Abnormal Psychology 3018 ADHD

NSW

No, many people are not getting help.a

It was the International Consensus Statement on ADHD, made by leading scientists and Psychiatrists. It said, as a matter of science, the idea that ADHD doesn’t exist is simply wrong.

1900 - 1950: Minimal Brain Dysfunction (damage).
1950 - 1969: Hyperkinetic/Hyperactivity Syndrome (DSM-2)
1970 - 1979: First recognition of Attentional Impairment & Impulsivity
1980: ADD w or w/o Hyperactivity (DSM-3)
1994: ADHD (inattentive, hyperactive subtypes - DSM-4)

The subtypes means that someone might present with only ONE specifier.
Presenting with only inattentiveness is harder to identify, as there are no behaviour problems but the person cannot complete tasks.

Disability-Adjusted Life Year, is a measure of overall disease burden expressed as the number of years lost due to ill-health, disability or early death.

It is very low compared to other disorders.

It is a common disorder but does not cause a high amount of impairment over a lifetime.

ADHD has a low DALY score because:

1. 1. Medication works really well.

2. 2. People tend to grow out of/adapt their ADHD for adult life.

Hyperactivity/impulsivity and inattention.

A. Fails to give close attention to detail or makes careless mistakes.
B. Has difficulty sustaining attention in tasks/play
C. Does not seem to listen when spoken to directly.
D. Does not follow through on instructions.
E. Has difficulty organising.
F. Avoids, dislikes, or is reluctant to engage in tasks that require mental effort.
G. Loses things.
H. Easily distracted.
I. Forgetful.

Because ‘attention’ is related to neurological processes, and that is not the problem in ADHD.

‘Inattention’ relates to the inability to SUSTAIN attention/action toward a goal/task.
It is the inability to persist toward a goal and avoid distractions.

The inability to be motivated when there are no rewards.

They are unable to resist distractions.

The working memory.

• respond to distractions more than others.

• react to events that are irrelevant to goal.

• get off task much faster than others.

• have difficulty re-engaging with tasks

• skip from one incomplete task to another.

a. Often fidgets, taps hands/feet, or squirms in seat.
b. Often leaves seat at times when remaining in expected.
c. Often runs/climbs in inappropriate situations.
d. Often unable to play/engage in activities quietly.
e. Often ‘on the go’, acting as if ‘driven by a motor’.
f. Often talks excessively.
g. Often blurts out an answer before questions are complete.
h. Often has difficulty waiting for turn.
i. Often interrupts or intrudes others.

Because children with ADHD have symptoms that are so excessive, and persistent that they may fail school, have no friends, the family is distressed, etc.

Emotional impulsivity.

• it is associated with poor emotional control.

• impatience.

• low frustration tolerance.

• quickness to anger.

• prone to emotional excitability/arousal.

ADHD is now classified as a Neurodevelopmental Disorder and an Externalising Disorder. It used to be considered a Disruptive Behaviour Disorder.

ED: ADHD, ODD (oppositional defiant disorder), CD (conduct disorder).
ND: ADHD, ASD (autism), learning disorders.
DBD: ODD, CD.

Because it is a neurodevelopmental disorder, not a functional behaviour problem.

Autism. Most kids with Autism have ADHD and many kids with ADHD have features of Autism.

Externalising Disorder.

• Oppositional Defiant Disorder: 50% comorbid with ADHD.

• Conduct Disorder: 20% comorbid with ADHD.

2:1

Hyperactive/impulsive features.

ADHD:

• often unable to play or engage in leisure activities quietly.

• often interrupts/intrudes on others.
  ODD:

• often deliberately annoys others.

• often blames others for own mistakes.

• often argues with authority figures/adults.

Autism.

A. Several symptoms present prior to age 12 years.
B. Several symptoms present in two or more settings.
C. Clear evidence that the symptoms interfere with social, academic, or occupational functioning.
D. Not better explained by another condition.

(B. Several symptoms present in two or more settings.)
Because the child must be assessed in many different setting (2+) to understand that it is the child, NOT the setting/specific people that trigger the issues.

2/3.

Anxiety: 8-30%.
Depressive: 15-75%.

12 but if a child has ADHD, they have always had it, since the time they could walk.

Hyperactivity presents first, it tends to decline over time. Inattention appears a while later and becomes increasingly apparent with age.

Medication cannot be used until the child is 7 or 8, so at first it is just behavioural treatments and coping strategies for the parents.

Exposure during pregnancy to:

• pesticides (household/outdoor).

• prenatal nicotine.

• lead.

• paracetamol?

• alcohol.

No, there is little evidence. Research shows that only 8% of children with ADHD have symptoms increased by food.

Lead. Ingesting it causes learning problems, a lot of kids diagnosed with ADHD were in fact lead poisioned.
(Also, as lead came down in population studies, violent crime was reduced).

0.8

Height.
ADHD: 0.8
Height: 0.85-0.9

We know genetics greatly influence certain disorders, yet when we look at the genome, we can't find anything (there are no specific genes that mark any disorder).

Warm, caring parental styles with healthy routines in place.

High parental involvement - reduced hyperactivity/inattention.
Inconsistent discipline - increased hyperactivity/inattention.

That they are just correlations, there is no indication of causation (what causes what).

ADHD symptoms may ELICIT bad parenting styles/negative responses from family members.

There are also improvements in quality of parenting.

Adoption study.

• Looked at biological Mum (gene-loading).

• Looked at rearing Mum (parental style).

• Measured child's ADHD symptoms.

Found that, biological Mum's gene-loading predicted child's ADHD symptoms.
Found that, more impulsivity in child predicted rearing Mum's hostility.

Thus, the child's genes produced the environment/parenting style.
And the parenting style exacerbates their symptoms.
A causal loop.

• parenting. | - ADHD symptoms (by age 6).

The Dopamine Receptor Gene (DRD4).

The association between inconsistent parenting and ADHD symptoms are stronger for those with the long allele of DRD4 gene (dopamine).

1. 1. Deficits in inhibitory-based executive function:

• cannot inhibit on-going responses for better alternatives (self-control, cognitive flexibility, emotional regulation, etc).

1. 1. Motivational dysfunction involving disruptive signalling of delayed reward:

• impairment in the contingency between present action and future reward (future reward has no control over current behaviour).

They have overlapping neural architecture (dopamine system) and are both shaped by the environment.

The two impairments (unable to inhibit response & motivational dysfunction) start to create failure in certain areas. The person is then reprimanded for failures, creating a negative association with tasks that involve delaying gratification. Over time, the person develops an aversion to tasks involving delayed gratification.

Conduct Disorder, because they are unable to regulate behaviour/emotions, they are then reprimanded for behaviour/emotions, exacerbating the symptoms.

Negative parenting in response to hyperactive behaviour makes the delay experience even more aversive.

If a reward is promised but not delivered, 'delay' might begin to signal uncertainty/disappointment.

No single test, diagnosis must be multi-factorial.

Interview should include:

• assessment of primary complaint

• review of symptoms

• medical/psychiatric/developmental history

• educational history

• family/social history

Interviews of people from at least 2 or more settings, including:

• the child.

• primary caregivers.

• teachers.

Individuals with ADHD can often function well in certain settings where they are interested and can maintain focus (e.g. video games, watching TV, etc.)
However, the symptoms must be present in group settings.

Connors.

Medication.

Titrated stimulants. They must be measured and monitored closely until the perfect dosage is found.

No, but combined treatment is better for comorbid symptoms/disorders (family interactions, peer relationships, academic functioning).