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Chapter 3

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Department
Psychology
Course
Psychology 2042A/B
Professor
St Pierre Jeff
Semester
Winter

Description
Chapter 3 Description and history of ADHD - Attention-deficit/hyperactivity disorder (ADHD): persistent age-inappropriate symptoms of inattention, hyperactivity, impulsivity -> cause impairment in major life activities - No distinct physical signs: identified by characteristic behaviors varying from child to child - Different patterns of behavior may have different causes Assessments begins with clinical interview and standardized rating scales completed by parent and teacher (circulating) Core characteristics of ADHD - Inattention and hyperactivity-impulsivity but: - Each dimension includes many distinct processes - Although discussed separately, attention and impulse control are closely connected developmentally - Categorical view of ADHD - The DSW V will change the criteria Inattention - Difficulty, during work or play, to focus on one task, or to follow through on requests or instructions o Inability to sustain attention, particularly for repetitive structured and less enjoyable tasks o Deficits may be seen in one or more types of attention  Attentional capacity  Selective attention  Distractibility  Sustained attention and vigilance (a core feature) Hyperactivity-impulsivity - Strong link between hyperactivity and impulsivity, suggesting both are part of fundamental deficit in regulating behavior - Hyperactivity o Primary impairment is inability to voluntarily inhibit dominant or ongoing behavior - Hyperactive behaviors include o Fidgeting and difficulty staying seated when required o Moving, running… o Excessively energetic, intense, inappropriate o Accomplishing little despite extreme activity - Impulsivity: o Unable to control immediate reactions or think before acting o Cognitive impulsivity: disorganization, hurried thinking and need for supervision o Behavioral impulsivity: difficulty inhibiting responses when situation require it o Emotional impulsivity: impatience, low frustration tolerance, hot temper, quickness to anger, and irritability - The primary attention deficit in ADHD is an inability…. Subtypes - Predominantly inattentive type ADHD-PI - Predominantly hyperactive-impulsive type ADHD HI o Primarily includes preschoolers and may have limited validity for older children (rarest group) - Combine type ADHD C o Children who have the both symptoms (hyperactivity and impulsivity)à o Referred for a treatment o Problems inhibiting behavior and behavioral persistence o Aggressiveness, defiance and peer rejection - Subtypes may be instable over time Additional DSM criteria - To diagnose ADHD using DSM, the behaviors must also! o Appear prior age 7 o Occur more often and with greater severity than other o Continue for more than 6 months o Occur across several settings o Produce significant impairments (social and academic) o Not be due to another disorder or serious life stressor - Important to assess both the child’s symptoms and impairment in functioning. Is the ability to delay an impulse that important? Video on webcity Self-control: the research plays a game and the reward is a marshmallow and said if you don’t eat it I will give you another one! http://www.youtube.com/watch?v=eJybVxUiy2U It depends of the age, younger they are and faster they eat the marshmallow. To change the experiment we could hidd the threat under a tissue for example. Associated problems: cognitive deficits - Executive functions: o Cognitive processes: working memory mental computation planning and anticipation, flexibility of thinking and the use of organizational strategies o Language processes: verbal fluency and the use of self-directed speech o Motor processes: allocation of effort, following, prohibitive instructions, response inhibition and motor coordination and sequencing. o Emotional processes: self-regulation of arousal level and tolerating frustration Inhibition Stroop: studies of interference in serial verbal reactions. Stroop colors and words. We have to inhibit a response that we are trained to do! To a psychologist there are two principal applications of the concept of inhibition. The first applies to the nervous system: neurons can serve either excitatory or inhibitory functions. The second applies to thought and behavior: cognitive processes (thoughts) can be activated or inhibited. Our view is that inhibition at the level of hardware implementation in the nervous system may inform, but should…. On s’en fou en faite! Cognitive deficits - Intellectual deficits: o Since most children with ADHD have at least normal intelligence, the difficulty may be in applying intelligence to everyday life