PSY341 Chapter 5.pdf

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22 Apr 2012
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ADHD: persistent age-inappropriate symptoms of inattention, hyperactivity, and impulsivity that are
sufficient to cause impairment in major life activities
Term ADHD may be new
But around for some time
Heinrich Hoffmann (1845)
o German neurologist
o Wrote child storybook
o First known accounts of hyperactivity
o Humor poem
o Describing “Fidgety Phil
“Life in Overdrive”
o More recent article
o About Dusty N
Common at mealtime
Primary symptoms
o Inattentive: not focusing on mealtime demands and behaving carelessly
o Hyperactive: constantly in motion
o Impulsive: acting without thinking
No distinct physical symptoms
Only identified by characteristic beh.
Vary child-to-child
Become blanket term
Inc.d effort and stricter rules wont help
o ADHD already trying hard
o Want to do well
o But constantly held back by limited self-control
o Thus hurt, confusion, sadness
o For being blamed
Overwhelming feelings (frustration, being different, not fitting in, etc.)
High costs
o $32B/year (2005)
o $11,000/child (2005)
Numerous explanations over 100 years
Early 1900s
o Compulsory education
Demanded self-controlled beh.
In group setting
Focused attention on children with ADHD symptoms
o Symptoms first described as disorder by George Still (1902)
Believed arose out of
Poor inhibitory volition
Defective moral control
o Another view of ADHD rose
o From worldwide influenza epidemic
o Children developed encephalitis and survived
o Experienced multiple beh. problems
Impaired attention
o These children and others suffered
Birth trauma
Head injury
Exposure to toxins
o Display beh. problems
o Labeled “brain injured child syndrome
o Associated with mental retardation
1940s and 1950s
o This label erroneously applied to others with similar beh.
o But no evidence of brain damage
o Or mental retardation
o Led to terms
“Minimal brain damage”
“Minimal brain dysfunction (MBD)”
o Convenient way to attribute beh. problems to physical cause
o Certain head injuries cane explain some ADHD
o But brain damage theory eventually rejected
o Since only explains few cases
Late 1950s
o Referred to as “hyperkinesis”
o Poor filtering of stimuli entering brain
o Led to definition of “hyperactive child syndrome
o Motor overactivity considered main feature of ADHD
o But soon realized hyperactivity not only problem
o Also child’s failure to regulate motor activity in relation to situational demands
o Argued that hyperactivity not only symptom
o Also deficits in
Impulse control
o Widely accepted
o Long lasting impact on DSM criteria
o Interest in ADHD inc.d
o Sharp rise in stimulant use
o Controversy to this day
o Other symptoms deemed central
Poor self-regulation
Difficulty in inhibiting beh.
Motivational deficits
DSM-IV-TR criteria for ADHD
2 lists of key symptoms
For defining ADHD
And distinguishing from related problems
o Symptoms of inattention
o Symptoms of hyperactivity-impulsivity
But this oversimplifies disorder
o Each dimension inc. many distinct processes, defined and measured in various ways
o Two closely connected developmental
Attention helps child regulate his beh, emotions, and impulses
Inattention (IA)
Difficulty to focus on one task
Or follow through on requests/instructions
May attend automatically to enjoyable things
But difficulty focusing on new or less enjoyable tasks
Common complains about IA
o Wont listen
o Wont follow instructions
o Wont finish chores or assignments
Not sufficient to say ADHD
When many types of attention
Child could have deficit in only one type
Or more than one type
Attentional Capacity
Attentional capacity: amount of info we can remember and attend to for a short time
ADHD no deficit in this
Remember same as others
Selective Attention
Selective attention: ability to concentrate on relevant stimuli, not distracted by noise in env’t
Distractibility: common term for deficit in selection attention
Distractions can be disruptive to all children
Including ADHD
But ADHD more likely than others to be distracted
By stimuli highly salient and appealing
Sustained Attention
Sustained attention: ability to maintain persistent focus over time when fatigued
Also called vigilance
Primary deficit in ADHD
Poorer performance when uninteresting or repetitive task
Most of us can do this when have to
ADHD may not be able to persist at task
Even when want to
Work best on self-paced tasks they have chosen
One of core ADHD deficits
But ADHD may show performance deficit from start of task
Not just decrement over time
Suggests that attentional problems may be in altering and preparing for task from onset
And not only sustaining attention that already occurred
Alerting: initial reaction to stimulus, and improves ability to prepare for what is about to happen
o May have alerting deficit
o Respond too quickly
o In situations requiring careful approach
o And too slowly
o In situations requiring quick response
o Seen in ADHD
o Thus deficits in sustaining attention may partly related to difficulty in altering
Hyperactivity-Impulsivity (HI)
Hyperactivity and impulsivity distinct in DSM
But when children display one, other also displayed
These symptoms best viewed as single dimension
Of hyperactivity-impulsivity (HI)