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Chapter 7

Ch. 7 - ADHD.docx

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PSYC 208
Paul Wehr

ADHD 10/19/2012 10:21:00 AM th Midterm Review: Wed Oct 24 , 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) 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 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  ADHD individuals and impulsive/hyperactive subtype discount the future more than controls (ADD do not)  $100 in a month or $100 now  $100 in a month or $95/90/70/60…  Sooner or later, people will switch to take the $100 in a month  The less impulsive you are, the earlier you switch (delaying gratification) Mismatch Hypothesis  Contemporary Environment: sustained attention, problem solving, and planning are important  Rough and tumble play necessary for normal brain development (prefrontal cortex) o Increases dopamine utilization o T.V., videogames, and internet reduce social play o Increase in prevalence of ADHD?  What was adaptive in the ancestral environment is no longer adaptive in modern environment o Not good to be a high risk-taker Alternative Hypothesis  High risk strategy  Individuals with ADHD are often successful by both social and evolutionary c
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