Week 8 ADHD Flashcards
What are the primary symptoms of ADHD?
inattentiveness
hyperactivity
impulsivity
2 key symptoms: symptoms of inattention + symptoms of hyperactivity-impulsivity
Why is ADHD included in the DSM-5 as a neurodevelopmental disorder?
Early onset and persistent course, is associated with lasting alterations in neural development, and is often accompanied by subtle delays and problems in language, motor and social development that overlap with other neurodevelopmental disorders
What does inattention refer to?
Limited ability to sustain attention to stick to tasks or play activities, to remember and follow through on instructions or rules to resist distractions
Involves difficulties in planning and organization and in timeliness and problems in staying alert
What does a child with ADHD struggle with? (more than 1)
a) attentional capacity
b) selective attention
c) distractability
d) sustained attention/vigilance
c and d.
- distractibility: children with ADHD are much more likely than others to be distracted by stimuli that are highly salient and appealing
- d: persistent focus over unchallenging, uninteresting tasks even when fatigued
a) is not the answer because they can remember the same amount of information for a short time as do other children.
b) is not the answer bc they can concentrate on things that they like
Do children with ADHD show difficulties in sustained attention only during the task itself?
No. Also shown from the very beginning of a task or response, not just a decline over time
Suggests that their attentional problems may also be in alerting and preparing for the task from the outset, and not only in sustaining attention during the task.
What does hyperactivity-impulsivity entail?
Involves the undercontrol of motor behavior, poor sustained inhibition fo behavior, the inability to inhibit dominant response in relation to ongoing situational demands.
What does the link between hyperactivity and impulsivity suggest about ADHD?
Children with ADHD have a deficit in regulating behavior
What are some signs of hyperactivity among children with ADHD?
Their activity is excessively energetic, intense, inappropriate and not goal-directed
The children are extremely active, but unlike other children with a high energy level, they accomplish very little.
What are some signs of impulsivity among children with ADHD?
Children who are impulsive seem unable to bridle their immediate reactions or think before they act
• Very hard for them to stop an ongoing behavior or to regulate their behavior in accordance with the demands of the situation or the wishes of others
• As a result, they may blurt out inappropriate comments or give quick, incorrect answers to questions that have not yet been completed
• Because it is difficult to wait or take turns, they interrupt conversations, intrude on others’ activities and lash out in frustration when upset
• Also have trouble resisting immediate temptations and delaying gratification
• Minor mishaps are common, but more serious accidents and injuries can result from reckless behavior.
What does cognitive impulsivity entail?
Disorganization, hurried thinking, and the need for supervision
May involve impulsive decision making in the child’s valuing of immediate rewards
What does behavioral impulsivity entail?
Impulsively calling out in class or acting without considering the consequences Children who are behaviorally impulsive have difficulty inhibiting their response when the situation requires it and are insensitive to the negative consequences of the behavior
What does emotional impulsivity entail?
Impatience, low frustration tolerance, hot temper, quickness to anger, and irritability
The term generally refers to how quickly and how likely an individual will react with negative emotions in response to negative events as compared with others of the same age or developmental level
Cognitive and behavioral impulsivity (and inattention) predict problems in________, particularly in _______.
academic achievement
reading
What are the 3 presentation types of ADHD?
ADHD-PI
ADHD HI
ADHD C
Which is the most common presentation in the general population?
ADHD PI (predominantly inattentive presentation)
What is the ADHD-PI presentation characterized by?
Inattentive to detail, easily distracted, careless, not listening, unfocused, disorganized, unable to sustain effort and forgetful
Often described as anxious and apprehensive and socially withdrawn and may display anxiety or mood disorders
One concern about the ADHD-PI presentation is that it may contain at least 3 diagnostic subgroups. What are these 3 subgroups?
1) Children who display both clinically significant symptoms of inattention and subclinical (below the DSM cutoff), but still substantial, levels of hyperactivity-impulsivity
2) Children whose inattentive symptoms are linked to problems with arousal and sluggish cognitive tempo (SCT), a cluster that includes symptoms such as daydreams, sleepy/drowsy/underactive/slow-moving, tired/lethargic, easily confused, stares blankly etc
3) Those who originally met criteria for the ADHD-C presentation but experience an age-related reduction in symptoms of hyperactivity-impulsivity, and as a result, no longer meet criteria for the ADHD
What is the ADHD-HI presentation characterized by?
