PSY341H5 Lecture 6: Week 6 Attention-Deficit/Hyperactivity Disorder

60 views15 pages
23 Oct 2018
School
Department
Course
Professor
Externalizing behaviour disorders
Want to focus on consequences and causes of these disorders
Attention deficit/hyperactivity disorder
Neurological disorder to do with attention, hyperactivity, and impulsivity
Social problems
Conduct disorder
Oppositional defiant disorder
Video clip:
A child's perspective of ADHD
Description
ADHD is exhibited as persistent age-inappropriate symptoms of inattention,
hyperactivity, and impulsivity that are sufficient to cause impairment in major
life activities
Course and outcome
Infancy
Signs of ADHD may be present at birth - no reliable or valid methods exist
to identify it
Preschool
Hyperactivity-impulsivity symptoms become more visible and significant
at ages 3-4
More visible symptoms
Course and outcomes in elementary school
Symptoms are especially evident when the child starts school
Oppositional defiant behaviors may increase or develop
Course and outcome in adolescence and adulthood
Many children with ADHD do not outgrow problems and some can get much
worse
At least 50% of clinic-referred elementary school children continue to stuffer
from ADHD into adolescence
Adult challenges - learn to cope
If not being treated it tends to stabilize through late childhood
Long-term consequences of ADHD
Video clip
Couldn’t stay focused, couldn’t stay on task
Look out for warning signs and look out for their children with ADHD
History (1 of 2)
Early 1900's
Following the worldwide influenza epidemic from 1917 to 1926
1940's-1050's: minimal brain damage
History (2 of 2)
Late 1950's
ADHD was called hyperkinesis
By the 1970's
Deficits in attention and impulse control, in addition to hyperactivity,
were seen as the primary symptoms
1980's saw increased interest in ADHD
Children's literature
German psychiatrist Heinrich Hoffmann
Video clip: the story of fidgety philipp
Core symptoms of ADHD
Inattention - hard to listen to instructions, etc.
Hyperactivity - fidgeting, cant sit still, difficulty engaging in quiet activities
Impulsivity - bursting out words, talking while others are talking, interrupting
others
Core characteristics
Key symptoms fall under two-well documented categories
Hyperactivity/impulsivity
Inattention
Using these dimensions to define ADHD oversimplifies the disorder
Inattention
Inability to sustain attention, particularly for repetitive, structured, and less
enjoyable tasks
Distractibility - can you do 2 things at once
Sustained attention issue
Deficits may be seen in one or more types of attention
Hyperactivity/impulsivity
Inability to voluntarily inhibit dominant or ongoing behavior
Hyperactive behaviours include
Impulsivity
Touching everything
Excessively talking
Fidgeting
Inability to control reactions
Disorganized
Emotional impulsivity: high temper, anger outbursts
ADHD presentation types
Predominantly inattentive presentation (ADHD-PI)
Kid shows symptoms of inattention
Related to learning disability
Process information slowly
Anxious
Mood disorders
Predominantly hyperactive-impulsive presentation (ADHD-HI)
Media/public considers
Preschool period
Limited ability for other age periods
Combined presentation (ADHD-C)
Both types occur in varying severity
More severe cases
Often referred to treatment
Additional DSM criteria
Appears prior to age 12
Persists more than 6 months
Occurs more often and with greater severity than in:
Kids of the same age and gender
Occurs across 2 or more settings
Interferes with social or academic performance
Not explained by another disorder
Limitations of DSM criteria for ADHD
DSM criteria shape our understanding of ADHD
Associated characteristics
Children with ADHD often display other problems in addition to their primary
difficulties
Cognitive deficits
Speech and language impairments
Developmental coordination and tic disorders Medical and physical
concerns
Social problems
Cognitive deficits: intellectual and academic
Intellectual deficits
Normal intelligence
Cannot apply the intelligence to everyday situations, including school
Impaired academic functioning
Typically do poorer in school
More of a consequence
Cognitive deficits: learning disorders and self-perceptions
Learning disorders are common for children with ADHD
Reading, math
School structures don’t help those kids to learn
Distorted self-perceptions
Positive illusory bias - extenuate themselves, see themselves too
positively
Speech and language impairments
Formal speech and language disorders
Difficulty understanding others’ speech
Excessive and loud talking
Frequent shifts and interruptions in conversation
Inability to listen
Inappropriate conversations
Speech production errors
Developmental coordination and tic disorders
As many as 30-50% of children with ADHD display motor coordination difficulties
Poor performance in sports or poor handwriting
