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Chapter 5

Child Psychology Chapter 5.docx

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Psychology 2042A/B
Scott Wier

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Child Psychology Chapter 5: Attention-Deficit/ Hyperactivity Disorder Description  ADHD describes children who display persistent age-inappropriate symptoms of inattention, hyperactivity, and impulsivity that are sufficient to cause impairment in major life activities  Heinrich Hoffmann is a neurologist that wrote a poem of a child aptly named “Fidgety Phil”  Mealtimes are an especially trying time for children with ADHD and their parents  Children who are inattentive find it difficult, during work or play, to focus on one task or follow through on requests or instructions  Child doesn’t or won’t listen  Different types of attention o Selective Attention – the ability to concentrate on relevant stimuli and not be distracted by noise in the environment o Sustained Attention – the ability to maintain a persistent focus over time or when fatigued  Distractibility – deficit in selective attention  Children with ADHD are more likely to be distracted  Attentional Capacity – the amount of information we can remember and attend to for a short time  Children with ADHD do not have a deficit in their attentional capacity  Primary attention deficit in ADHD seems to be sustained attention  Children with ADHD may not be able to persist at a task even when they want to  They work best on self-paced tasks they have chosen  Children with ADHD may show performance deficits from the very beginning of a task or response  Alerting – an initial reaction to a stimulus and involved the ability to prepare for what is about to happen  Deficits in sustaining attention may be partly related to their difficulty in alerting Hyperactivity-Impulsivity (HI)  Hyperactivity and impulsivity are part of a fundamental deficit in regulating behaviour  Different reasons for hyperactivity impulsivity, the main problem in ADHD seems to be one of controlling motor behaviour Hyperactivity  Activity is excessively energetic, intense, inappropriate, and not goal directed  Children with ADHD display more motor activity when they sleep than other children  Largest differences are found in situations requiring the child to inhibit more activity Impulsivity  Children who are impulsive seem unable to bridle their immediate reactions or think before they act  Hard to stop an ongoing behaviour or to regulate their behaviour with demands of the situation  Difficulty resisting immediate temptations and delaying gratifications  Impulsivity may take different forms: o Cognitive Impulsivity – disorganization, hurried thinking, and the need for supervision o Behavioural Impulsivity – acting without considering the consequences  Cognitive and behavioural impulsivity predict problems with academic achievement, particularly in reading  Only behavioural impulsivity predicts rue breaking behaviour and may be a sign of increased risk for conduct problems Subtypes  Subtype: a group of individuals with something in common that makes them distinct from other groupings o Predominantly Inattentive Type (ADHD-PI) – children who primarily have symptoms of inattention o Predominantly Hyperactive Impulsive Type (ADHD-HI) – children who primarily have symptoms of hyperactivity-impulsivity o Combined Type (ADHD-C) – children who have symptoms of BOTH inattention and hyperactivity-impulsivity  ADHD-PI described as inattentive, drowsy, daydreamy, spacey, easily confused. They may have a learning disability and display low academic achievement. Often anxious and apprehensive, socially withdrawn and may display mood disorders  ADHD-HI and ADHD-C subtypes display problem in inhibiting behaviour and in behavioural persistence, aggressive, defiant, rejected by peers, and suspended form school  ADHD-C most often referred for treatment  ADHD-HI subtype is the rarest group primarily includes preschoolers Additional DSM Criteria  To diagnose ADHD using DSM o Appear before age 7 o Occur often and with greater severity than in other children of the same age and sex o Continue for more than 6 months o Occur across several settings o Produce significant impairments in the child’s social or academic performance  Disruptive behaviours of children with mild intellectual disabilities, learning disorders, or conduct problems may be mistaken for ADHD as can the inattentive or restless behaviours of children with anxiety disorders  Since there is only a modest relationship between symptoms and impairment, a child can display ADHD symptoms without displaying significant impairment What DSM Criteria Don’t Tell Us  DSM criteria for ADHD have a number of limitations o Developmentally Insensitive – the number of symptoms needed to make a diagnosis is not adjusted for age or level of maturity o Categorical View of ADHD – research supports the idea that ADHD is a dimensional rather than categorical disorder o Requirement of an