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Chapter 5

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Western University
Psychology 2042A/B
Scott Wier

Attention-Deficit/HyperactivityDisorder (ADHD) December-22-11 10:22 PM - The disorder was first described more than 100 years ago - DESCRIPTION - Attention-deficit/hyperactivity disorder (ADHD) - describes children who display persistent age-inappropriate symptoms of inattention, hyperactivity, andimpulsivity that are sufficient tocause impairment in major life activities - Inattentive - not focusing on demands of a particular task and behaving carelessly - Hyperactive - constantly in motion - Impulsive - acting without thinking - ADHD has no distinct physical symptom that can be seen in an X-ray or a lab test - Can only be identified by characteristic patterns of behaviour, which vary from child to child - Inaddition to the child's personal suffering, the societal costs of ADHD are also high, with an estimated average cost of ab out 32 billion a year in the US - HISTORY - 1902 -George Stilldescribed symptoms of overactivity and inattention as a disorder and believed the symptoms arose out of poor inh ibitory volition anddefective moral control - 1917 to1926 - children who developed encephalitis (brain inflammation) and survived experienced multiple behaviour problems, including irritability,impaired attention, and hyperactivity These children and others who has suffered birth trauma, head injury, or exposure to toxins displayed behaviour problems labelled brain injured child syndrome (associated with mental retardation) - 1940s/1950s -thelabel brain injured child syndrome was given tochildren displaying similar behaviour but with no evidence of brain damage or mental retardation This led to the terms minimal brain damage and minimal brain dysfunction (MBD) - these terms provided a convenient way to attribute behaviour problems toa physical cause - Brain damage theory was rejected - Late 1950s - hyperkinesis - attributed to the poor filtering of stimulientering the brain Hyperactivechild syndrome - motor overactivity was considered the main feature of ADHD - 1970s -deficits in attention and impulse control were also primary symptoms of ADHD Widely accepted theory - 1980s -interest in ADHD kids increased - sharp rise in stimulant use created controversy which continues today - Central impairments of ADHD - poor self-regulation, difficulty inhibiting behaviour, motivational deficits CORECHARACTERISTICS - Mainfeatures of DSM-IV diagnostic criteria for ADHD 1) Six, or more, of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Inattention a) Fails to pay close attention to details, makes careless mistakes in schoolwork, work, other activities b) Difficulty sustaining attention in tasks or play activities c) Doesn't seem tolisten when spoken to directly d) Doesn't follow through on instructions, fails to finish schoolwork, chores, duties in workplace e) Difficulty organizing tasks and activities f) Avoids/dislikes/reluctant to engage in tasks that require sustained mental effort (homework) g) Loses things necessary for tasks h) Easily distracted by extraneous stimuli i) Forgetful 2) Six, or more, of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Hyperactivity a) Fidgets/squirms b) Leaves seat in classroom c) Runs around/climbs excessively in inappropriate situations d) Difficulty playing quietly e) "onthe go"/"driven by a motor" f) Talks excessively Impulsivity g) Blurts out answers before question is completed h) Difficulty awaiting return i) Interrupts/intrudes on others - Todefine the two dimensions of ADHD as inattention and hyperactivity-impulsivity oversimplifies the disorder Each dimension includes many distinct processes that have been defines and measured in various ways Althoughwe discuss attention and impulse control separately, the two are closely related developmentally Attention- helps the child regulate his behaviour, emotions, and impulses - Commoncomplaints about inattention are that the child won't listen, follow instructions, or finish chores/assignments It's not sufficient to say that a child has an attention deficit when there are so many different types of attention The child could have a deficit in only one type or more than one types - Attentionalcapacity - 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 - Selectiveattention - the ability to concentrate on relevant stimuliand not be distracted by noise in the environment Distractability -deficit in selective attention ADHD kids are more likely to be distracted by stimulithat are highly salient (important) and appealing - Sustained attention - or vigilance, is the ability to maintain a persistent focus over time or when fatigued Primary attention deficit in ADHD kids is sustained attention They work best on self-paced tasks they've chosen or find interesting that don't require them to sustain their attention - Alerting - an initial reaction to a stimulus and involves the ability to prepare for what is about tohappen - Core features of ADHD - deficits in sustained attention which may be partly related to difficulty in alerting- HYPERACTIVITY-IMPULSIVITY (HI) - The strong link between hyperactivity and impulsivity suggests that both are part of a fundamental deficit in regulating beha viour - Mainproblem in ADHD seems to be one of controlling motor behaviour - Hyperactivity - They are extremely active, but stillaccomplish very little - Even during sleep, recordings of body movements suggests that ADHD kids display more motor activity than others - Largest difference is found when the child is required to inhibit motor activity - Impulsivity - They experience difficulty resisting immediate temptations and delaying gratification - Impulsivity may take several forms Cognitiveimpulsivity - disorganization, hurried thinking, and the need for supervision Behaviouralimpulsivity - calling out in class or acting without considering the consequences; have difficulty inhibiting their response when the situationrequires it Only behavioural impulsivity predicts rule-breaking behaviour - may be a specific sign of increased risk for conduct problems Cognitive and behavioural impulsivity (and inattention) predict problems with academic achievement, esp in reading - SUBTYPES - Subtype -a group of individuals with something in common; symptoms, etiology, problem severity, or likely outcome - Three ADHD subtypes Predominantly inattentivetype (ADHD-PI) - describes children who primarily have symptoms of inattention - Pure attention deficit - Inattentive, drowsy, daydreamy, spacey, in a fog, easily confused - May have a learning disability, process info slowly, hard to remember things, low academics - Anxious and apprehensive, socially withdrawn, may display mood disorders Predominantly hyperactive-impulsive type (ADHD-HI) - describes children who have primarily symptoms of hyperactivity-impulsivity - Rarest group - Includes preschoolers mainly - Problems in inhibiting behaviour and in behavioural persistence - Aggressive, defiant, rejected by peers, suspended by school or placed in special ed classes - Usually younger than kids with ADHD-C, so it's unknown whether they are actually two different subtypes or just the same kids at different ages Combined type(ADHD-C) - describes children who have symptoms of both inattention and hyperactivity-impulsivity - Problems in inhibiting behaviour and in behavioural persistence - Aggressive, defiant, rejected
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