Adhd

Front 1

Attentional Capacity

Back 1

the amount of info that can be remembered and attended to for a short time

i.e. directions or a phone number

- not a deficit for ADHD

Front 2

Selective Attention

Back 2

Ability to focus on relevant stimuli and not be distracted by irrelevant stimuli

- doesn't see a difference between relevant and irrelevant stimuli ( it all seems relevant)

Front 3

Sustained Attention

Back 3

Ability to maintain persistent focus on a task over a period of time, or when fatigued

Front 4

Inattention

Back 4

- not focused on demands or details

- "careless" mistakes, seeming not to listen

- difficulty organizing

- distractible, forgetful

- sluggish, slow to respond, staring into space, underactive/lacks energy

Front 5

Hyperactivity

Back 5

- constantly in motion, "on-the-go"

- more likely to occur in situations where the child is required to sit still and regulate his/her behavior

- actigraph indicates no difference in activity level in the morning, but more active at night

Front 6

Impulsivity

Back 6

- "Acting without thinking"

- Often perceived as careless, irresponsible, immature, lazy and rude

Front 7

Predominantly Inattentive Presentation

Back 7

6+ of 9 inattentive symptoms

Front 8

Predominantly Hyperactive-Impulsive Presentation

Back 8

6+ of 9 hyper-impulsive symptom

Front 9

Combined Presentation

Back 9

6+ inattentive symptoms and 6+ hyperactive-impulsive symptoms

Front 10

ADHD: DSM5 Crtieria

Back 10

-several symptoms must be present before age 12, for older adolescents and adults - 5 required

- present for 6 months

- inconsistent with developmental level

- several symptoms must occur in at least several settings

- symtoms do not occur exclusively during the course of other psychotic disorders

Front 11

Social Behavior Relationships of ADHD

Back 11

- not well-liked by peers

- those with inattentive p are more likely to be *neglected* by their peers

- those with hyperactive-impulsive p are more likely to be *rejected* by peers

- family relations impacted

Front 12

Health, Sleep and Accidents of ADHD

Back 12

- sleep difficulties

- greater accidental injuries than other children (driving)

Front 13

Executive Functioning ADHD

Back 13

- deficits in cognitive processes necessary for goal-directed behavior

- deficits in working, verbal self-regulation, inhibition behavior, motor control, planning

Front 14

Adaptive Functioning

Back 14

- lower level of self-care and independence than expected given their level of intellectual ability

- failure to perform known skills

Front 15

Academic Achievement

Back 15

- lower than control children

- many have learning disabilities

Front 16

ADHD epidemiology

Back 16

- 9% of children

- threefold increase in the US since the 1970s

- ADHD combined presentation most common

- boys more than girls (2:1) (girls- inattenttive)

- diagnosis decreases from childhood onward

- occurs in all social classes, some report higher levels in lower SES

- symptoms are same across cultures, but prevalence may vary to cultural norms

Front 17

ADHD comorbid disorders

Back 17

- specific learning disorder (15-40%)

- oppositional defiant disorder and CD

- ODD 50%, CD 30-56%

- ADHD --> ODD --> CD

-substance use disorders (predictor of smoking)

- disruptive mood dysregulation disorder

- anxiety 25%
- depression, 20-40%

Front 18

ADHD Infancy and Childhood Course

Back 18

Those with reduced behavioral inhibition and effortful control and with elevated novelty-seeking may be at risk of ADHD

- early onset may be associated with worse outcomes

Childhood is the stage when most ADHD cases are diagnosed

Front 19

ADHD Course in Adolescence

Back 19

Hyperactive symptoms become less obvious while others persist

- gross motor areas of the brain may develop early while inhibition areas may develop later than in normally-developing kids

Front 20

ADHD Course in Adulthood

Back 20

A "substantial proportion" of children with ADHD remain relatively impaired into adulthood

65% of boys diagnosed in late childhood no longer met full criteria for ADHD as adults

Front 21

ADHD Theories

Back 21

- Under-arousal in kids with ADHD

- Motivational deficit: high preference for immediate gratification over delayed reward

- behavioral inhibition deficits

- self-regulation deficits

Front 22

ADHD Neurobiological Causes

Back 22

Frontal lobe: significant reduction in the thickness of right dorsolateral and orbitofrontal cortex

Basal ganglia: growth peaks much later than in typically developing children, usually between 10-17 --> less pruning

NTs: dopamine and norepinephrine

Front 23

ADHD Gentic Causes

Back 23

ADHD runs in families and children show greater similarity to biological than adoptive parents

Front 24

Is there a gene for ADHD?

Back 24

maybe one or more associated with the dopamine system

dopamine receptors are prevalent in prefrontal cortex and basal ganglia, areas responsible for attention and inhibitory control

people with lesions in these areas display ADHD symptoms

Front 25

ADHD Causes from Birth complication and prenatal risk

Back 25

- low birth weight, injury at birth

- prenatal smoking and alcohol

Front 26

ADHD psychosocial causes

Back 26

- affect severity, continuity and nature of symptoms

- family factors are some of the most influential psychosocial factors

Bidirectional: more hostile, intrusive parenting

Front 27

ADHD Assessment

Back 27

Consider: Developmental history, info from diff settings, diff diagnosis

Interviews: parents, parent-child interactions, teachers

Rating Scales: assess symptoms + concurrence with other disorders

Additional Measures: standardized tests of intelligence, procedures to evaluate inattention and impulsivity

Front 28

ADHD medications

Back 28

Stimulants: increase dopamine activity in underactive brain regions

Non-stimulants: (SNRIs) block reuptake of norepinephrine; low risk of misuse

- focus on alleviating core systems and reduce co-occuring symptoms (aggressive, noncompliant, opp behavior)

- effective for kids and somewhat for older

Front 29

Concerns about ADHD meds

Back 29

not permanent fixes

not effective for 10-20% of children; even if behaviors are alleviated, behavior is only comparable to other children (%)

adverse side effects: sleep, appetite, pains, irritability, jitteriness

Over-prescribed to control behaviors "quick fix"

- concern for inappropriate prescription

Front 30

ADHD psychosocial treatments

Back 30

Behavior Management

Parent Training

Multimodal Psychosocial Therapy

Working Memory Training

Front 31

Behavior Management

Back 31

- immediate, tangible rewards

- more focus on key functional domains (social relationships and school performance)

Front 32

Parent Training

Back 32

effective for 25% of kids

- bring behavior under parental control, strengthen desirable behaviors, set clear expectations, consistently discipline

- can improve parent-child relationships

Front 33

Multimodal Psychosocial Therapy (MPT)

Back 33

•Educationalskills training: Time management,listening comprehension

•SocialSkills training: Basic interactionskills, dealing with conflict

Front 34

Working Memory Training

Back 34

•Mayreduce inattentive symptoms

Front 35

Mosteffective treatment

Back 35

•combinationof pharmacological and psychosocial treatments

–92%of children with ADHD receive only medication; only 26% participate inpsychosocial intervention