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Attention Deficit Hyperactivity Disorder

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3 views

Attention Deficit Hyperactivity Disorder

Uploaded by

Soma Pramanik
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Attention Deficit Hyperactivity

Disorder
Historical Emergence

● Features first described by 1775 by the German physician


Melchior Adam Weikard
● Syndrome involving hyperactivity described by Heinrich
Hoffmann (1945)
● Deficiency in “volitional inhibition” described as the primary
problem. (Still, 1902)
He describes how sensory stimuli capture the patient’s attention and divert him
from his thoughts: “... it is easier to perceive impressions through the sense
organs than to form or retain ideas, to recover past memories or to do other
reflective operations. Each sense can disturb us in our thoughts or thinking,
distract us from our object and draw our attention to something else. Of all the
senses, this occurs most often with hearing and sight. The result is distraction,
lack of attention, inattention.” (Weikard)
● Childhood hyperactivity promoted as a brain disorder by Strauss and Lehtinen
(1947) based on similarities with behaviour of children who had suffered brain
damage due to encephalitis.
● However, this claim led to confusion in classification and the hypothesis was
refuted by other findings, such as, many children with acquired brain damage
do not have hyperactivity (Rutter & Quinton, 1977)
● Currently, ADHD classified as a neurodevelopmental disorder. (DSM-V, 2013)
● Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing
pattern of inattention and/or hyperactivity-impulsivity that interferes with
functioning or development. (NIMH)
● Symptoms of ADHD include inattention (not being able to keep focus),
hyperactivity (excess movement that is not fitting to the setting) and
impulsivity (hasty acts that occur in the moment without thought). (APA)
● ADHD can have a significant impact the individual in many aspects of an
individual’s life including academic and professional achievements, interpersonal
relationships, and daily functioning (Harpin, 2005).
● There are three main types of ADHD:
● Predominantly inattentive
● Predominantly hyperactive/ impulsive
● Combined.
● Symptoms must be present before the individual is 12 years of age.
● Symptoms must be present in more than one of the following settings: home,
school, clinic.
Symptoms: Inattention

❖ Overlook or miss details and make seemingly careless mistakes in schoolwork, at


work, or during other activities
❖ Have difficulty sustaining attention during play or tasks, such as conversations,
lectures, or lengthy reading
❖ Not seem to listen when spoken to directly
❖ Find it hard to follow through on instructions or finish schoolwork, chores, or duties
in the workplace, or may start tasks but lose focus and get easily sidetracked
❖ Have difficulty organizing tasks and activities, doing tasks in sequence, keeping
materials and belongings in order, managing time, and meeting deadlines
❖ Avoid tasks that require sustained mental effort, such as homework, or for teens and
older adults, preparing reports, completing forms, or reviewing lengthy papers
❖ Lose things necessary for tasks or activities, such as school supplies, pencils, books,
tools, wallets, keys, paperwork, eyeglasses, and cell phones
❖ Be easily distracted by unrelated thoughts or stimuli
❖ Be forgetful in daily activities, such as chores, errands, returning calls, and keeping
appointments
Symptoms: Hyperactivity/ Impulsivity

❖ Fidget and squirm while seated


❖ Leave their seats in situations when staying seated is expected, such as in the
classroom or the office
❖ Run, dash around, or climb at inappropriate times or, in teens and adults, often feel
restless
❖ Be unable to play or engage in hobbies quietly
❖ Be constantly in motion or on the go, or act as if driven by a motor
❖ Talk excessively
❖ Answer questions before they are fully asked, finish other people’s sentences, or
speak without waiting for a turn in a conversation
❖ Have difficulty waiting one’s turn
❖ Interrupt or intrude on others, for example in conversations, games, or activities
ADHD

Biological

● Symptoms of ADHD seven times more likely in probands of ADHD in males (Biederman, Faraone,
Keenan, Knee, & Tsuang, 1990); similar trend seen for females as well. (Faraone et al., 1992; Faraone,
Biederman, Keenan, & Tsuang, 1991)
● Extreme scores on the inattention dimension are moderately heritable in case of ADHD, inattentive and
combined types.
● However, extreme scores on the hyperactivity–impulsivity dimension were not significantly heritable i.e.
ADHD, hyperactive-impulsive type not significantly heritable.
Genetic

● Genes responsible for dopamine transporter (DAT1), dopamine receptors (DRD4 &
DRD5), serotonin transporter (5HTT), serotonin receptor (HTR1B), and
norepinephrine receptors (ADRA2A & ADRA2C)found to be replicated in ADHD.
● Replicated risk locus found on gene location 17p11.
Environmental

● Maternal smoking during pregnancy


● Low birth weight
● Fetal alcohol exposure
● Pediatric head injury
● Environmental lead exposure
(Barkley, 1996)
Brain mechanisms

Structural

● Lack of frontal asymmetry


● Abnormalities in volume of caudate nucleus
● Globus pallidus found to be smaller
● Decreased areas in different regions of the corpus callosum
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ADHD- disorder of executive functions (Brown, 2013)

❖ Primary deficits in organization, planning and activation to work


❖ Defined attention as ability to focus, sustain & shift one’s focus; ability to
regulate one’s alertness; and capacity for sustained effort and processing
speed
❖ Difficulty in/ poor development of emotional regulation skills resulting in
difficulty in managing frustration and modulating emotions
❖ Difficulty in cognitive regulation resulting in challenges in working memory
& recall of information

Focus on
inattention
ADHD- a disorder of intention? Focus on
motivation
❖ Focus on motivational components that implicate altered reward processes (Sonuga-Barke,
2003)
❖ Motivational style characterized by attempts to escape or avoid delay.
❖ Children & adults with ADHD found to have lower scores on Conscientiousness (McIntosh
and Cole-Love, 1996), particularly for symptoms of inattention (Nigg et al., 2002)
❖ ADHD linked with lower Agreeableness, more so for hyperactivity and impulsivity.
❖ Children & adults with ADHD found to have significantly higher scores on Neuroticism. (Nigg
et al., 2002)
❖ Dysfunction in ADHD located in in any of three neurobiological circuits that differentially
affect cognitive control, reward processing, and one’s ability to build temporal prediction.
(Durston et al., 2011)
https://apsard.org/
eight-pictures-
describe-brain-
mechanisms-in-adhd/
Assessment of ADHD & Issue of Comorbidity

❖ Diagnostic interview
❖ Questionnaires : ADHDT, Conners 4th edition (Parents, Teacher, Self)
❖ Direct testing of attention: neuropsychological assessment of executive functions- response inhibition,
working memory, processing speed, ability to focus

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