Children with symptom criteria for hyperactivity-impulsivity but not inattention
Rarest presentation and includes primarily preschoolers
Many of those diagnosed with ADHD-HI as preschoolers do not meet diagnostic criteria for ADHD at a later age, suggesting that the preschool diagnosis reflects a typical developmental phase and possibly a time-limited behavior disorder
What traits do children with ADHD-C display?
More likely to display problems in inhibiting behavior and in behavioral persistence
Also more likely to be aggressive, defiant, rejected by peers and suspended from school or placed in special education classes
Children with (presentation) are the ones most referred for treatment.
ADHD-C
To qualify for a diagnosis of ADHD, the symptoms must appear before the age of? How long must the symptoms last for?
12
at least 6 months
What limitations exist when it comes to DSM criteria of ADHD?
- Developmentally insensitive
2. Categorical view of ADHD
What are some examples of executive function deficits do children with ADHD exhibit?
Response inhibition, vigilance, working memory and planning
In fact, many symptoms of inattention and hyperactivity reflect impairments in EF
While impairments in EF are viewed as a key deficit of ADHD, why is it not a “must-have” for a diagnosis of ADHD?
Not uniquely associated with ADHD
EF deficits only occur in half of children with ADHD
How does ADHD affect performance in IQ tests?
They score 5 - 9 points lower than their actual score.
Not surprising given that IQ tests include subtests related to specific deficits of children with ADHD
Lower IQ scores can be the direct result of the effects of ADHD symptoms on test-taking behavior
How does ADHD contribute to impaired academic functioning?
Inattention at 7 y/o predictive of poor academic outcomes at 16 y/o
Lower productivity, grades and scores
Children with ADHD who display ________________ tend to report lower self-esteem, whereas children with ADHD who display _______ tend to exaggerate their self-worth
inattentive and depressive/anxious symptoms
hyperactivity-impulsivity and conduct problems
What is the exaggeration of one’s competence know as?
positive illusory bias
What is an increase in positively biased self-perception of behavior in children associated with?
greater aggression over time.
Why is a positive bias present in children with ADHD?
helps with coping despite frequent failures - reflects diminished self-awareness due to impairments in executive functions
The type of speech and language impairment may be related to the child’s specific ADHD symptoms. How so?
Symptoms of hyperactivity-impulsivity were related to poor language skills, whereas symptoms of inattention were related to weaker receptive and expressive vocabulary skills.
In addition to showing a higher prevalence of formal communication and language disorders, children with ADHD may have difficulty in understanding others’ speech and in using appropriate language in everyday situations
Why do children with ADHD experience social problems?
they don’t listen, are hostile, argumentative, unpredictable and explosive
might end up being frequently in conflict with others. common for children with ADHD to be removed from lessons because of disruptive behavior.
children with ADHD do play by the same social rules and conventions as others, but just appear to not learn from past mistakes despite this form of awareness
Reliable identification of ADHD occurs between () to () years of age.
3 to 4.
Why is difficult to identify early markers of ADHD symptoms in infancy?
Parents’ recollections may be colored by their child’s later difficulties.
Most infants with a difficult temperament do not develop ADHD.
Although a difficult temperament in infancy may indicate something amiss in development (and in some cases may be a risk factor for later ADHD), it cannot by itself be taken as an early sign of ADHD
How do ADHD symptoms manifest themselves in preschool?
• Preschoolers with ADHD act suddenly and without thinking, dashing from activity to activity, grabbing at immediate rewards; they are easily bored and react strongly and negatively to routine activities
• Parents find it very difficult to manage the hyperactivity and noncompliance of their child, who may also be defiant and aggressive.
• Preschoolers with ADHD often roam about the classroom or daycare, talking excessively and disrupting other children’s activities
• Those who display a persistent pattern of hyperactive-impulsive and oppositional behavior of at least one year, particularly males, are likely to continue on to difficulties into middle childhood, adolescence and adulthood.
• Difficulties in resisting temptation, delaying gratification, and inhibiting behavior during the preschool years also predict ADHD symptoms in 3rd grade.
At this age, the combination of severe ADHD-related symptoms and disruptions in the parent-child relationship is especially predictive of continuing ADHD behavior patterns.
What do children with ADHD struggle with in school?
sustained attention and goal-directed persistence
What problems might result from difficulties in sustained attention and goal-directed persistence?