onset before age 7 is unsupported o Requirement of persistence for 6 months may be too brief for young children o Requirement that symptoms must be demonstrated across at least two environments confound settings with informants – most accurate identification is achieved by blending of reports Cognitive Deficits  Children with ADHD display cognitive deficits, including deficits in executive functions, intellectual deficits, impairments in academic functioning, learning disorders and distorted self-perceptions Executive Functions  Executive Functions: underlie the child’s capacity for self-regulation  Executive functions include: o Cognitive Processes – working memory, planning etc. o Language Processes – verbal fluency o Motor Processes – motor coordination o Emotional Processes – moral reasoning, frustration, etc.  For most children these processes work in concert, enabling them to exercise deliberate control of their attention and impulses and to maintain problem solving behaviours in order to attain a future goal  Children with ADHD shoe deficits in one or more executive functions, especially response inhibition, vigilance, working memory, and planning  Executive functioning deficits are not uniquely associated with ADHD but autism and conduct disorders  Executive functioning deficits do not occur in al children with ADHD Intellectual Deficits  Most children with ADHD are of at least normal overall intelligence  They do score about 5 to 9 points lower on IQ tests than both control children and their own siblings  Lower IQ scores can be the direct result of ADHD symptoms on test-taking behaviour Impaired Academic Functioning  Severe difficulties in school lower productivity, grades, and scores on achievement tests  Many fail to advance in grade or may be placed in special education classes and may be expelled or fail to finish high school Learning Disorders  Many Children with ADHD have a specific learning disorder, they have trouble with language, typically reading, spelling, and math  Different pathways underlie the association between ADHD and learning disorders  Findings suggest that the two disorders and transmitted independently within families Distorted Self-Perceptions  Many children with ADHD report a higher self-esteem than is warranted by their behaviour  This exaggeration of one’s competence is referred to as a positive illusory bias  Self-esteem in children with ADHD may vary with the subtype of ADHD, the accompanying disorders and the area of performance being assessed  Children who display inattentive and depressive, anxious symptoms tend to report lower self-esteem  Children with symptoms of hyperactivity-impulsivity and conduct problems appear to exaggerate their self worth  Bias is most dramatic in the areas of performance in which the child is more severely impaired  Explanations for the positive illusory bias have been proposed self protective function allowing the child to cope every day despite frequent failures; it reflects a diminished self-awareness as a result of impairment of executive functions; or not knowing what constitutes successful or unsuccessful performance  One or more executive explanations likely play a role Speech and Language Impairments  Children with ADHD show a higher prevalence of formal speech and language disorders and may have difficulties comprehending others speech and using appropriate language in everyday situations  Children ramble on, but their conversation is characterized by speech production errors Medical and Psychical Concerns  Children with ADHD also experience health-related problems, accident proneness, and risk taking behaviours Health Related Problems  Association between ADHD and general health is not clear at this time  Higher rates of asthma, bed wetting, and sleep disturbances are common in children with ADHD  Sleep problems may be related to their use of stimulant medications, conduct or anxiety disorders, rather than to only their ADHD  Overlap exist between ADHD and developmental coordination disorder (DCD), a condition characterized by marked motor coordination  Tic disorders: sudden, repetitive, non-rhythmic motor movements or sounds such as eye blinking, facial grimacing, throat clearing, and grunting  Tic disorders decline and do not significantly affect psychosocial functioning Accident-Proneness and Risk Taking  Children with ADHD are more accident prone  ADHD is a significant risk factor for early initiation of cigarette smoking, substance abuse, and risky sexual behaviour  May be due to co-occurring conduct problem  Impulsive behaviour was the most significant childhood characteristic that predicted reduced life expectancy Social Problems  Social problems in family life and at school are common in children with ADHD  Sever social disability are at greatest risk for poor adolescents outcomes and other disorders such as depression and conduct disorder  Social blunders by children with ADHD appear more thoughtless than intentional Family Problems  Parents may experience high levels