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Chapter 9

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Psychology 2320A/B
Alvin Segal

Ch 9 Psych dimensional and categorical approachesEvolving Ideas about ADHDdefect in moral control as inattentive impulsive overactive lawless and aggressive epidemics of encephalitis aroused interest in patients who suffered from brain infection and left with some of these attributes children who had suffered head injury birth trauma exposure to infections and toxinsemphasis given to overactivity or motor restelessness in childrenterms o hyperkinesis o hyperkinetic syndrome o hyperactive child syndromehyperactivity was downgraded in importance attention deficit took focus shift reflected in DSMIII recognized ADD either with hyperactivity or without hyperactivityDSMIIIR disorder relabeled Attention Deficit Hyperactivity DisorderADHDChildren received diagnostic if they showed 8 of 14 symptoms o Different mixes of inattention hyperactivity and impulsivity Disorder viewed as unidimensionalso any mix met criteriaUnidimensional view fell by wayside instead two dimensions or factors o Inattentiono HyperactivityimpusivityAssociationattributable to shared genetic influence DSM Classification and DiagnosisDSMIVETR which uses label ADHD two factors of inattention and hyperactivityimpulsivity compose three subtypes of disorder o Predominately Inattentive Type ADHDI o Predominately HyperactiveImpulsive Type ADHDHI o Combined Type ADHDC A either 1 or 21 6 of 9 symptoms for inattention have persisted for 6 months to a gdegree that is maladaptive and inconsistent with developmental level2 6 of 9symptoms for hyperactivityimpulsivity have persisted for 6 months to a degree that is maladaptive and inconsistent with developmentsome hyperactiveimpulsive inattentive symptoms present before age 7some impairment from symptoms is present in 2 settings schoolhomemust be significant impairment in social academic or occupational functionsymptoms do not occur exclusively during the course of a Pervasive Developmental Disorder Schizophrenia or other Psychotic Disorder are not better accounted for by another mental disorder mood anxiety dissociative personality disorder31401ADHD Combined Type both criteria A1A2 met for past 6 months31400ADHD Predominantly Inattentive Type A1 met not A2 for 6mo31401Predominantly HyperactiveImpulsive TypeA2 met not A1 for 6mfor individuals who have symptoms no longer meet full criteria partial remission should be specifiedyouth diagnosed later do not appear different from those with onset before age 7those whose symptoms appear later are excluded from diagnosisdifficult to reliably establish age of onset by retrospective recall of parentsraise age of onset criterion or eliminate DSM symptoms list does not appear to be a good fit with behaviours of older youth with ADHDAlthough symptoms of ADHD lessen by adolescence still require same number of symptomsexclude some adolescentsDescription Primary FeaturesInattentiondo not listen easily distracted do not stick to task disorganized lose things daydreamchildren appear unable to focus and concentrate at some times other times able to sit for hoursattention is situationalcan appear normal when child is interested or motivated but problematic when task is boring repetitious or effortful ADHD people do pay less attention to work than children with learning disabilitiesnormalAmong thesedeficit in selective attention SAability to focus on relevant stimuli and not be distracted by irrelevantFor ADHDdistraction appears more likely when tasks are boringdifficult or when irrelevant stimuli are novel or salientImpairment in attentional alertingability to immediately focus on something of importance Sustained attentiondifficulty continuing to focus on task stimulus over period of timeExecutive attention network involving anterior structures of brain modulates activation of other brain networksExecutive attention is important in tasks requiring individual to monitor conflicting stimuli or suppress responseExecutive attention critical in ADHD because regulation of behaviour is central in disorder Hyperactivity and Implusivitychildren with ADHD described as always on the run driven by motor restless fidgety and unable to sit stillmay display gross bodily movements sand talk excessively to themselves or othersmuch info about acitivy problems comes from parents and teach reports
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