Lecture 9 ADHD

Doing this by hand cuz ai sucks

Neurodivergent

differing in mental or neurological function from what is considered typical or normal (frequently used with reference to autistic spectrum disorders or attention deficit hyperactivity disorders); not neurotypical.

Neuro-atypical

refers to people whose neurological structure or function doesn't fit what the medical community defines as "normal".

Many people identify as neurodiverse, including people with:

• autism

• Attention Deficit Hyperactivity Disorder ADHD

• Tourette Syndrome

• Depression

• Dyslexia

• OCD

• Schizophrenia

How does the Neurodiversity Paradigm view neurodiversity?

neurological differences, including ADHD and autism, as normal variations of the human experience.

• Neurodiversity promotes understanding, acceptance, and adaptation rather than “fixing” or “curing.”

the Neurodiversity Paradigm: What is the Paradigm Shift?

Paradigm Shift: This is in contrast with the traditional medical model, which often views ADHD and autism through a lens of deficits and pathology.

How does the DSM characterize ADHD?

• characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

• The DSM-5-TR defines ADHD as involving symptoms that are:

  • present in at least two or more settings (e.g., at home, school, or work) and

  • have persisted for at least six months to a degree that is inconsistent with the individual’s developmental level.

Symptoms must be present before the age of 12,  cause impairment in social, academic, or occupational functioning, and not be better explained by another mental disorder.

ADHD: Two symptom categories - Inattention,

• involves difficulties sustaining attention, frequent careless mistakes, seeming not to listen when spoken to directly, and failing to follow through on tasks or instructions.

• Additional symptoms may include:

  • avoidance of tasks requiring sustained mental effort, being easily distracted, and frequently losing items necessary for tasks.

ADHD: Two symptom categories - Hyperactivity and Imulsivity

includes behaviors such as fidgeting, difficulty remaining seated, feelings of restlessness, difficulty in engaging in quiet activities, excessive talking, blurting out answers, and difficulty waiting one's turn.

Is ADHD a neurodevelopmental disorder?

yuh

ADHD is the ___ prevalent childhood psychological

disorder in Canada

most

does ADHD come from a single gene?

no bruh

• Potential complex epigenetic contributions (no single gene!)

• Persists into adulthood

approximately _% of Canadian children and _%

of adults are diagnosed with ADHD; about __mill ppl

5, 4, 1.5mill

Who is more likely to be diagnosed?

• males, but there was a prominent recent increase in females

What is ADHD really?

• Problem with regulation of attention, not just inattention

• Can present as over-focused (i.e., when very interested)

• Difficulty refocusing/transitioning from one activity to another

• Attention levels may fluctuate from day to day (even for same tasks)

How does Gabor Mate view ADHD?

ADHD as a Response, Not a Disease

• ADHD is not primarily a genetic disorder, but rather a response to early childhood stress and emotional disconnection.

• when children experience chronic stress, lack of attuned caregiving, or emotional insecurity, their developing brains adapt by tuning out, a coping mechanism that can later manifest as attention difficulties.

Does Mate believe it is rooted in early development?

• He emphasizes that ADHD emerges from environmental and relational factors:

  • Emotional stress in early life disrupts brain development (even in utero), especially in areas related to self-regulation and attention.

  • This “tuning out” becomes ingrained as a survival strategy — an adaptive response in a stressful environment that later becomes maladaptive in school or work settings.

How does Mate emphasize the role of connection and comapssion?

• He emphasizes that ADHD emerges from environmental and relational factors:

• Emotional stress in early life disrupts brain development (even in utero), especially in areas related to self-regulation and attention.

• This “tuning out” becomes ingrained as a survival strategy — an adaptive response in a stressful environment that later becomes maladaptive in school or work settings.

Types of ADHD (DSM-5-TR)

• Predominantly Inattentive (previously ADD)

• Predominantly Hyperactive/Impulsive

• Combined

How does Mate view medication in the treatment process?

• Maté does not reject medication — he acknowledges that stimulants can help manage symptoms —but he argues they don’t address the root cause.

  • True healing involves addressing the underlying emotional wounds and stress patterns that contributed to the condition.

ADHD is not a disease; it is a mode of adaptation to early stress. -Understanding that helps us move from blame and frustration to empathy and healing.

How does Inattentiveness present?

• fails to give close attention to details or makes careless mistakes

• has difficulty sustaining attention

• does not seem to listen when spoken to directly

• does not follow through on instructions and fails to finish tasks

• has difficulty organizing tasks and activities

• dislikes or avoids tasks that require sustained mental effort

• loses things necessary for tasks or activities

• is often easily distracted (either external distraction or internal thoughts)

• forgetful in daily activities

How does hyperactive/impulsiveness present?

