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Chapter 9

Chapter 9 - ONLINE

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Psychology 2042A/B
Richard Brown

Psych 2042A Chapter 9: Attention-Decit Hyperactivity Disorder children who receive the diagnosis of ADHD are recognized in both dimensional and categorical classications 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 decits were given more emphasis than hyperactivity -1980 (DSM III) recognized attention decit 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 Classication rst 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 t 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. 1 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 decit exists in ADHD) automatic, early-developing attention voluntary, and immersed in higher order cognition selective attention decits 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 difcult 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 decits are not the primary denition 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, dgety, 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 deciency 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 difculties 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 2 preacademic school decits 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 decits on experimental and neuropsychological tasks that are interpreted as difculties 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 decits 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 difculty 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 denition 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 conict: parents being less rewarding and more negative and directive (mother-child appear to be more difcult 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 conict, separation and divorce parents of youth with ADHD are themselves at genetic risk for a variety of problems, including the symptoms of ADHD 3
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