but performance still did not normalize to control levels.
- Key Conclusion: ADHD is characterized by deficits in both executive function (EF) and motivation.
- Left Graph (ADHD group):
— Performance in ADHD drops over time in the low-reward conditions (dotted lines).
— Performance is better maintained with higher rewards, showing a strong dependency on reinforcement. - Right Graph (Control group):
— Performance remains relatively stable over time, regardless of reward level.
— This suggests that controls can sustain attention and effort without requiring strong external reinforcement.
Explain treatment based on the dual pathway model:
- Diminish demands:
- Divide tasks in multiple steps
- Provide structure
- use to-do lists
- Keep instructions short and repeat them
- Ignore motor activity
- Prevent distraction - Increase motivation
- Use reward systems
- Reinforce desired behavior immediately
- Make desired behavior explicit
- Create attractive tasks
- anticipate for problems
- praise : correct 5:1
