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5 - ADHD Part 1

The document discusses Attention Deficit Hyperactivity Disorder (ADHD), including that it has a strong genetic basis, often persists into adulthood, and is a neurodevelopmental disorder associated with neuropsychological deficits like impaired working memory that can contribute to functional impairments in academic, family, and social domains.

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22 views

5 - ADHD Part 1

The document discusses Attention Deficit Hyperactivity Disorder (ADHD), including that it has a strong genetic basis, often persists into adulthood, and is a neurodevelopmental disorder associated with neuropsychological deficits like impaired working memory that can contribute to functional impairments in academic, family, and social domains.

Uploaded by

chuquer2000
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Attention Deficit Hyperactivity Disorder

(ADHD)

PSY4105
Dr. Caroline Sullivan
Today
 ADHD
◦ Diagnostic criteria
◦ Course & etiology
◦ Comorbid conditions
◦ Neuropsychological deficits
◦ Functional deficits
 Academic
 Family
 Social
 Next time:
◦ Evaluation and treatment
Fact or Fiction?

 ADHD usually persists into adulthood


◦ FACT
 People with ADHD have average IQ
◦ FACT
 ADHD only affects boys
◦ FICTION
 Children with ADHD who take medication are more
likely to abuse drugs when they become teenagers
◦ FICTION
Fact or Fiction? (cont’d)
 The rate of diagnoses of ADHD in children is increasing
◦ FACT
 Children are more likely to show signs of ADHD if they
consume a lot of food dyes
◦ FICTION
 Kids with ADHD are more likely to repeat grades
◦ FACT
 A diagnosis of ADHD is more likely than physical
conditions to lead to long-term economic disadvantage
◦ FACT
What is Attention-Deficit /
Hyperactivity Disorder (ADHD)?
ADHD is a
neurobiological problem
that is usually first
noticed in the preschool
and early school years.
Inattention Hyperactivity Impulsivity
Symptoms of Inattention
At least 6 of 9 symptoms:
 Poor attention to details,
makes careless mistakes
 Difficulty concentrating
 Doesn’t seem to listen
 Fails to follow through on
instructions & finish work
 Difficulty organizing work and
self
 Avoids/dislikes lengthy,
effortful tasks
 Loses things Meet my son, Marleau
 Easily distracted
 Forgetful
Types of Attention
1) Attention capacity:
 Can’t remember phone number unless you write it down
2) Selective Attention:
 Distraction – can’t do homework if tv on in another room
3) Sustained Attention:
 Ability to pay attention when tired or disinterested in the
subject

Which is the primary deficit in ADHD?


◦ Sustained attention – especially for repetitive,
structured, and uninteresting tasks
Symptoms of Hyperactivity & Impulsivity
At least 6 of 9 symptoms:
 Fidgets or squirms
 Leaves seat when not
appropriate
 Runs or climbs excessively
 Difficulty playing quietly
 “On the go” or “driven by
a motor”
 Blurts out answers to
questions
 Talks excessively
 Difficulty awaiting turn
 Interrupts or intrudes on
others
Which behaviours match
which symptoms?
Inattention Hyperactivity
 Poor attention to details, Fidgets or squirms
makes careless mistakes Leaves seat when not
 Difficulty concentrating appropriate
 Doesn’t seem to listen Runs or climbs excessively
 Fails to follow through on Difficulty playing quietly
instructions & finish work “On the go” or “driven by a
 Difficulty organizing work and motor”
self
 Avoids/dislikes lengthy,
Impulsivity
effortful tasks Talks excessively
 Loses things Difficulty awaiting turn
 Easily distracted Interrupts or intrudes on
others
 Forgetful
Blurts out answers to
◦* Associated with poor academic
questions
performance *
Symptoms must be.....