Overlap exists between ADHD and developmental coordination disorder (DCD)
Tic disorders occur in 20% of children with ADHD
Medical and physical concerns
Health-related problems
Higher rates of asthma and bedwetting
Bedwetting very common
Sleep disturbances may be related to use of stimulant medications and/or co-
occurring conduct or anxiety disorders
Accident-proneness, risk taking, and impulsivity
Social problems
Family problems include:
Negativity, sibling conflict, maternal depression, paternal antisocial behavior, and
marital conflict
Family difficulties may be due to co-occurring conduct problems
Peer problems
ADHD children can be bothersome, stubborn, socially awkward, and socially
insensitive
Accompanying psychological disorders and symptoms
Up to 80% of children with ADHD have a co-occurring psychological disorder
Oppositional defiant disorder (ODD) and conduct disorder (CD)
Anxiety disorders
30-40% experience excessive anxiety
Accompanying psychological disorders and symptoms mood disorders
Mood disorders
Depression, anxiety
Prevalence rates vary widely with sampling methods
Approx. 6-7% of school age children
Gender
ADHD occurs more frequently in boys
Overall rates decrease in adolescence for both sexes - ratio remain
the same
Ratio in clinical samples is 6:1, with boys being referred more often than girls
DSM criteria (cutoffs and symptoms) may be more appropriate to boys than girls
Girls with ADHD may be more likely to display inattentive/ disorganized symptoms
Clinic-referred school-age children with ADHD display similar symptoms
Girls with ADHD who display impulsive-hyperactive behaviors
Socioeconomic status and culture
ADHD affects children from all social classes
Findings are inconsistent regarding relationships among ADHD,
race, and ethnicity
ADHD is found in all countries and cultures
Cultural differences may reflect cultural norms and tolerance for ADHD symptoms
ADHD is a universal phenomenon that is diagnosed more often in boys than girls in
all cultures
Outcomes, causes, etc. similar for wherever it is found in the world
Theories and causes
Explanations for ADHD
Trait from evolutionary past as hunters
ADHD is a myth fabricated because society needs it
Some theories
Cognitive functioning deficits
Reward/motivation deficits
Arousal level deficits
Self-regulation deficits
Genetic influences
ADHD runs in families
Adoption studies
Twin studies
75% heritability estimates
Specific gene studies
Focus on serotonin system
Pregnancy, birth, and early development
Factors that compromise development of the nervous system before and after birth
may be related to ADHD
Mother's use of cigarettes, alcohol, and other drugs during pregnancy are associated
with ADHD
Neurobiological factors
Research shows differences on:
Measures of brain activity during vigilance tests
Blood flow to prefrontal regions and pathways connecting them to limbic
system
Brain abnormalities
Abnormalities primarily in the frontostriatal circuitry are implicated
Specific regions of the thalamus may also be involved
Diet, allergy, and lead
Sugar is not the cause of hyperactivity
Allergic reactions and diet
Low levels of lead may be associated with ADHD symptoms
The role of diet, allergy, and lead is still in the research phase
Family influences
Importance of family influences
Family influences may lead to ADHD symptoms or to
a greater severity of symptoms
Family problems may result from interacting with a child who is difficult to
manage
Family conflict is likely related to the presence, persistence, or later emergence
of associated oppositional and conduct disorder
Activity
Discussion: discuss some of the commonly use explanations for emergence of ADHD,
compare and contrast them in terms of persuasiveness
Biological: parents don’t blame themselves
Developmental: pathways in symptoms
Family influences: family history, correct the families behaviour, show empathy,
acknowledge their frustrations
Does the child's age and development matter? If so, how?
BREAK
Treatment
Less than half of the children with ADHD receive treatment
The primary treatment approach combines:
Stimulant medication
Parent management training
Educational intervention
Treatment of ADHD
Drug therapy: psychostimulants such as ritalin are most used, based on presumed
link to dopamine
Dopamine is what needs to be changed in children with ADHD
The treatment of ADHD with medication is connected to a number of controversies
Behavioural interventions: reinforcing appropriate behaviours, token economies
Medication
Stimulants have been used to treat ADHD since the 1930's
Among the most effective stimulants are dextroamphetamine and
methlyphenidate
Effects are temporary and occur only while medication is taken, beneficial in
the short term
Medication
Homework
Medication search: ritalin and strattera
Why are physicians, pediatricians, teachers, and parents so interested in
strattera?