• fidgets, taps hands or feet, squirms in chair

• leaves seat inappropriately

• runs about or climbs in inappropriate situations

• unable to play quietly

• difficulty staying still for long periods of time (“on the go” “driven by a motor”)

• talks excessively

• blurts out answers before question has been completed

• difficulty waiting his or her turn

• interrupts or intrudes on others (conversations, belongings, activities)

How does ADHD in females often present?

• is frequently underdiagnosed

• symptoms may present differently than in males

• often show more inattentive 

• Many females with ADHD develop compensatory strategies, such as perfectionism or masking symptoms

• increased risk for conditions like anxiety, depression, and eating disorders, which can complicate diagnosis and treatment.

• can lead to difficulties in maintaining academic performance, friendships, and social interactions, especially as expectations increase with age

• Symptoms of ADHD in females can be exacerbated during hormonal shifts 

Assessment of ADHD in Children

Multi-Informant Reports, Standardized Rating Scales, Developmental and Behavioral History, Observational Assessments, Cognitive and Academic Testing

Multi-Informant Reports

Gathering information from multiple sources is essential, including parents, teachers, and sometimes other caregivers, to gain a comprehensive understanding of the child’s behaviors across different settings.

Standardized Rating Scales

Tools like the Conners' Rating Scale or the ADHD Rating Scale (ADHD-RS) are commonly used to assess symptoms and compare them to age-related norms

Developmental and Behavioral History:

 Reviewing the child's developmental milestones and behavior patterns helps identify whether symptoms have been present since early childhood and if they are consistent with ADHD

Observational Assessments

Direct observations of the child’s behavior in structured and unstructured settings (e.g., classrooms, play settings) can provide insights into their attention span, impulsivity, and hyperactivity.

Cognitive and Academic Testing

Assessing for potential learning disabilities or cognitive challenges, such as memory or processing speed issues, is essential, as these often co-occur with ADHD and can impact academic performance.

Assessment in Adults

• Self-Report and Collateral Information

• Adult-Specific Rating Scales

• Developmental History and Symptom Persistence

• Functional Impact

• Screening for Co-Occurring Conditions

Differential Diagnosis: What Else Could It Be?

• History of trauma

• Family issues

• Sleep issues

• Vision/hearing problems

• Medication side effects

list of treatment options:

• Medication

• Behaviour Coaching

• Individual Psychotherapy

• Community Support

• External Organizers

Multimodal treatments include meds and therapy, what else is this called?

Pharmacological (Medication) Treatments:

• Stimulants (first-line medications)

• Non-stimulant medications

Behavioral and Psychosocial Treatments:

• Parent Management Training (PMT)

• Behavioral classroom interventions

• Cognitive Behavioral Therapy (CBT)

• Dialectical Behavior Therapy (DBT)–informed skills

• Coaching interventions

• Social skills training

• Mindfulness-based cognitive therapy (MBCT)

Multimodal treatments also include…

Educational & Environmental Supports

• Individualized Education Plans (IEPs) or 504 accommodations

• Classroom modifications: seating placement, shorter work periods, extra test time

• Consistent routines and structure at home and school

• Teacher collaboration and psychoeducation

Lifestyle & Complementary Approaches

• Sleep hygiene improvement (ADHD is closely tied to sleep disruption)

• Regular physical exercise (aerobic activity shown to improve executive functioning)

• Balanced nutrition: omega-3 supplementation has modest benefits

• Mindfulness meditation and yoga (some evidence for reduced hyperactivity and impulsivity)

• Biofeedback/neurofeedback (mixed evidence, but sometimes used as adjunct)

• Psychoeducation for individuals and families

are meds a good treatment option for ADHD? is it fine alone?

pharmacological treatment is generally more effective than behavioural therapy alone in reducing the core symptoms of ADHD.

• A combination of medication plus well-implemented behavioural/psychosocial therapy tends to yield better functional outcomes (such as school or work performance, social and parent-child relationships) than either intervention alone, particularly in the short term

• Behavioural therapy alone may be less effective when core symptoms — especially impulsivity and attentional dysregulation — remain high, when there is limited contextual support (e.g., in the home/school environment), or when the therapy lacks intensity, fidelity or engagement.”

What are some personality characteristics of inattention?

• Attention Dysregulation NOT a Deficit in attention

• Hyperfocus Inspiration (whatever that fucking means)

• Notice what others miss

• Able to attend to and work with large volumes of information

What are some personality characteristics of impulsivity?

• Fearless

• Passionate

• Spontaneous

• Fun

• Fresh perspectives

• Pushing limits

• Honest

• Intuitive

What are some personality characteristics of hyperactivity?

• Active bodies and minds

• Resourceful

• Motivated

• ENERGY!!!

• Fast thinkers

• Enthusiastic