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PSYC 3342 (5)
Lecture 2

Ch. 5 ADHDLEcture 2 ADHD.docx

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Douglas College
PSYC 3342

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)  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 o Requirement that symptoms must be demonstrated across at least two environments confounds settings (home, school) with informants(parent, teacher) Associated Characteristics  Cognitive deficits o Executive functions:  Cognitive processes: working memory, mental computation, planning and anticipation, flexibility of thinking, use of organizational strategies  Language processes: verbal fluency, communication, use of self-directed speech  Motor processes: allocation of effort, following prohibitive instruction, response inhibition, motor coordination and sequencing  Emotional processes: self-regulation of arousal level, tolerating frustration, mature moral reasoning o Intellectual deficits: since most kids with ADHD have at least normal intelligence to everyday life situations o Impaired academic functioning o Learning disorders common for kid with ADHD  Problem areas: reading, spelling, math  Different pathways may underlie the link between ADHD and learning disorders o Distorted self-perceptions  Positive illusory bias  Speech and language impairments o About 30-60% of kids with ADHD have impairments in speech and language  Formal speech and language disorder  Difficulty comprehending others' speech  Difficulty using appropriate language in everyday situation Excessive and loud talking   Frequent shifts/interruptions in conversation  Inability to listen  Speech production errors  Medical and physical concerns o Health related problems  Higher rates of asthma and bedwetting  Sleep disturbances, which may be related to use of stimulant medications and/or co- occurring conduct or anxiety disorder  Motor coordination difficulties; overlap with developmental coordination disorder (DCD)  20% have tic disorders o Accident proneness and risk taking  Over 50% are accident prone and at higher risk for traffic accidents  At risk for early initiation of cigarette smoking  Reduced life expectancy o Social problems o Family problems include negativity, child noncompliance. High parental control, sibling conflict, maternal depression, paternal antisocial behavior, marital conflict o Peer problems: disliked and uniformly rejected by peers, have few friends, receive low social support from peers, can't apply their social understanding in social situations Accompanying psychological disorders and symptoms  As many as 80% if kids with ADHD have a co-occurring psychological disorder  Oppositional defiant disorder (ODD) and Conduct disorder (CD) o About 50% of kids with ADHD meet criteria for ODD by age 7 or later o About 30-50% of kids with ADHD develop CD o A common predisposing cause for ADHD, ODD and CD  Genetics and shared environment  Anxiety Disorders o About 25% of kids with ADHD experience excessive anxiety, although relationship between ADHD and anxiety disorders is reduced or eliminated during adolescence  Mood disorders o As many as 20-30% of kids with ADHD experience depression o More will develop depression or another mood disorder by early adulthood  May be that family risk for one disorder increases ri
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