Compare and contrast the 2 drugs
Medication
Discussion
There are several cases in which parents have been charged with educational neglect
for choosing not to give their child Ritalin (e.g., “Parents lose fight to take 8-year-old
off Ritalin: Child’s hyperactivity disrupted classes, school officials say”. The Sunday
Gazette Mail, Oct 22, 2000, Charleston, West Virginia, http://www.wvgazette.com).
How much influence should schools have in deciding whether a child should be
placed on stimulant medication?
Put pressure on parents to make classroom environments regular
It should be parents decision, but schools should have some say because it is
very disruptive
Dilemma: should we adjust to the child or should the school accommodate to
the child's needs?
Parent management training (PMT 1 of 2)
Provides parents with a variety of skills
Managing the child’s oppositional and noncompliant behaviors
Coping with emotional demands of raising a child with ADHD
Containing the problem so it does not worsen and does not affect other family
members such as siblings
Parent management training (PMT 2 of 2)
Parents are:
Taught to understand biological basis of ADHD
Given a set of guiding principles
Taught behavior management principles and techniques
Token economies - daily report cards, providing rewards based on behaviours
Educational intervention
Teacher and child must set realistic goals and objectives
Response-cost procedures are used to reduce disruptive or off-task behaviors
Many strategies are basic good teaching methods
School-based interventions for ADHD have received considerable support
Educational intervention
Activity video clip: do you see (non) effective strategies that the teacher is using?
Video 1 Positive: teacher was patient, and acknowledged what jojo was talking
about, reinforcing his good actions, acknowledged the bully
Video 1 Negative: when he involved every student in the conflict and let them
listen it was not effective,
Video 2 positive: brought attention to work being important, teacher cared
about him, not experiencing the punishment as a punishment, open-ended
communication
Video 2 negative: drew attention to the fact that jojo stayed in from play time
to finish his work
Intensive interventions
Summer treatment programs
Maximize opportunities to build effective peer relations in normal settings and
provide continuity with academic work so gains from school year aren’t lost
Are coordinated with stimulant medication trials, PMT, social skills training,
and educational interventions
Help to increase better peer relationships
Additional interventions
Family counseling and support groups
Group therapy for families with similar issues
Individual counseling
Helps the child exponentially
Helps children to feel less abnormal
Activity: treatment of ADHD
Instructions: Think of specific behaviours that a child with ADHD may have difficulty
with on a daily basis (e.g., remembering to take completed homework to school;
sitting still during dinner; not asking parental permission before doing something,
etc.). Then write several clear, specific, and positive statements about behaviors that
you would like to see the child perform every day. One example is already provided.
Try to come up with at least five more. Finally, decide on appropriate rewards and
punishments that could easily be given to the child on a daily basis, depending on the
child’s total point value at the end of the day. Remember that rewards and
punishments should be specific and short term (such as “30 minutes of video games
that night”).
Keeping things in perspective
Children with ADHD have problems that should not be minimized
Each child is unique and has assets and resources that need to be recognized and
supported
Week 5: Attention-Deficit/Hyperactivity Disorder
Monday, October 22, 2018
2:29 PM
Unlock document

This preview shows pages 1-3 of the document.
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Externalizing behaviour disorders
Want to focus on consequences and causes of these disorders
Attention deficit/hyperactivity disorder
Neurological disorder to do with attention, hyperactivity, and impulsivity
Social problems
Conduct disorder
Oppositional defiant disorder
Video clip:
A child's perspective of ADHD
Description
ADHD is exhibited as persistent age-inappropriate symptoms of inattention,
hyperactivity, and impulsivity that are sufficient to cause impairment in major
life activities
Course and outcome
Infancy
Signs of ADHD may be present at birth - no reliable or valid methods exist
to identify it
Preschool
Hyperactivity-impulsivity symptoms become more visible and significant
at ages 3-4
More visible symptoms
Course and outcomes in elementary school
Symptoms are especially evident when the child starts school
Oppositional defiant behaviors may increase or develop
Course and outcome in adolescence and adulthood
Many children with ADHD do not outgrow problems and some can get much
worse
At least 50% of clinic-referred elementary school children continue to stuffer
from ADHD into adolescence
Adult challenges - learn to cope
If not being treated it tends to stabilize through late childhood
Long-term consequences of ADHD
Video clip
Couldn’t stay focused, couldn’t stay on task
Look out for warning signs and look out for their children with ADHD
History (1 of 2)
Early 1900's
Following the worldwide influenza epidemic from 1917 to 1926
1940's-1050's: minimal brain damage
History (2 of 2)
Late 1950's
ADHD was called hyperkinesis
By the 1970's
Deficits in attention and impulse control, in addition to hyperactivity,
were seen as the primary symptoms
1980's saw increased interest in ADHD
Children's literature
German psychiatrist Heinrich Hoffmann
Video clip: the story of fidgety philipp
Core symptoms of ADHD
Inattention - hard to listen to instructions, etc.
