Psych130M - Module 6

ADHD - Midterm Review

DSM Criticisms

1. Categorical vs Dimensional Measurement

2. over-specification

3. heterogeneity within diagnostic classes

4. failure to consider development

5. failure to consider culture and other contextual issues

DSM-5-TR Criteria for ADHD

1. Core symptoms threshold reached

   1. up to 16yrs: 6+ symptoms per category

   2. 17yrs+: 5+ symptoms per category

2. age of onset

   1. symptoms present before 12

3. pervasiveness:

   1. symptoms present in 2+ settings

4. impairments

5. differential diagnosis

ADHD Symptoms: Inattention Type

1. fails to pay attention to details

2. difficulty sustaining attention

3. does not listen

4. does not follow-through

5. difficulty organizing

6. difficulty with tasks requiring sustained mental efforts

7. loses things

8. distracted easily

9. forgetful

ADHD Symptoms: Hyperactivity/Impulsivity Type

1. fidgety

2. restless

3. on the go, driven by motor

4. talks too much

5. blurts out

6. difficulty waiting turn

What are the 3 ADHD diagnosis classifications

Predominantly Inattentive Type

Predominantly Hyperactive/Impulsive Type

Combined Type

When looking at ADHD classifications, how long ago must the symptoms be met?

within 6 months

How is ADHD assessed? Which is most effective?

Most efficiently accomplished with parent AND teacher rating scales

symptom rating scales must be combined with clinical interview

• to assess onset and rule out other disorders

assessment must include evaluation of child’s functioning in key developmental domains (relationships, academics progress, classroom, family(

for treatment planning:

• contexts of symptoms and their impact should be collected routinely

Differential Diagnosis: Disorders you should rule out first (overlapping symptoms)

anxiety

• inattentive, restless, potentially mimicking ADHD symptoms

depressive disorder

• irritability, lack of concentration, low energy

substance use disorder

• inattention, hyperactivity

Oppositional Defiant Disorder (ODD)

• behavioral problems (but ODD is usually defiance/negativism)

Autism (ASD)

• may co-occur (ASD = issues with social communication)

What functional systems are impaired in ADHD?

impacted functional systems as altered neural development

1. attention

   1. alert/vigilance

2. cognitive control and executive functioning

3. motivation and reinforcement

4. temporal information processing

attention systems functions

orienting

• aligning attention to source of info

selective/executive attention

• ability to filter information

• ability to selectively focus and shift attention

alert/vigilance

• ability to stay “alert” (aroused)

Cognitive control/executive function (definiton and components)

a set of cognitive processes that allow an individual to produce meaningful, goal-directed behavior by selecting relevant thoughts/actions

Components:

1. working memory

   1. ability to keep something in mind while doing something else

2. response suppression

   1. ability to interrupt a response during dynamic moment-to-moment behavior

3. set shifting/cognitive flexibility

   1. ability to shift one’s mental focus within a task or alternate between tasks

Motivation systems (components)

The approach/reward system

• controls individual’s approach or willingness to approach possible incentive or reward

• underlying neural structure

  • dopaminergic system (including the nucleus accumbens and ascending limbic-frontal dopaminergic networks)

• clinical implications

  • substance use, impulsivity, ADHD, mood disorders

The withdraw or reactive control system

• controls individuals responses to potential threat or punishment, or novelty

• underlying neural structural

  • limbic system (including amygdala, hippocampus, and their interconnections)

• clinical implications

  • anxiety, phobias, depression, PTSD

  • intensifies ADHD

temporal information processing (part of brain and effects)

associated with poor time estimation and poor time reproduction

cerebellum: the internal “clock”

What are the brain structures associated with ADHD

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Corpus callosum

Anterior cingulated cortex

prefrontal cortex

basal ganglia

cerebellum

Limitations of Existing Research on Environmental Risk Factors for ADHD

Problematic outcome measurement

Problematic exposure measurement

• caregiver report/recall vs biomarkers

• single exposure vs cumulative exposure

lack of longitudinal studies

come studies failed to consider other environmental factors that might confound the relation between target risk factor and ADHD

most studies did not use genetically-informed designs

few studies have examined gene-environment interactions

ADHD Treatment in childhood

CNS stimulant medication

• stimulate the brain, speeding up mental/physical processes

behavior therapy

• behavioral parent training

• teacher-delivered classroom behavioral intervention

• intensive peer intervention (summer camp treatment)

ADHD Treatment in adolescence (issues)

stimulant meds:

• up to 90% of teens with adhd refuse medication by end of high school

behavioral therapy

• parent training

  • parents and teens often disengage bc high parent/teen conflict

• teacher-delivered intervention

  • secondary school teachers often refuse to implement bc higher emphasis on student independence

What is the most appropriate intervention for teens with adhd

adolescent-directed interventions with motivation enhancement components

ADHD Treatment in adolescence (efficacy)

cognitive enhancement training = not effective (ex: neurofeedback)

behavior therapy produced greatest effects on functional impairment

medication produces greatest effects on ADHD symptoms