Rehabilitation Sciences 3760A/B Lecture Notes - Lecture 10: Prefrontal Cortex, Low Birth Weight, Dopamine Receptor
14 Dec 2016
School
Department
Professor
Key terms
Impulsive: acting without thinking about consequences more likely to take risks and be
disobedient
Pervasive: get stuck, they might do a task and they are hyper focused and might repeat certain
things
Hyperactive: activity that is persistency active
It was thought to just be a misbehave
AOS category – not otherwise specified, make sure that these children get access and that they do
not have compounding things and get worse
What type of person is type 1? And type 2? Examples.
• What do you notice about that list and those symptoms?
• What happens when kids start school? What is expected?
o They need to know how to socialize
o Share
o Listen to instructions
o Sit and pay attention for long periods of time
o Follow a schedule and do things at set times and that is why we start to see these
type 1 and 2 things = those things settle around age 4-5
• The children around 4-5 get used to organization
• Is this hereditary?
o Yes it does run in families, there is about 25%
• Siblings share about 50%
• What does that tell us on a biological basis?
o Shows that there is a genetic component, but genetics alone does not explain what
we see
o Manifest differently in different generations
o Has certain expectations – and can even be different subtype
• Identical twins share all DNA – here the number is 82%
• Look at children prenatally, we can see that these children are overly active, and that the
mothers have noticed moving and flipping early on, and that they might be colicky and
irritable
• Children with ADHD have lower of dopamine and norepinephrine in pre-frontal cortex
• We can see that the metabolism in that part f the brain is less and some parts of the brain
is smaller and differences in hoe some of the areas in brain are connected.
o Anatomical differences in the brain
Specific Genes?
• Found differences on Chromosome 16 and found certain areas that had deleted or
duplicated DNA segments
• Variable number of gene copies
• Normal – expected, but we have seen twice as many of these variations and abnormalities
in kids with ADHD
• We see ADHD comorbid with Autism, and sometimes Schizophrenia
• Dopamine genes – low levels of dopamine in kids with ADHD
o DAT1 – dopamine transporter
o DRD4 – dopamine receptor
Environment Basis?
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Risk Factors – Increase the likelihood of a child to be diagnosed
Prognostic factors – help us understand the outcomes
• Too much TV viewing too early, video games
• Mannerism
• Alcohol, tobacco, lead exposure have an effect on the developing brain
• Low birth weight – vulnerable
• Problematic pregnancy
• Consumption of sugar – sugar high is more temporary. Children that don’t have ADHD
things settle down.
o Elimination diets for a few weeks – studying sugar effects
▪ Add a sugar drink and observe daily
▪ Daily in ADHD watch them
▪ Not complete reduction but there is some for ADHD
• Pre-frontal cortex
Once upon a time children with ADHD were called Fidgety Phils
• ADHD is more common in boys
• Known as that because of their behaviour, they were fidgety and agitated
• Min brain damage
o Not an explanation
o Then changed it to min brain dysfunction
• ADD did not highlight the hyper compulsion that we now see
Key Characteristics
• Easily Distractible, not focused
• Hyperactive
• We see differences in genders
o Boys = more hyperactive
• Impulsive
• In school – they will be frustrated, then because of that they will act out, and lower
motivation, and they will fall behind if not diagnosed, bad handwriting, might not be good
at making friends, which decreases their participation and impacts their participation =
high obesity risk and DM2,etc
• Metabolism slower, and certain areas are smaller, and pre-frontal cortex affected
• Soft neurological sigs – behavuours, things we can observe (NESS) looks at 21 items that
affect neurological signs
• Hard neurological signs – anatomical things
o 81.7% = yes they could
• Nose to finger – repeated movement that looks at coordination
o RAM = rapid alternating movement
▪ Children with ADHD have difficulties with this task
▪ It must be fine tuned
o Cerebellum is involved with fine tuned movement – also see that in children with
ADHD (issues)
• How to test – if not sure, follow up with assessments and more tests
• Run children through a screen to make sure that they are not missing anything
Comorbidities
• Higher co-mor with mood disorders and anxiety
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• Some may have beh issues but not necessarily be diagnosed with a behavoural disorder
o BE VERY SPECIFIC
• They might throw tandtums, argue, run around the classroom, be aggressive
• There are certain diagnostic criteria to be diagnosed with beh disorder – above and
beyond to what we would expect
o More hostile, aggressive, more severe
• Difficulties with sleep
Stats
• 5-12% - talking about the prevalence
• Boys are 2x more likely to have ADHD
o Chromosomes
o Hormones
o Have certain biases about how girls and boys might behave
• The prevalence is higher – children are more diagnosed each year
o What is the reason?
▪ Misdiagnosed
▪ Definition/criteria change
▪ Children are resilient and outgrow symptoms
• Majority of them do not, but it is possible
• More likely to have a learning disability
o Math, reading and spelling
▪ Areas that are of focus, especially in the early years
• There is a correlation between SES (risk factor) and ADHD, and health (also risk factor)
o Could be something about nutrition and how the brain is functioning
o Maybe it could be reduced or prevented with some of these factors
o SES – where they live, schools, exposure to toxins
• See that it highlights pops that are at risk, vulnerability
• ADHD is developmental
• SUBJECTIVE: What one person that considers to be disorganized might not be to another
person
• Masking:
• Environmental masking: no opportunity to exhibit behaviour, refers to fact that
symptoms are present in some situations but not others, not obvi at home, but rly
obvi at school
Assessment
• Parents may think that it is normal, while compared side by side to another child – see diff
• More expected of children
• Teachers may have a taught eye – know what to look for – notice it more
• Now teachers are more educated about it
• Teachers can only make suggestions and observations
o They cannot say that I think that a child has ADHD
• Specific assessments – don’t need to memorize those but those rae there to HIGHLIGHT
who is involved in a diagnosis
Diagnostic Criteria
• Why do we have 2 or more settings
o Pervasive - Bigger picture
▪ Means it is affecting multiple areas, it is much more pervasive
• We also want to make sure that we are addressing the masking issue
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Impulsive: acting without thinking about consequences more likely to take risks and be disobedient. Pervasive: get stuck, they might do a task and they are hyper focused and might repeat certain things. It was thought to just be a misbehave. Aos category not otherwise specified, make sure that these children get access and that they do not have compounding things and get worse. Environment basis: too much tv viewing too early, video games, mannerism, alcohol, tobacco, lead exposure have an effect on the developing brain. Risk factors increase the likelihood of a child to be diagnosed. Prognostic factors help us understand the outcomes: low birth weight vulnerable, consumption of sugar sugar high is more temporary. Key characteristics: easily distractible, not focused, hyperactive, we see differences in genders, boys = more hyperactive. Comorbidities: higher co-mor with mood disorders and anxiety affect neurological signs.
