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Lecture 9

PSYC 356 Lecture Notes - Lecture 9: Neuroplasticity, Preterm Birth, Stimulus Control


Department
Psychology
Course Code
PSYC 356
Professor
Martin Davidson
Lecture
9

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Another Theory
- Behavioural disinhibition hypothesis (Barkley)
o Core of ADHD lack of ability to adjust activity levels to fit setting
o Not an attention deficit
o Struggle reducing AND increasing activity level
Sluggish, inattentive
Impulsivity
- Cognitive impulsivity
o Hurried thinking, disorganization
- Behavioural impulsivity
o Not inhibiting actions/responses
o Not considering consequences
o Predicting of rule-breaking behaviour
- Emotional impulsivity
o Low frustration tolerance, temper, irritability
Differential Diagnosis
- What else looks like inattention, hyperactivity and/or impulsivity?
- Anxiety (inattention, restlessness)
- Autism (disruptive/impulsive behaviour
- Conduct problems/oppositional (impulsive, disruptive, etc.)
- Sleep problems (inattention)
- What else?
o Family dysregulation
Associated Features
- Cognitive deficits
o Executive functioning: ability to plan, direct, monitor, organize behaviour towards
a goal
Behaviour regulation: manage emotions (frustration) and behaviour
Metacognition: Initiate/plan, organize, shift focus, memory, monitor)
o Intellectual
Slightly lower cognitive scores
o Academic functioning
o Learning disorders
High comorbidity (estimates vary; at least 25%)
Dyslexia? If it is not neurological it is not a learning disorder
o Self perception
HI tend to overestimate abilities/functioning
Inattentive with lower self-esteem
- Developmental Coordination
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o Problems with motor coordination common
o Clumsiness, poor handwriting, delays in motor milestones
o 30-50% comorbidity
- Tic Disorders
o Sudden, repetitive, involuntary movements (Tourette’s) or speech sounds
- Health-related issues
o Sleep disturbances
o Accident prone (see above)
o Substance use
Social and Family Issues
- Social problems
o Struggle with listening/shifting
o Tend to be more hostile/argumentative/explosive
Not all ADHD kids
o Frequent conflict
Struggle to follow rules, learn from past mistakes
o More likely to be rejected
Struggle with emotional awareness of self/others
- Family problems
o Interactions focus on compliance/direction
Pattern of negative interaction
Parents feel incompetent/helpless
Comorbidity
- Oppositional Defiant Disorder
o About 50%
- Conduct Disorder
o 30-50%
- Anxiety Disorders
o 25%
- Mood Disorders
o 20-30%
Prevalence and Course
- 6-7% of school aged children and adolescents
- More common in boys (2-6 times more common)
o Boys show more disruptive behaviour
o Inattentive girls may go unnoticed
o Criteria originally based on boys’ behaviour
o Girls show similar course and associated difficulties
Developmental Considerations
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- Not generally diagnosed before preschool
o Symptoms more normative before school age
o Criteria may not be observable until entering structure of school
- Preschool age
o Impulsivity, switching quickly between tasks, reactive to routine, difficulties with
delay of gratification/resisting temptation
- Elementary school age
o Problems with sustained attention/goal directed behaviour; distractibility; poor
performance; disorganization
o Continuity of hyperactive/impulsive symptoms and an increase in
defiane/hostility
- Adolescents
o Decrease in hyperactive/impulsive behaviour (still more prevalent than in peers)
o Can be continuous into adulthood
Restless, easily bored, constantly seeking novelty, work difficulties,
struggle to maintain relationships
Causes
- Genetics
o Runs in families
- Complications with pregnancy/birth
o Low birth weight
o Maternal stress
o Malnutrition
o Maternal substance use (cigarettes, alcohol)
- Neuro
o Prefrontal cortex + basal ganglia + cerebellum
o Delayed development in prefrontal cortex (aka sexy executive functioning area)?
- Diet/allergies
o First you get the sugar…
o Artificial food dyes? Additives/preservatives?
Controversial? Debate coming back
- Family influences
o Goodness of fit
o Is it ADHD if it’s not a problem in the context?
Treatment
- Stimulant meds (methamphetamines)
o Positive effects on inattention and hyperactivity
o Temporary effects
o Higher doses needed for hyperactivity
o Lower doses for inattention
o Side Effects
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