Hyperactivity - fidgeting, cant sit still, difficulty engaging in quiet activities
Impulsivity - bursting out words, talking while others are talking, interrupting
others
Core characteristics
Key symptoms fall under two-well documented categories
Hyperactivity/impulsivity
Inattention
Using these dimensions to define ADHD oversimplifies the disorder
Inattention
Inability to sustain attention, particularly for repetitive, structured, and less
enjoyable tasks
Distractibility - can you do 2 things at once
Sustained attention issue
Deficits may be seen in one or more types of attention
Hyperactivity/impulsivity
Inability to voluntarily inhibit dominant or ongoing behavior
Hyperactive behaviours include
Impulsivity
Touching everything
Excessively talking
Fidgeting
Inability to control reactions
Disorganized
Emotional impulsivity: high temper, anger outbursts
ADHD presentation types
Predominantly inattentive presentation (ADHD-PI)
Kid shows symptoms of inattention
Related to learning disability
Process information slowly
Anxious
Mood disorders
Predominantly hyperactive-impulsive presentation (ADHD-HI)
Media/public considers
Preschool period
Limited ability for other age periods
Combined presentation (ADHD-C)
Both types occur in varying severity
More severe cases
Often referred to treatment
Additional DSM criteria
Appears prior to age 12
Persists more than 6 months
Occurs more often and with greater severity than in:
Kids of the same age and gender
Occurs across 2 or more settings
Interferes with social or academic performance
Not explained by another disorder
Limitations of DSM criteria for ADHD
DSM criteria shape our understanding of ADHD
Associated characteristics
Children with ADHD often display other problems in addition to their primary
difficulties
Cognitive deficits
Speech and language impairments
Developmental coordination and tic disorders Medical and physical
concerns
Social problems
Cognitive deficits: intellectual and academic
Intellectual deficits
Normal intelligence
Cannot apply the intelligence to everyday situations, including school
Impaired academic functioning
Typically do poorer in school
More of a consequence
Cognitive deficits: learning disorders and self-perceptions
Learning disorders are common for children with ADHD
Reading, math
School structures don’t help those kids to learn
Distorted self-perceptions
Positive illusory bias - extenuate themselves, see themselves too
positively
Speech and language impairments
Formal speech and language disorders
Difficulty understanding others’ speech
Excessive and loud talking
Frequent shifts and interruptions in conversation
Inability to listen
Inappropriate conversations
Speech production errors
Developmental coordination and tic disorders
As many as 30-50% of children with ADHD display motor coordination difficulties
Poor performance in sports or poor handwriting
Overlap exists between ADHD and developmental coordination disorder (DCD)
Tic disorders occur in 20% of children with ADHD
Medical and physical concerns
Health-related problems
Higher rates of asthma and bedwetting
Bedwetting very common
Sleep disturbances may be related to use of stimulant medications and/or co-
occurring conduct or anxiety disorders
Accident-proneness, risk taking, and impulsivity
Social problems
Family problems include:
Negativity, sibling conflict, maternal depression, paternal antisocial behavior, and
marital conflict
Family difficulties may be due to co-occurring conduct problems
Peer problems
ADHD children can be bothersome, stubborn, socially awkward, and socially
insensitive
Accompanying psychological disorders and symptoms
Up to 80% of children with ADHD have a co-occurring psychological disorder
Oppositional defiant disorder (ODD) and conduct disorder (CD)
Anxiety disorders
30-40% experience excessive anxiety
Accompanying psychological disorders and symptoms mood disorders
Mood disorders
Depression, anxiety
Prevalence rates vary widely with sampling methods
Approx. 6-7% of school age children
Gender
ADHD occurs more frequently in boys
Overall rates decrease in adolescence for both sexes - ratio remain
the same
Ratio in clinical samples is 6:1, with boys being referred more often than girls
DSM criteria (cutoffs and symptoms) may be more appropriate to boys than girls
Girls with ADHD may be more likely to display inattentive/ disorganized symptoms
Clinic-referred school-age children with ADHD display similar symptoms
Girls with ADHD who display impulsive-hyperactive behaviors
Socioeconomic status and culture
ADHD affects children from all social classes
Findings are inconsistent regarding relationships among ADHD,
race, and ethnicity
ADHD is found in all countries and cultures