situations - Impaired academic functioning - Lower productivity, grades - Learning disorders common for children with ADHD: o Problem areas: reading, spelling, math o Show distinct patterns of cognitive deficits o Different pathways may underlie the link between ADHD and learning disorders - Distorted self-perceptions! o Positive illusory bias: exaggeration of one’s competence. o Self-esteem may vary with the subtype of ADHD, the accompanying disorders, and the area of performance being assessed. Speech and language impairments - About 30-60 - Common examples: o Excessive and loud talking o Frequent shifts and interruptions in conversation o Inability to listen o Inappropriate conversation - Accident-proneness and risk taking! o Over 50% are described as being accident prone o At higher risk for accidents o For early initiation of cigarette and substance abuse o Reduced life expectancy o Higher medical costs Social problems of ADHD - Family problems include: (can lead for the parent to a feeling of deception, or being bad parents because the child is stubborn and repeat all the time the same actions..) o Negativity child noncompliance, excessive parental control sibling conflict, maternal depression, paternal antisocial behavior and marital conflict o Links between ADHD and high levels of family problems may be due to co-occurring conduct problems - Peer problems: o Children with ADHD can be bothersome, stubborn, socially awkward and socially insensitive o Talking out of turn= rejected by peers, have a fewer friends, receive low social support from peers o Can’t apply their social understanding in social situations o Positive friendships may buffer negative outcomes. Accompanying psychological disorders and symptoms - Oppositional defiant disorder ODD and conduct disorder CD o About 50% of children with ADHD meet criteria for OD by age 7 or later o About 30-50% of children with ADHD develop CD o Longitudinal studies have found that ADHD leads to ODD and CD rather than vice versa o A common genetic contribution for ADHD, ODD and CD is likely o Evidence for a contribution from shared environment. - Anxiety disorders: o About 25% of children with ADHD experience excessive anxiety o Inconsistent findings regarding whether or not co-occurring anxiety worsens symptoms or severe… - Mood disorders: - Adhd at 4-6 years is a risk factor for future depression and suicidal behavior - As many 20-30% will develop depression or any other mood disorder by early adulthood TIC disorders: can’t inhibit movement (C.f. CPRI: brake shop clinic) About 20% of children with ADHD also have tic disorders: - Sudden, repetitive, non-rhythmic motor movements or sounds such as eye blinking, facial grimacing, throat clearing and grunting Tourette syndrome: - “you say itch I say twitch o The longer you suppress the worse it feels o Real cost involved:  Permanent poison ivy: irritation  Exhaustion  Sacrifice attention, social implications - Stigma: potential pejorative idea of this disease Sensory processing dysfunction, disinhibition (poor inhibitory control) over sensory input - Or sensory integration disorder - Or sensory defensiveness - Or sensory hypersensitivities (in every day life, if I wear a hat I’ll not feel it anymore after 5 sec of wearing it. But these kids are hyper sensitive so they feel everything and this all the day! So they are never comfortable in their own skin) - Or sensory hyposensitivities Prevalence and course -prevalence rates vary widely ith sampling methods: It is estimated that about 6-7% of school-age children Gender - More frequently in boys than girls - Ratio decline by adulthood - Ratio in clinical samples with boys being referred more often than girls since boys tend to be more defiant and aggressive; however, when girls display defiance and aggression Socioeconomic status and culture - ADHD affects children from all social classes, but is slightly more prevalent among lower SES groups best accounted for by co-occurring conduct problems - Founding all countries and culture: o Highest rates south America and Africa 8-12% o Lowest rates in japan and china 2-5% o European and north American rates in middle 4-6% - Cultural differences may reflect cultural norms and tolerance for ADHD symptoms o Becoming an identified child with ADHD is partly a function of the discrepancy btn a child’s behavior and cultural expectations about how children ought to behave - ADHD is a universal phenomenon that is diagnosed more often in boys than girls in all cultures o Expression, associated features, impairments, and outcomes are quite similar wherever it occurs. Myth buster If I read about a peer reviewed research study in the paper, it must be true Course and outcome Infancy: -
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