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Chapter 9

Psychology 2042A/B Chapter Notes - Chapter 9: Attention, Abusive Power And Control, Impulsivity


Department
Psychology
Course Code
PSYCH 2042A/B
Professor
Richard Brown
Chapter
9

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Psych 2042A
Chapter 9: Attention-Deficit Hyperactivity Disorder
children who receive the diagnosis of ADHD are recognized in both dimensional and
categorical classifications of behavioural disorders
controversy focused n both the nature of ADHD and the pharmacological treatment
that was widely introduced in the late 1960s
Evolving Ideas about ADHD
English physician George Still, who described a group of boys with a “defect in moral
control” as inattentive, impulsive, overactive, lawless, and aggressive, among other
things
in the US, epidemics of encephalitis (1917-18) aroused interest in patients who
suffered this brain infection and who were left with similar attributes
children who suffered from birth trauma, head injury, and exposure to infections
and toxins also had a comparable clinical picture
1950s: emphasis on overt motor behaviour - terms hyperkinesis, hyperkinetic
syndrome, and hyperactive child syndrome were applied
in time, attention deficits were given more emphasis than hyperactivity -1980 (DSM III)
recognized attention deficit disorder (ADD) either with hyperactivity or without
1986 - label of ADHD formed, with children who showed at least 8/14 symptoms
mixes of inattention, hyperactivity and impulsivity - ADHD considered as
unidimensional ... or were the 3 co-occurring and independent of each other?
this unidimensional was eventually set aside and that ADHD consisted of 2
dimensions:
inattention
hyperactivity-impulsivity
DSM Diagnosis and Classification
first foundation of ADHD was from DSM-IV in 1994
composed of 3 subtypes (with the 2 dimensions): symptoms in Table 9.1 (p.233)
Predominantly Inattentive Type (ADHD-I) - 6 or more symptoms of inattention
Predominantly Hyperactive-Impulsive Type (ADHD-HI) - 6 or more symptoms of
hyperactivity/impulsivity
Combined Type (ADHD-C) - 6 or more symptoms from any of the 2 dimensions
diagnosis of ADHD demands the presence of some symptoms before 7 yrs old, and
for a period of 6 months
must have clear evidence of impaired social, academic, or occupational functioning
symptoms must be pervasive- that they occur in at least 2 settings (ie. home, school)
symptom list sometimes does not fit with adolescents with ADHD
Description: Core Features
Inattention
children with inattention do not stick to the task but skip rapidly from one activity to
another, do not attend to what it said to them, are easily distracted, daydream, or
lose things.
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these children seem to be inattentive most of the time, but they can also sit for
hours drawing or building blocks - attention is situational
attention has many components - different components, or abilities, develop over
different periods and are linked to different brain structures or systems - distinction
between: (not clear which deficit exists in ADHD)
automatic, early-developing attention
voluntary, and immersed in higher order cognition
selective attention deficits are found - selective attention is the ability to focus on
relevant stimuli and not be distracted by irrelevant stimuli - for children with ADHD,
distraction appears more likely when tasks are boring or difficult or when irrelevant
stimuli are novel or salient
continuous performance tests (CPT) are used to evaluate sustained attention
(attention over a period of time)
ADHD children usually do not react to target stimuli and are slower in
responding than normal children
sustained attention deficits are not the primary definition of ADHD, because
they can also occur in other disorders
attention is known to modulate the activation of other brain networks
Hyperactivity and Impulsivity
Hyperactivity
always on the run, driven by a motor, restless, fidgety, and unable to sit still
gross bodily movements and may talk excessively to themselves or others
objective assessment of hyperactivity can be made by direct observations and
with actigraphs (small devices worn by the child to measure movement)
in the morning, no differences between ADHD and non-ADHD kids, but in
the afternoon, less activity for non-ADHD and more active for ADHD
motor excess and restlessness are more likely to occur in highly structured
situations that demand children to sit still and regulate their behaviour
Impulsivity
deficiency in inhibiting behaviour, holding back, or controlling behaviour
activities that require patience or restraint are not well accomplished.
child is usually judged as irresponsible, immature, lazy, or rude
stop task is a measure used: 2 sorts of stimuli are presented, and keys are to
be pressed once they are shown, but sometimes, the key presses are to be
withheld when a special signal (tone) comes on, the child must rapidly inhibit
Description: Secondary Features
Motor Skills
motor incoordination affect about half of children with ADHD
difficulties shown in clumsiness, delay in motor milestones, poor performance in
sports, and the like
children with ADHD appear affected when tasks involve complex movement and
sequencing - higher order control (organization and regulation of behaviour)
Intelligence, Academic Achievement
children with ADHD perform lower on intelligence tests (avg of 9 points lower)
they exhibit a range of general intelligence, including into the gifted range
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preacademic school deficits have been shown in preschoolers with ADHD
low achievement tests scores (56% need tutoring), low school grades, being
held back a year (30%), placement in special education classes (30-40%)
Cognition: Executive Functions
exhibit deficits on experimental and neuropsychological tasks that are interpreted
as difficulties in executive functions (refer to several cognitive processes
necessary for goal-directed behaviour)
ie. planning, organizing actions, and self-regulation
associated with frontal areas of the brain and their connections
Adaptive Functioning
deficits in self-care and independence are sometimes impaired
many engage in more immature behaviour than what their abilities seem to
warrant, and require greater adult monitoring
ADHD might be best seen as a disorder of “doing” rather than “knowing”
Social Behaviour and Relationships
their behaviour is usually seen as negative by others, and have difficulty with peer
relationships
when this is combined with noncompliance and aggression, this is more serious
inadequately process social-emotional cues - they may know what is appropriate,
but be unable to enact the proper behaviour (especially when excited or irritated)
sometimes have social goals that can create problems
ie. their definition of fun is to the extent that they are willing to break rules
may be unaware of their negative impact to others, may rate their relationships as
overly positive, and overestimate the degree to which they are liked by others
Peer and teacher relations
have trouble keeping and making friends, often disliked by peers
viewed as disruptive and unpredictable and react with rejection and withdrawal
negative reactions apply more strongly to children who are impulsive and
hyperactive, those with only attention problems tend to be ignored or neglected
troubles with peer relations can sometimes initially show up in adolescence
teachers of young children associated all subtypes of ADHD with less
cooperation and fewer other positive behaviours, and they associated
hyperactivity-impulsivity with disruptive and less self-controlled behaviour
teachers tend to be directive and controlling when interacting with children with
ADHD
Family relations
parent-child conflict: parents being less rewarding and more negative and
directive (mother-child appear to be more difficult that father-child)
evidence shows that mothers give more commands and rewards to children,
and that interactions are more emotional and rancorous
have more arguments, negative communications, and hostility
parenting stress becomes apparent, lowered sense of parenting, competence,
decreased contact with extended family, increased alcohol use, and increased
rates of marital conflict, separation and divorce
parents of youth with ADHD are themselves at genetic risk for a variety of
problems, including the symptoms of ADHD
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