Cultural differences may reflect cultural norms and tolerance for ADHD symptoms
ADHD is a universal phenomenon that is diagnosed more often in boys than girls in
all cultures
Outcomes, causes, etc. similar for wherever it is found in the world
Theories and causes
Explanations for ADHD
Trait from evolutionary past as hunters
ADHD is a myth fabricated because society needs it
Some theories
Cognitive functioning deficits
Reward/motivation deficits
Arousal level deficits
Self-regulation deficits
Genetic influences
ADHD runs in families
Adoption studies
Twin studies
75% heritability estimates
Specific gene studies
Focus on serotonin system
Pregnancy, birth, and early development
Factors that compromise development of the nervous system before and after birth
may be related to ADHD
Mother's use of cigarettes, alcohol, and other drugs during pregnancy are associated
with ADHD
Neurobiological factors
Research shows differences on:
Measures of brain activity during vigilance tests
Blood flow to prefrontal regions and pathways connecting them to limbic
system
Brain abnormalities
Abnormalities primarily in the frontostriatal circuitry are implicated
Specific regions of the thalamus may also be involved
Diet, allergy, and lead
Sugar is not the cause of hyperactivity
Allergic reactions and diet
Low levels of lead may be associated with ADHD symptoms
The role of diet, allergy, and lead is still in the research phase
Family influences
Importance of family influences
Family influences may lead to ADHD symptoms or to
a greater severity of symptoms
Family problems may result from interacting with a child who is difficult to
manage
Family conflict is likely related to the presence, persistence, or later emergence
of associated oppositional and conduct disorder
Activity
Discussion: discuss some of the commonly use explanations for emergence of ADHD,
compare and contrast them in terms of persuasiveness
Biological: parents don’t blame themselves
Developmental: pathways in symptoms
Family influences: family history, correct the families behaviour, show empathy,
acknowledge their frustrations
Does the child's age and development matter? If so, how?
BREAK
Treatment
Less than half of the children with ADHD receive treatment
The primary treatment approach combines:
Stimulant medication
Parent management training
Educational intervention
Treatment of ADHD
Drug therapy: psychostimulants such as ritalin are most used, based on presumed
link to dopamine
Dopamine is what needs to be changed in children with ADHD
The treatment of ADHD with medication is connected to a number of controversies
Behavioural interventions: reinforcing appropriate behaviours, token economies
Medication
Stimulants have been used to treat ADHD since the 1930's
Among the most effective stimulants are dextroamphetamine and
methlyphenidate
Effects are temporary and occur only while medication is taken, beneficial in
the short term
Medication
Homework
Medication search: ritalin and strattera
Why are physicians, pediatricians, teachers, and parents so interested in
strattera?
Compare and contrast the 2 drugs
Medication
Discussion
There are several cases in which parents have been charged with educational neglect
for choosing not to give their child Ritalin (e.g., “Parents lose fight to take 8-year-old
off Ritalin: Child’s hyperactivity disrupted classes, school officials say”. The Sunday
Gazette Mail, Oct 22, 2000, Charleston, West Virginia, http://www.wvgazette.com).
How much influence should schools have in deciding whether a child should be
placed on stimulant medication?
Put pressure on parents to make classroom environments regular
It should be parents decision, but schools should have some say because it is
very disruptive
Dilemma: should we adjust to the child or should the school accommodate to
the child's needs?
Parent management training (PMT 1 of 2)
Provides parents with a variety of skills
Managing the child’s oppositional and noncompliant behaviors
Coping with emotional demands of raising a child with ADHD
Containing the problem so it does not worsen and does not affect other family
members such as siblings
Parent management training (PMT 2 of 2)
Parents are:
Taught to understand biological basis of ADHD
Given a set of guiding principles
Taught behavior management principles and techniques
Token economies - daily report cards, providing rewards based on behaviours
Educational intervention
Teacher and child must set realistic goals and objectives
Response-cost procedures are used to reduce disruptive or off-task behaviors
Many strategies are basic good teaching methods
School-based interventions for ADHD have received considerable support
Educational intervention
Activity video clip: do you see (non) effective strategies that the teacher is using?
