PSYC 208 Chapter Notes - Chapter 7: Prefrontal Cortex, Dialectical Behavior Therapy, Psychoeducation

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3 Feb 2013
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ADHD 10/19/2012 10:21:00 AM
Midterm Review: Wed Oct 24th, 2-6pm @ Kenny 1910
Midterm 2
Chapter 4, 6, 7, 8, 9 (maybe 10)
No schizophrenia
ADHD Symptomatology
Chronic and pervasive inattentiveness (can‟t organize, plan), hyperactivity (physical or
mental overactiveness), and impulsivity (inability to delay gratification) that exceed typicality
(everybody has imperfect attention) quantitative difference
o Mixed subtype (ADHD)
o Hyperactive/impulsive subtype
o Inattentive subtype (ADD)
Diagnosis usually made at preschool or elementary school age (median age of onset = 7yrs);
occasionally during adulthood (continuity of symptoms since childhood)
Hyperactivity and impulsivity decline with age; de nova diagnosis in adulthood not possible
Epidemiology
Primary school children (5%-10%)
o Self-report rates lower
o Parent and teacher ratings higher
o Diagnostic threshold
Symptoms weaken as person gets older
Later in life for ADHD children
o Teenagers (60%-80%)
o Young adults (2%-8%)
o Adulthood: 30%-70% continue to have sub-threshold criteria
Male to female ratio (3 9):1
o Ratio for inattentive subtype approximately equal
Genetic Risk Factors
Polygenetic disorder consisting of multiple polymorphisms with small but additive or
epistatic effects
o Gene involved in „novelty seeking,‟ OCD, Tourette‟s Syndrome
o Allelic variations influence regulation of dopamine, norepinephrine, and serotonin
activity in the brain (all reduced)
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Environmental Risk Factors (Correlational)
Maternal smoking and alcohol abuse during pregnancy; maternal stress during pregnancy,
particularly weeks 12-22 (critical period of nervous system development)
Complications during pregnancy or birth; stress to the fetus, preterm delivery, low birth
weight
o Full-term: 37 weeks
o Age of viability: 22-26 weeks
Psychosocial stressors
o Severe early deprivation (deprivation of food…)
o Institutional rearing (orphanage, foster home…)
o Abuse
o Family conflict
o Maternal psychopathology
Psychophysiological Mechanisms
Neurotransmitter abnormalities
o Dopamine deficiency (hyperactivity)
Interaction between dopamine transporter gene and early psychosocial
stressors
o Norepinephrine deficiency in prefrontal cortex (attention deficits)
o Serotonin deficiency (Impulse control and emotional lability (change extreme
emotions quickly))
Brain abnormalities
o Reduced cortical gray and white matter volumes in frontal and temporal lobes
o Smaller cerebellum and basal ganglia (involved in motor activity)
o Smaller corpus callosum
o Reduced activity in regions involved in behavioral inhibition
Treatment
Dopamine-releasing stimulants (inverted U shaped relationship between dopamine and
attention, impulse control, working memory)
More opportunities for social play
Behavior therapy (operant conditioning)
Drugs
o Releases dopamine increase nervous system/dopamine activity
o High levels of dopamine: decreases ability to pay attention
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o Normal: good ability to pay attention
o Low: can‟t pay attention
Rough and tumble play will utilize dopamine for the rest of their lives good
o Brains utilize dopamine when you play
o Encourage this type of play
Behavior therapy
o Punishing kids by taking away toys
Evolutionary Synthesis
Evidence for greater risk-taking in ADHD individuals
o Smoking, alcohol, and illicit drug use
o Antisocial and criminal behavior
o Extramarital affairs
o Delay discounting
o Kids get the idea that they are living in a dangerous environment better to take
risks in dangerous environments
You might not be around to collect the reward in the future
Genes associated with ADHD coincide with the dispersal of anatomically modern humans
out of Africa (40,000 50,000 years ago)
o Increased environmental variability and unpredictability
o Selection for
novelty” seeking” and risk-taking
o Immediate resource extraction
o ADHD girls more likely to report childhood abuse
Generally come from a dangerous environment greater risk taking and
greater novelty seeking (good strategy for an uncertain environment)
Sexual selection for risk-taking is greater in men:
o More dangerous for women to engage in risky behavior (primary caregiver)
Dangerous to go hunting/battle with a baby
o Less need for women to take risks (reproductive variability is low)
o Being male is a risky reproductive strategy (reproductive variability is high)!
Males need to take bigger risks to be successful
o Humans are mildly polygamous
Consistent with the male bias in ADHD and impulsive/hyperactive subtypes
Delay Discounting
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