of distress and related problems, commonly depression in mothers and antisocial behaviour  Further stress on family life because parents of children with ADHD may themselves have ADHD which can be a barrier to effective treatment for the child  Mothers tend to display similar interaction difficulties with their children without ADHD as they do with their child with ADHD  Problems in the family are not restricted to situations that directly involve the child with ADHD  Children with ADHD also report more maternal mental health problems, greater parenting stress, less parenting competence, greater caregiver strain, less instrumental support, slightly higher rates of marital conflict, separation, and divorce  Parents of these children also show increased alcohol consumption  High levels of family conflict in many cases are due to the child’s co-occurring conduct problem rather than due to the child’s ADHD alone Peer Problems  Peer problems are apparent at an early age and are quickly evident when the child enters a new social situation  Often has an annoying quality that brings out the worst in other children  Children with ADHD are disliked and uniformly rejected by peers, have a few friends, and report receiving low social support from peers  Social problems may increase their risk of later disorders other than ADHD  Children with ADHD are not deficient in social reasoning or understanding  Simply don’t apply their knowledge during social exchanges Oppositional Defiant Disorder and Conduct Disorder  Children with ADHD typically have a mixed bag of symptoms and impairments, with ADHD being only one  ADHD is so challenging many children with ADHD have a co-occurring psychological disorder, such as oppositional and conduct disorders, anxiety and mood disorders  About one-half of all children with ADHD (mostly boys) meet the criteria for oppositional defiant disorder (ODD) by age 7 or later  Children with ODD overreact by lashing out at adults and other kids  They are stubborn, short-tempered, argumentative, and defiant.  Children with CD, violate societal rules and are at high risk for getting into serious trouble at school or with the police  CD is also associated with the use of illegal drugs  Early occurring ADHD is one of the most reliable predictors of ODD and CD  ADHD leads to ODD and CD rather than vice versa  Persistent and severe ODD and CD outcomes among children with ADHD are related to the presence of a specific gene (COMT gene) associated with the regulation of neurotransmitters in the areas of the brain implicated in the area of the brain implicated in ADHD  ADHD, ODD, and CD runs in families Anxiety Disorders  Children with ADHD experience excessive anxiety  These anxieties are unrealistic, more frequent, and more intense than normal, they have a negative on the child’s thinking and behaviour  Display social and academic impairments and experience greater long-term impairment and mental health problems than those with either condition alone  Relationship between ADHD and anxiety disorders is reduced or eliminated during adolescence Mood Disorders  Children with ADHD experience depression, lowers self-esteem, reduces interest or pleasure in favorite activities, increases irritability, and disrupts sleep, appetite and the ability to think  ADHD and depression may be a function of family risk for one disorder increasing risk for the other  Association between ADHD and bipolar mood disorder  Diagnosis of childhood BP increases the child’s risk for previous or co-occurring ADHD, but ADHD does not appear to increase the child’s risk for BP Prevalence and Course  ADHD affects children throughout the world and across all socioeconomic levels  ADHD one of the most common referral problems in North America and elsewhere  Prevalence estimates of ADHD are much higher when based on one person’s opinion rather than bases on a consensus Gender  Occurs more frequently in boys than in girls  In adolescence, rates of ADHD decrease for both sexes  Boys referred more often because of their overt defiance and aggression  When girls display defiance and aggression, they are referred at a younger age than boys  ADHD in girls may go unrecognized and unreported because teachers may fail to recognize and report inattentive behaviour unless it is accompanied by the disruptive symptoms normally associated with boys  DMS specified cutoffs and symptoms may be more appropriate to boys than girls  Girls to display inattentive/disorganized symptoms; forgetfulness, anxiety, depression, and hyperverbal rather than hyperactive motor behaviour  Girls in community samples tend to be less impaired than boys with ADHD with respect to their core symptoms and accompanying academic and social difficulties  Girls less likely to receive treatment with stimulant medication  Clinic referred children with ADHD have been found to be quite similar with respect to their expression and severity of symptoms  Girls with ADHD who display impu
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