Video 1 Positive: teacher was patient, and acknowledged what jojo was talking
about, reinforcing his good actions, acknowledged the bully
Video 1 Negative: when he involved every student in the conflict and let them
listen it was not effective,
Video 2 positive: brought attention to work being important, teacher cared
about him, not experiencing the punishment as a punishment, open-ended
communication
Video 2 negative: drew attention to the fact that jojo stayed in from play time
to finish his work
Intensive interventions
Summer treatment programs
Maximize opportunities to build effective peer relations in normal settings and
provide continuity with academic work so gains from school year aren’t lost
Are coordinated with stimulant medication trials, PMT, social skills training,
and educational interventions
Help to increase better peer relationships
Additional interventions
Family counseling and support groups
Group therapy for families with similar issues
Individual counseling
Helps the child exponentially
Helps children to feel less abnormal
Activity: treatment of ADHD
Instructions: Think of specific behaviours that a child with ADHD may have difficulty
with on a daily basis (e.g., remembering to take completed homework to school;
sitting still during dinner; not asking parental permission before doing something,
etc.). Then write several clear, specific, and positive statements about behaviors that
you would like to see the child perform every day. One example is already provided.
Try to come up with at least five more. Finally, decide on appropriate rewards and
punishments that could easily be given to the child on a daily basis, depending on the
child’s total point value at the end of the day. Remember that rewards and
punishments should be specific and short term (such as “30 minutes of video games
that night”).
Keeping things in perspective
Children with ADHD have problems that should not be minimized
Each child is unique and has assets and resources that need to be recognized and
supported
Week 5: Attention-Deficit/Hyperactivity Disorder
Monday, October 22, 2018 2:29 PM
Unlock document

This preview shows pages 1-3 of the document.
Unlock all 15 pages and 3 million more documents.

Already have an account? Log in
Externalizing behaviour disorders
Want to focus on consequences and causes of these disorders
Attention deficit/hyperactivity disorder
Neurological disorder to do with attention, hyperactivity, and impulsivity
Social problems
Conduct disorder
Oppositional defiant disorder
Video clip:
A child's perspective of ADHD
Description
ADHD is exhibited as persistent age-inappropriate symptoms of inattention,
hyperactivity, and impulsivity that are sufficient to cause impairment in major
life activities
Course and outcome
Infancy
Signs of ADHD may be present at birth - no reliable or valid methods exist
to identify it
Preschool
Hyperactivity-impulsivity symptoms become more visible and significant
at ages 3-4
More visible symptoms
Course and outcomes in elementary school
Symptoms are especially evident when the child starts school
Oppositional defiant behaviors may increase or develop
Course and outcome in adolescence and adulthood
Many children with ADHD do not outgrow problems and some can get much
worse
At least 50% of clinic-referred elementary school children continue to stuffer
from ADHD into adolescence
Adult challenges - learn to cope
If not being treated it tends to stabilize through late childhood
Long-term consequences of ADHD
Video clip
Couldn’t stay focused, couldn’t stay on task
Look out for warning signs and look out for their children with ADHD
History (1 of 2)
Early 1900's
Following the worldwide influenza epidemic from 1917 to 1926
1940's-1050's: minimal brain damage
History (2 of 2)
Late 1950's
ADHD was called hyperkinesis
By the 1970's
Deficits in attention and impulse control, in addition to hyperactivity,
were seen as the primary symptoms
1980's saw increased interest in ADHD
Children's literature
German psychiatrist Heinrich Hoffmann
Video clip: the story of fidgety philipp
Core symptoms of ADHD
Inattention - hard to listen to instructions, etc.
