PSYC 3342 Lecture Notes - Lecture 2: Developmental Coordination Disorder, Oppositional Defiant Disorder, Attention Deficit Hyperactivity Disorder Predominantly Inattentive

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6 Feb 2013
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ADHD
Description and History
Description
o Attention-deficit/hyperactivity disorder(ADHD) describes kids who display persistent age-
inappropriate symptoms of inattention, hyperactivity and impulsivity that are sufficient to
cause impairment in major life activities
o New name, not new disorder
o No distinct physical signs: identified through characteristics patterns of behavior
o These characteristic patterns vary from child to child
o Different patterns of behavior may have different causes
History
o Early 1900s: kids who lack self-control and showed symptoms of overactivity/inattention in
school were said to have poor " inhibitory volition" and "defective moral control"
Worldwide influenza epidemic of 1917-1926
o "brain injured kid syndrome" (often associated with mental retardation): kids who
developed and survived encephalitis during epidemic and those who suffered birth trauma,
head injury or exposure to toxins
o Concept evolved to "minimal brain damage" and "minimal brain dysfunction" in the 1940s
and 1950s because some kids displayed similar behaviors with no evidence of brain damage
or mental retardation
o In late 1950s: called hyperkinesis and was attributed to poor filtering of stimuli entering the
brain
Led to definition of hyperactive child syndrome; motor overactivity was seen as main
feature of ADHD
Soon recognized another problem: kid's failure to regulate motor activity in relation to
situational demands
o By 1970s, deficits in attention and impulse control, in addition to hyperactivity, were seen as
they primary symptoms
o Most recently, there's a focus on problems in self-regulation, behavioral inhibition and
motivational deficits
Core Characteristics
Key symptoms fall under two -well documented categories: inattention and hyperactivity-
impulsivity
Using these two dimensions to define ADHD oversimplifies the disorder
o Each dimension includes many distinct processes
o Although discussed separately, attention and impulse control are closely connected
developmentally
Inattention (IA)
o Difficulty, during work or play, to focus on one task or to follow through on requests of
instructions
Inability to sustain attention, particularly for repetitive, structured, and less enjoyable
tasks
Deficits may be seen in one or more types of attention
Attentional capacity
Selective attention/distractibility
Sustained attention/vigilance (core feature of ADHD)
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May be a problem in alerting (the ability to prepare for what is about to
happen)
Hyperactivity-impulsivity (HI)
o Strong link between hyperactivity and impulsivity, suggesting both are fundamental deficits
in regulating behavior
o Hyperactivity (HI): primary impairment in HI is inability to voluntarily inhibit dominant or
ongoing behavior
o Hyperactive behaviors include:
Fidgeting, difficulty staying seated when required
Moving, running, climbing about, touching everything in sight
Excessive talking and pencil tapping
Accomplishing little despite extreme activity
o Impulsivity (IA): unable to control immediate reactions or think before acting
Cognitive impulsivity: disorganization, hurried thinking, need for supervision
Behavioral impulsivity: difficulty inhibiting responses when situations require it
o The primary attention deficit in ADHD is an inability to engage and sustain attention and to
follow through on directions or rules while resisting salient distractions
Subtypes
o Predominantly inattentive type (ADHD-PI): primary symptoms of inattention
Inattentive, drowsy, daydreamy, spacey, in a fog, easily confused
May have learning disability, process information slowly, have trouble remembering
things, have low academic achievement
Often anxious, apprehensive, socially withdrawn, with mood disorders
o Predominantly Hyperactive-Impulsive Type (ADHD-HI): primarily symptoms of hyperactivity-
impulsivity (rarest group)
Preschoolers; limited validity for older kids
May be a distinct subtype of ADHD-C
o Combined type (ADHD-C) : kids who have symptoms of both inattention and hyperactivity-
impulsivity; most often referred for treatment
o Kids with ADHD-HI and ADHD-C are more likely to display:
Problems inhibiting behavior
Problems with behavioral persistence
Aggressiveness, defiance, peer rejection, suspension from school, and placement in
special education classes
Additional DSM Criteria
o Behavior appears prior to age 7
o Occurs more often/with greater severity than in other kids of the same age and sex
o Continue for more than 6 months
o Behaviors occur across several settings
o Produce significant impairments in kid's social of academic performance
o Behaviors not due to another disorder or serious life stressor
Important to assess both symptoms and impairments
What DSM doesn’t tell us
o Developmentally insensitive
o Categorical view of ADHD
requirement of an onset before age 7 uncertain
o Requirement of persistence for 6 months may be too brief for young kids
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