Attentional Disorders

Front 1

how is attention conceptualized?

Back 1

1. selective attention

2. divided attention (multi-tasking)

- visual and auditory can be done but not two of same sensory

3. vigilance

4. *sustained*: maintaining focus over extended period of time

Hint 1

types of attention?

Front 2

definition of attention

Back 2

means by which we actively processa limited amount of information from the enormous amount of informationavailable through our senses, stored memories, and other cognitive processes

Hint 2

how do we process?

Front 3

attention disorders and the DSM

Back 3

attention disorders now a neurodevelopmental disorder

Hint 3

how did it change in DSM V?

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Attention-Deficit/Hyperactivity Disorder: Criteria A**

Back 4

A. Either (1) or (2):

(1) inattention:

- six (or more) of the followingsymptoms of inattention

- have persisted for at least 6 months to a degree thatis maladaptive and inconsistent with developmental level:

(a) often fails to give close attention to details or makes careless mistakesin schoolwork, work, or other activities

(b) often has difficulty sustaining attention in tasks or playactivities

(c) often does not seem to listen when spoken todirectly

(d) often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior orfailure to understand instructions)

(e) often has difficultyorganizing tasks and activities

(f) often avoids, dislikes, or is reluctant to engage in tasks that requiresustained mental effort (such as schoolwork or homework)

(g) often loses things necessary for tasks or activities (e.g., toys,school assignments, pencils, books, or tools)

(h) is often easily distracted by extraneous stimuli (i) is often forgetful in dailyactivities

(2) hyperactivity-impulsivity:

- six (or more) of the followingsymptoms of hyperactivity-impulsivity

- have persisted for at least 6 months to adegree that is maladaptive and inconsistent with developmental level:

Hyperactivity

(a) often fidgets with hands or feet or squirms in seat

(b) often leaves seat in classroom or in other situations in which remainingseated is expected (c) often runs about or climbs excessively in situations in which it is inappropriate(in adolescents or adults, may be limited to subjective feelings ofrestlessness)

(d) often has difficulty playing or engaging in leisure activitiesquietly

(e) is often "on the go" or often acts as if "driven bya motor"

(f) often talks excessively

Impulsivity

(g) often blurts out answers before questions have beencompleted

(h) often has difficulty awaiting turn

(i) often interrupts or intrudes on others(e.g., butts into conversations or games)

Hint 4

inattention OR hyperactivity-impulsivity

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ADHD: Criteria B

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B. Some hyperactive-impulsive orinattentive symptoms that caused impairment were presentbefore age 12 years.

Hint 5

onset?

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ADHD: Criteria C

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C. Some impairment from thesymptoms is present in two or more settings (e.g., at school [or work] and athome).

Hint 6

settings?

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ADHD: Criteria D

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D. There must be clear evidence ofclinically significant impairment in:

- social,

- academic, or

- occupationalfunctioning.

Hint 7

specific impairment in fxning

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ADHD: Criteria E

Back 8

E. The symptoms do not occurexclusively during the course of

- PervasiveDevelopmental Disorder,

- Schizophrenia, or

- other Psychotic Disorder

andare not better accounted for by another mental disorder

- (e.g., Mood Disorder, AnxietyDisorder,DissociativeDisorders,or a PersonalityDisorder).

Hint 8

association to other disorders?

Front 9

ADHD code based on type

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314.01Attention-Deficit/Hyperactivity Disorder, Combined Type: ifboth Criteria A1 and A2 are met for the past6 months

314.00Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type: ifCriterion A1 is met but Criterion A2 is NOT met for the past 6 months

314.01Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-ImpulsiveType:if Criterion A2 is met but Criterion A1 is NOT met for the past 6 months

Hint 9

3 major types

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ADHD DSM-V subtypes

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Predominantly Inattentive Type(ADHD-PI)

- lesscommon, may be co-morbid with learning disorders, slow processing speed,difficulties with information retrieval, and anxiety/mood disorders

Predominantly Hyperactive-ImpulsiveType (ADHD-HI) and Combined Type (ADHD-C)

- associatedwith aggressiveness, defiance, peer rejection, suspension, and placement inspecial education classes

Hint 10

characteristics and comorbidity?

Front 11

prevalence of ADHD

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- DSM-V: about 5% of children

- Diagnosed morefrequently in BOYS(2 times more likely)

- Referral differences for girls versusboys

- DSM criteria may be more appropriate forboys

- Gender differences in community versusclinic samples

- Slightly more prevalent among lower SESgroups - Found in all countries and cultures,although rates vary

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associated characteristics of ADHD

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1. Cognitive Deficits

- deficitsin executivefunctions

- difficultiesin applying intelligence (although usually have normal intelligence)

- academicdelays

- learningdisorders, especially in reading, spelling, math

- distortedself-perceptions

2. Speech and Language Impairments

3. Medical and Physical Concerns

- sleepdisturbances common

- associatedwith accident-proneness and risky behaviors (Dueto impulsivity)

4. Social Problems

- Profoundlyrejected by peers

- Difficultieswith social interactions

- Increasedaggression and fixed social reputation - Missedsocial cues and poor attribution

Hint 12

4 major characteristics

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gender differences of ADHD

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1. More common in boys

2. Tend to have lower ratings onhyperactivity, inattention, impulsivity

3. Greater intellectual impairments and moreinternalizing problems

4. Girls employ more relational aggression

Hint 13

4 main differences

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comorbidities of ADHD

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1. 44% of children with ADHD have at leastone other disorder

2. Out of the ones with comorbidity, 43%have at least two or more

3. Most common overlap with ODD and CD

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developmental course of ADHD

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1. Likely that ADHD is present atbirth, but difficult to identify

2. Hyperactivity-impulsivity usuallyappears first

3. Onset often in preschool years, andusually by school age 4. Deficits in attention increase asschool demands increasenIn early school years oppositionaland socially aggressive behaviors often develop

5. Most children still have ADHD asteens, although HI behaviors decrease

6. Problems often continue intoadulthood

Hint 15

6 developmental courses

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interrelated theories of ADHD

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1. Motivation Deficits

- diminishedsensitivity to rewards and punishment, resulting in deterioration ofperformance when rewards infrequent

2. Deficits in Arousal Level

- lowarousal, resulting in excessive self-stimulation (hyperactivity) in order tomaintain an optimal level of arousal

3. Deficits in Self-regulation

- inabilityto use thought and language to direct behavior, resulting in impulsivity, poormaintenance of effort, deficient modulation of arousal level, and attraction toimmediate rewards

4. Deficits in Behavioral Inhibition

- inabilityto control behavior, which is the basis for the many cognitive, language, andmotor difficulties associated with ADHD

Hint 16

4 major theories; deficits in what?

Front 17

theories and causes of ADHD

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1. Genetics

- predisposition

- dopamine transporter gene (DAT) and the dopamine receptor gene (DRG) appear to be implicated

2. Pregnancy, Birth, and Early Development

- pregnancy and birth complications

- maternal substance abuse (esp. stimulants)

3. Neurobiologial factors

- frontostriatal circuitry

- smaller cerebral volumes and cerebellum

4. Diet, allergy, red dye, and lead

- no empirical support

Hint 17

4 possible causations

- mainly biological

Front 18

possible treatments of ADHD

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1. medication

- Ritalin => dextroamphetamine & methylphenidate

2. Parent Management Training (PMT)

- provides parents with skills to help manage child's behavior reduce parent-child conflict, and cope with difficulties

3. educational intervention

- focus on managing behaviors that interfere with learning, suitable environment in classroom

Hint 18

3 major treatments