Hyperactivity - fidgeting, cant sit still, difficulty engaging in quiet activities
Impulsivity - bursting out words, talking while others are talking, interrupting
others
Core characteristics
Key symptoms fall under two-well documented categories
Hyperactivity/impulsivity
Inattention
Using these dimensions to define ADHD oversimplifies the disorder
Inattention
Inability to sustain attention, particularly for repetitive, structured, and less
enjoyable tasks
Distractibility - can you do 2 things at once
Sustained attention issue
Deficits may be seen in one or more types of attention
Hyperactivity/impulsivity
Inability to voluntarily inhibit dominant or ongoing behavior
Hyperactive behaviours include
Impulsivity
Touching everything
Excessively talking
Fidgeting
Inability to control reactions
Disorganized
Emotional impulsivity: high temper, anger outbursts
ADHD presentation types
Predominantly inattentive presentation (ADHD-PI)
Kid shows symptoms of inattention
Related to learning disability
Process information slowly
Anxious
Mood disorders
Predominantly hyperactive-impulsive presentation (ADHD-HI)
Media/public considers
Preschool period
Limited ability for other age periods
Combined presentation (ADHD-C)
Both types occur in varying severity
More severe cases
Often referred to treatment
Additional DSM criteria
Appears prior to age 12
Persists more than 6 months
Occurs more often and with greater severity than in:
Kids of the same age and gender
Occurs across 2 or more settings
Interferes with social or academic performance
Not explained by another disorder
Limitations of DSM criteria for ADHD
DSM criteria shape our understanding of ADHD
Associated characteristics
Children with ADHD often display other problems in addition to their primary
difficulties
Cognitive deficits
Speech and language impairments
Developmental coordination and tic disorders Medical and physical
concerns
Social problems
Cognitive deficits: intellectual and academic
Intellectual deficits
Normal intelligence
Cannot apply the intelligence to everyday situations, including school
Impaired academic functioning
Typically do poorer in school
More of a consequence
Cognitive deficits: learning disorders and self-perceptions
Learning disorders are common for children with ADHD
Reading, math
School structures don’t help those kids to learn
Distorted self-perceptions
Positive illusory bias - extenuate themselves, see themselves too
positively
Speech and language impairments
Formal speech and language disorders
Difficulty understanding others’ speech
Excessive and loud talking
Frequent shifts and interruptions in conversation
Inability to listen
Inappropriate conversations
Speech production errors
Developmental coordination and tic disorders
As many as 30-50% of children with ADHD display motor coordination difficulties
Poor performance in sports or poor handwriting
Overlap exists between ADHD and developmental coordination disorder (DCD)
Tic disorders occur in 20% of children with ADHD
Medical and physical concerns
Health-related problems
Higher rates of asthma and bedwetting
Bedwetting very common
Sleep disturbances may be related to use of stimulant medications and/or co-
occurring conduct or anxiety disorders
Accident-proneness, risk taking, and impulsivity
Social problems
Family problems include:
Negativity, sibling conflict, maternal depression, paternal antisocial behavior, and
marital conflict
Family difficulties may be due to co-occurring conduct problems
Peer problems
ADHD children can be bothersome, stubborn, socially awkward, and socially
insensitive
Accompanying psychological disorders and symptoms
Up to 80% of children with ADHD have a co-occurring psychological disorder
Oppositional defiant disorder (ODD) and conduct disorder (CD)
Anxiety disorders
30-40% experience excessive anxiety
Accompanying psychological disorders and symptoms mood disorders
Mood disorders
Depression, anxiety
Prevalence rates vary widely with sampling methods
Approx. 6-7% of school age children
Gender
ADHD occurs more frequently in boys
Overall rates decrease in adolescence for both sexes - ratio remain
the same
Ratio in clinical samples is 6:1, with boys being referred more often than girls
DSM criteria (cutoffs and symptoms) may be more appropriate to boys than girls
Girls with ADHD may be more likely to display inattentive/ disorganized symptoms
Clinic-referred school-age children with ADHD display similar symptoms
Girls with ADHD who display impulsive-hyperactive behaviors
Socioeconomic status and culture
ADHD affects children from all social classes
Findings are inconsistent regarding relationships among ADHD,
race, and ethnicity
ADHD is found in all countries and cultures
Cultural differences may reflect cultural norms and tolerance for ADHD symptoms
ADHD is a universal phenomenon that is diagnosed more often in boys than girls in
all cultures
Outcomes, causes, etc. similar for wherever it is found in the world
Theories and causes
Explanations for ADHD
Trait from evolutionary past as hunters
ADHD is a myth fabricated because society needs it
Some theories
Cognitive functioning deficits
Reward/motivation deficits
Arousal level deficits
Self-regulation deficits
Genetic influences
ADHD runs in families
Adoption studies
Twin studies
75% heritability estimates
Specific gene studies
Focus on serotonin system
Pregnancy, birth, and early development
Factors that compromise development of the nervous system before and after birth
may be related to ADHD
Mother's use of cigarettes, alcohol, and other drugs during pregnancy are associated
with ADHD
Neurobiological factors
Research shows differences on:
Measures of brain activity during vigilance tests
Blood flow to prefrontal regions and pathways connecting them to limbic
system
Brain abnormalities
Abnormalities primarily in the frontostriatal circuitry are implicated
Specific regions of the thalamus may also be involved
Diet, allergy, and lead
Sugar is not the cause of hyperactivity
Allergic reactions and diet
Low levels of lead may be associated with ADHD symptoms
The role of diet, allergy, and lead is still in the research phase
Family influences
Importance of family influences
Family influences may lead to ADHD symptoms or to
a greater severity of symptoms
Family problems may result from interacting with a child who is difficult to
manage
Family conflict is likely related to the presence, persistence, or later emergence
of associated oppositional and conduct disorder
Activity
Discussion: discuss some of the commonly use explanations for emergence of ADHD,
compare and contrast them in terms of persuasiveness
Biological: parents don’t blame themselves
Developmental: pathways in symptoms
Family influences: family history, correct the families behaviour, show empathy,
acknowledge their frustrations
Does the child's age and development matter? If so, how?
