Chapter 7 Summary.docx

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Family Relations and Human Development
FRHD 2110
Agnieszka Woznia

Chapter 7 Summary: Learners with Attention Deficit Hyperactivity Disorder History Dr. George Still - Physician credited being one of the first to bring what is now called ADHD to attention of the medical profession - Described cases of children who displayed cruelty, impulsivity, disobedience and problems of attention and hyperactivity - Referred to them as having “defective moral control” o Involves inhibitory volition: the ability to refrain from acting in impulsively inappropriate behaviours Barkley - Based on the notion that an essential impairment in ADHD is a deficit involving behavioural inhibition - Speculated many children had mild brain pathology, many children had normal intelligence, was more prevalent in boys than girls, evidence towards heredity, many children and relatives also had other physical problems (ex: depression) Kurt Goldstein - Reported on psychological effects on brain injury in soldiers (suffered head wounds in WW1) (inability to concentrate on what was in front of them, were overly distracted by all surrounding things) - Witnessed disorganized behaviour, hyperactivity, perseveration and forced responses to stimuli - Perseveration: tendency to repeat behaviours over and over again The Strauss Syndrome - Heinz Werner and Alfred Strauss, 1930s and 1940s - Tried to replicate Goldstein’s findings and noted the same behaviours (distracted easily and hyperactivity) in children with intellectual disabilities - Did experiments showing slides with pictures and background images, children with supposed brain damage responded that they saw the background images(normally lines, ex. Wavy) - Children showing distractibility and hyperactivity were considered to be exhibiting the Strauss Syndrome William Cruickshank - 1957 - Used the experiment by Werner and Strauss with children who had cerebral palsy and had normal intelligence - Demonstrated that those without intellectual abilities could also have symptoms of distractibility and hyperactivity - Was first to create an educational program that meets criteria for ADHD - Children were referred to as “minimally brain injured” if they had normal intelligence but displayed symptoms of distractibility and hyperactivity - Replaced with label “hyperactive child syndrome” in 1960s which was preferred as it describes behaviour not on unreliable diagnosis of brain injury - By the 1980s, the label was no longer favoured, as inattention was being noted as a more important symptom to be recognized Current ADHD 3 types: 1) ADHD, predominantly inattentive type 2) ADHD, predominantly hyperactive-impulsive type 3) ADHD, combined type - To be diagnosed with a type of ADHD, 6 or more symptoms from a specific section(table 7.1) must be noted **see DSM-IV Table 7.1 (pg. 173) for Diagnostic criteria** Prevalence - most frequent reasons children are referred for behavioural problems to guidance clinics (1/3 to ½ of reported cases are due to ADHD) - more frequent in boys than girls (5:1 ratio) - boys more likely to display hyperactive-impulsive type, whereas girls are more likely to display inattentive type Assessment 4 important components to assessing if a child had ADHD: 1) Medical exam  to see if there may be another cause for the symptoms, rule out other medical conditions (ex: seizure disorders, brain tumors) 2) Clinical Interview  of parent and child, provides info on the child’s physical and psychological characteristics, family dynamics and peer interactions 3) Rating Scales  quantification to the identification process, Conner’s Scale and the ADHD Rating Scale, parents or teachers rate the child based on the 18 criteria listed on the DSM-IV (table 7.1) 4) Behavioural observation  done while child performs tasks requiring sustained attention, can be done in classrooms of clinicians observation rooms, may also use a Continuous Performance Test - Continuous Performance Test: test measuring a person’s ability to sustain attention to rapidly presented stimuli Causes - neurological dysfunction (can be caused by hereditary factors, teratogenic or other medical factors) - abnormalities in: 1) Frontal Lobe  especially in prefrontal lobes, responsible for executive functions such as the ability to regulate one’s own behaviour 2) Basal Ganglia deep within the brain, consists of several parts (caudate and Globus pallidus are those that are abnormal in ADHD) 3) Cerebellum  responsible for coordination and control of motor behaviour, contains more than half of the brain’s neurons 4) Abnormal levels in Dopamine and Norepinephrine  neurotransmitters - Hereditary factors o If a child has ADHD, 32% chance their sibling will also o Children of adults with ADHD have a 52% chance of having ADHD o If an identical twin has ADHD, it is likely that the second twin will also - Toxins and Medical factors o Toxins: poisons in the environment that can cause fetal malformations and can result in cognitive impairments o Complications at birth, low birth rate and use of alcohol during pregnancy increase the risk of ADHD in a child o Evidence not as strong as for hereditary factors Psychological and Behavioural Characteristics - Inattention, hyperactivity and impulsivity are a result of problems in behavioural inhibition (switching mentally from one task to another) Barkley’s Model of ADHD - Model proposes that problems in behavioural inhibition set the stage for problems in executive functions and time management, disrupting the person’s ability to engage in persistent goal directed behaviour - Behavioural inhibition involves the ability to: o Delay a response o Interrupt an ongoing response if one detects that it is inappropriate o Protect a response from distracting and competing stimuli - Executive Behaviours: the ability to regulate one’s behaviour through working memory, inner speech, control of emotions and arousal levels and analysis of problem solutions to others - Prefrontal and frontal lobes control executive functions which relates to how those with ADHD often have abnormalities in these areas - Inner Speech: internal language used to regulate ones behaviour, delayed or impaired in those with ADHD - Deficit in time awareness and management - With the problems in executive functions, results can be deficits in engaging in goal directed activities, take a toll on self-regulation Support students with ADHD through transitions - Allow time in between asking a student to do or say something and expecting it to occur - Avoiding overloading a student’s working memory by limiting the number of steps or sequence of procedures a student must keep in working memory by providing a visual for students to refer to - Create routine procedures for daily transitions - Preparing students for the type of response that will be required when asking a question - Dividing instruction into consistent, predictable sequences throughout the day Adaptive Skills - Traditionally associated with the area of intellectual disability - Adaptive Skills: skills needed to adapt to one’s living environment (ex: communication, self- care, social skills, health and safety, functional academics, leisure and work) Problems Socializing with Peers - Majority of those with ADHD experience significant problems in peer relations - Others often find those with ADHD uncomfortable to be around - Social rejection leads to social isolation - Children and adults with ADHD have few friends, and desperately want to be liked - Viewed as rude by others due to their lack of ability to regulate their behaviour Coexisting Conditions - ADHD often occurs along with other behavioral and learning problems - Those with ADHD have a higher risk of substance abuse 1) Learning Disabilities  diagnostic criteria overlap of 10-20% between ADHD and learning disabilities, strongest between ADHD, predominantly inattentive type 2) Emotional of Behavioural Disorders  25-50% of people with ADHD also exhibit some form of emotional or behavioural disorder, some exhibit aggressive acting out behaviours while others have withdrawn behaviours that accompany anxiety or depression 3) Substance abuse  adults with ADHD are twice as likely to abuse alcohol or become dependent on drugs, children with ADHD are extremely vulnerable for early drug use, adults with ADHD are twice as likely to smoke cigarettes Ed
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