Low academic productvitiy
Poor organization
Trouble meeting deadline
Inability to follow through on social promises or commitment to peers
During elementary school, what other problems might surface?
oppositional defiant behaviors
Describe one possible developmental pathway of ADHD.
genetic risk –> prenatal alcohol/tobacco exposure, pregnancy complications –> disturbances in dopamine transmission + abnormalities in frontal lobes and basal ganglia –> failure to adequately suppress inappropriate responses –> cognitive deficits + behavioral symptoms –> impairments + parenting disruptions –> ODD and CD symptoms
With a high heritability estimate of 75%, what does it suggest about ADHD?
highly heritable can inherit a bit one
Most attention on the genes that contribute to ADHD has been on genes involved in ______________. Why?
dopamine regulation.
Dopamine is a neurotransmitter that plays a huge role in psychomotor activity and reward seeking.
Brain structures implicated in ADHD are rich in dopamine innervation, and neuroimaging studies have found evidence for dopamine dysregulation in these brain structures
What does medication for ADHD target?
Blocks the dopamine transporter (DAT1) to increase availability of dopamine in the synapse
Studies consistently show an association between ADHD and a variant of one of the dopamine receptor genes, _____.
DRD4
What is the DRD4 gene linked to?
The personality trait of sensation seeking.
How is pregnancy related to ADHD symptoms?
Mother’s use of cigarettes, alcohol, and other drugs during pregnancy - association has been established between maternal cigarette smoking during pregnancy and ADHD
exposure to alcohol may also lead to symptoms of inattention, hyperactivity, impulsivity and associated impairments in learning and behavior
Brain abnormalities in children with ADHD are related to neural circuits that deal with ______________ (5)
Which parts of the brain are affected?
- attentional processes
- inhibitory control and executive functions
- motivation
- frustration tolerance
- reward anticipation and sustained attention
Which parts of the brain are affected for ADHD?
PFC, basal ganglia
children with ADHD have smaller total and right cerebral volumes and a smaller cerebellum
specific regions of the thalamus
Some deficits associated with ADHD, such as learning temporal associations and events and their consequences, may involve a ____________ network.
cerebellar-prefrontal-striatal network
What is the default mode network in charge of?
active during rest but shut off during task engagement
What is the cognitive control network in charge of?
involved in executive functions
Delay in brain maturation in children with ADHD, particularly in the __________, has been noted.
prefrontal cortex
List 3 components in the primary treatment approach for children with ADHD.
- medication
- parent management training
- educational intervention
How does medication work for children with ADHD?
Alter activity in fronto-striatal region by affecting neurotransmitters (dopamine) important to this region.
List some advantages of taking stimulants.
increases in sustained attention, impulse control and persistence of work effort
decreases in task-irrelevant activity and noisy disruptive behaviors
improve child’s academic productivity, cooperation and social interactions
What are some limitations of taking stimulants?
magnitude and continuity of effects are uncertain.
temporary effect and problems still remain there
What is PMT for ADHD aimed at?
teaching both effective parenting strategies and practices for coping with the challenges of parenting a child with ADHD.
What does PMT teach to achieve its aim?
provide parents with a variety of skills to help them:
- manage child’s oppositional and non-compliant behaviors
- cope with the emotional demands of raising a child with ADHD
- contain the problem to ensure it does not worsen
- keep the problem from adversely affecting other family members
Parents are first taught about ADHD so that they understand the __________ of the disorder.
Why?
biological basis
Information helps to remove the burden of guilt from praents who may think they have caused the problem
Parents are also given a set of guiding principles for raising a child with ADHD, such as using more immediate, frequent and powerful consequences.
Parents are also taught behavior management principles and techniques. Provide some examples of this.
1) Identify behaviors to encourage or discourage
Use rewards and sanctions and praise child’s strengths and accomplishments
2) Disruptive behavior - use penalties
3) School-home-based reward program: teachers can evaluate on a daily report card. card serves as a means for rewards or punishments (usually tokens) that will be administered at home for classroom conduct.
To enhance coping, what else are parents taught in PMT?
reducing their own levels of arousal through relaxation, meditation or exercise
What are educational interventions focused on?
Managing inattentive and hyperactive-impulsive behaviors that interfere with learning and on providing a classroom environment that capitalizes on the child’s strengths