BREAK
Treatment
Less than half of the children with ADHD receive treatment
The primary treatment approach combines:
Stimulant medication
Parent management training
Educational intervention
Treatment of ADHD
Drug therapy: psychostimulants such as ritalin are most used, based on presumed
link to dopamine
Dopamine is what needs to be changed in children with ADHD
The treatment of ADHD with medication is connected to a number of controversies
Behavioural interventions: reinforcing appropriate behaviours, token economies
Medication
Stimulants have been used to treat ADHD since the 1930's
Among the most effective stimulants are dextroamphetamine and
methlyphenidate
Effects are temporary and occur only while medication is taken, beneficial in
the short term
Medication
Homework
Medication search: ritalin and strattera
Why are physicians, pediatricians, teachers, and parents so interested in
strattera?
Compare and contrast the 2 drugs
Medication
Discussion
There are several cases in which parents have been charged with educational neglect
for choosing not to give their child Ritalin (e.g., “Parents lose fight to take 8-year-old
off Ritalin: Child’s hyperactivity disrupted classes, school officials say”. The Sunday
Gazette Mail, Oct 22, 2000, Charleston, West Virginia, http://www.wvgazette.com).
How much influence should schools have in deciding whether a child should be
placed on stimulant medication?
Put pressure on parents to make classroom environments regular
It should be parents decision, but schools should have some say because it is
very disruptive
Dilemma: should we adjust to the child or should the school accommodate to
the child's needs?
Parent management training (PMT 1 of 2)
Provides parents with a variety of skills
Managing the child’s oppositional and noncompliant behaviors
Coping with emotional demands of raising a child with ADHD
Containing the problem so it does not worsen and does not affect other family
members such as siblings
Parent management training (PMT 2 of 2)
Parents are:
Taught to understand biological basis of ADHD
Given a set of guiding principles
Taught behavior management principles and techniques
Token economies - daily report cards, providing rewards based on behaviours
Educational intervention
Teacher and child must set realistic goals and objectives
Response-cost procedures are used to reduce disruptive or off-task behaviors
Many strategies are basic good teaching methods
School-based interventions for ADHD have received considerable support
Educational intervention
Activity video clip: do you see (non) effective strategies that the teacher is using?
Video 1 Positive: teacher was patient, and acknowledged what jojo was talking
about, reinforcing his good actions, acknowledged the bully
Video 1 Negative: when he involved every student in the conflict and let them
listen it was not effective,
Video 2 positive: brought attention to work being important, teacher cared
about him, not experiencing the punishment as a punishment, open-ended
communication
Video 2 negative: drew attention to the fact that jojo stayed in from play time
to finish his work
Intensive interventions
Summer treatment programs
Maximize opportunities to build effective peer relations in normal settings and
provide continuity with academic work so gains from school year aren’t lost
Are coordinated with stimulant medication trials, PMT, social skills training,
and educational interventions
Help to increase better peer relationships
Additional interventions
Family counseling and support groups
Group therapy for families with similar issues
Individual counseling
Helps the child exponentially
Helps children to feel less abnormal
Activity: treatment of ADHD
Instructions: Think of specific behaviours that a child with ADHD may have difficulty
with on a daily basis (e.g., remembering to take completed homework to school;
sitting still during dinner; not asking parental permission before doing something,
etc.). Then write several clear, specific, and positive statements about behaviors that
you would like to see the child perform every day. One example is already provided.
Try to come up with at least five more. Finally, decide on appropriate rewards and
punishments that could easily be given to the child on a daily basis, depending on the
child’s total point value at the end of the day. Remember that rewards and
punishments should be specific and short term (such as “30 minutes of video games
that night”).
Keeping things in perspective
Children with ADHD have problems that should not be minimized
Each child is unique and has assets and resources that need to be recognized and
supported
Week 5: Attention-Deficit/Hyperactivity Disorder
Monday, October 22, 2018 2:29 PM
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