Persistent Pervasive Impairing


( > 6 months) ( > 1 setting)
2 Dimensions - 3 Specifiers
Inattentive Hyperactive /
Subtype Impulsive
“ADD” Subtype

Combined Type
“Classic ADHD”
DSM-5
Major Changes:
• ADHD is categorized under neurodevelopmental disorders
• Subtypes changed to “specifiers of current presentation”
• Is more relevant for diagnosis of adult ADHD
Moderate Changes:
 “Age of onset” criteria changed – symptoms before age 12
Minor Changes:
 Requirement of multiple informants included
 Autism and PDD have been removed from exclusionary
criteria
 More examples of symptoms
Prevalence
 7-12% of school age population worldwide
 2nd most prevalent children’s mental health
disorder
 Most prevalent referral in mental health clinics
 Male bias

 In Ontario
 2.1 millions students
 ~ 100,000 with ADHD
 1-3 students per class
ADHD & Gender
 2-4% of girls
 6-9% of boys
 But referral, assessment and diagnosis of boys with
ADHD is much more common (2.5:1)
 Clinical sample: 6:1
 Inattention type is relatively more
common in girls
 Slightly more common with lower SES
ADHD is a neurodevelopmental disorder

“An illness of the central nervous


system caused by known genetic,
metabolic, or other biological
factors”
Parts of the brain involved in ADHD
Superior Frontal Anterior
Parietal Eye Field Cingulate
Posterior Lobe Gyrus
Area Frontal
Area
Temproparietal
Junction
Prefrontal
Cortex
Thalamus

Pulvinar

Superior
Colliculus

Posner & Rothbart (2007), Annual Rev


Psych
ADHD persists into adolescence &
adulthood, but changes in its
behavioural manifestation

Childhood Adolescence Adulthood

1o Combined 1o Inattentive 1o Inattentive


Type Type Type

OVERT COVERT
Course
 Infancy – difficult temperament
◦ Irritable
◦ Over-active
◦ Unpredictable behaviour
◦ Erratic eating and sleeping
 Preschool – symptoms become noticeable
◦ Impulsive behaviour
◦ Easily bored
◦ Over-reactive emotionally
◦ Non-compliance and defiance
Course
 Early school years– diagnosis often made
◦ School requires attention and compliance
◦ Defiance and conduct problems increase
◦ Academic/learning problems
◦ Hyperactivity slowly declines
 Adolescence
◦ Many individuals “outgrow” ADHD symptoms
in adolescence
◦ Symptoms continue for about 50% of children
◦ By adulthood, individuals with ADHD perform
normally on most measures of attention
Functional Deficits
Etiology
 Genetic influences
◦ Strongly genetic
◦ 80% heritability

 Reduced dopaminergic activity


 Reduced blood flow in the frontostriatal
networks
Etiology
 Many poorly supported or discredited
theories exist to explain ADHD
◦ Food allergies
◦ Poor parenting techniques
 If anything, bidirectional causality
◦ Vaccines ( )
 Sugar consumption and exposure to
screen time can increase ADHD
symptoms but do not cause it
80% Comorbidity
 Learning disorders = 25%
◦ Especially writing disorder
 Oppositional Defiant Disorder (ODD) = 50% by age 7
 Anxiety disorders = 25%
 Mood disorders = 20-30%
 Tics = 20%
 Sleep disorders = 20%
 Risk-taking behaviours and substance use
Neuropsychological Findings
What is working memory?

A limited-capacity cognitive
system that allows us to actively hold and use critical
information in mind despite ongoing distraction

Auditory-Verbal Visual-spatial

E.g. Digit span E.g. CogMed


Working Memory is
Impaired in ADHD
Many people with ADHD exhibit significant
impairments in working memory:
• Particularly those with symptoms of inattention
• Particularly for visual-spatial information
• Impairments evident across all ages, but diminish in
adolescence
• Problems evident on standardized tests
• Working memory is the one cognitive impairment
that is really important in education!
Let’s think about how working
memory deficits might affect:

 Learning the alphabet


 Following a conversation
 Writing a paragraphe
 Playing a game (e.g. cards)
 Learning to add and substract
 Genetic basis
 Persists into adulthood
 Neurocognitive disorder – not just a
behavioural disorder
 Neuropsychological deficits (particularly
working memory) central to ADHD
 Inattention, not hyperactivity/impulsivity, is
key in learning problems

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