ADHD

Psyc-127c

Criteria for ADHD (how many symptoms, length)

At least 6 items from either the Inattention category or the Hyperactivity Category for at least 6 months (if 17, 5+ symptoms)

Criteria for Inattention

1. Fails to give close attention to details, careless mistakes
2. Often has difficulty sustaining attention
3. Often does not seem to listen when spoken directly
4. Often does not follow through on instructions, fails to finish work
5. Often has difficulty organizing
6. Often avoids or reluctant to engage tasks that require sustained mental effort
7. Often loses things necessary for tasks or activities
8. Often easily distracted
9. Often forgetful in daily activities

Criteria for Hyperactivity

1. Often fidgets with hands or feet or squirms in seat
2. Often leaves seat in situations where remaining seated is expected
3. Often runs or climbs excessively
4. Often has difficulty playing quietly
5. Can’t sit still for too long, “on the go”
6. Often talks excessively
7. Often blurts out answers before question
8. Often has difficulty waiting turn
9. Often interrupts others

Define Inattention

Principally sustained attention or task persistence

Define Hyperactivity

Principally poor inhibitory control

Criteria B-E of ADHD

B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12
C. Criteria for ADHD are met in 2+ settings (home, work, school, etc.)
D. There must be clear evidence that the symptoms interfere with or reduce the quality of social ,academic, or occupational functioning
E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better accounted for by another mental disorder

Prevalence Rate of ADHD

Danielson et al. (2024) says 11.4% lifetime, 10.5% currently diagnosed

Examples of Economic Consequences of ADHD

Education, Caregiver Burden, loss of parent productivity

Is ADHD easy to detect at birth?

No, prior to age 4 it’s too difficult

Are there reliable ADHD detection tools?

No

Which ADHD category appears first then slowly dissipates?

Hyperactivity-impulsivity

Which ADHD category is presistant across ages?

Inattention

What’s the relationship between attention deficit and school demand?

Increased school demand increases attention deficit

Is ADHD Equifinal or Multifinal?

Multifinal

Clincal and Health Outcomes of ADHD

- Higher health care expenses
- Substandard academic achievement
- Poor social functioning
- Eating pathology
- Substance problems
- Occupational instability
- Risky bike riding
- Driving risks and auto accidents
- Workplace incompetency

ADHD is __% comorbid with ____.

50%, aggression/conduct problems

__% of ADHD patients will have significant _________.

25-33%, mood disturbance

3 examples of possible internalized problems

Depression, anxiety, bipolar

Do comorbid illnesses change treatment recomendations?

Yes

Until what year was ADHD research mostly in boys only?

2001

What are negative consequences for parents who have an ADHD child?

Maternal depression, alcohol + substance abuse, marital discord, parenting stress. Bidirectional

What are negative consequences of parent-child interactions with ADHD?

Less responsive, more negative/directive, evident in preschool & school-age & adolescent youth (across development)

What are negative social skill consequences of ADHD?

Less cooperation, less empathy, applies to interactions with peers & siblings & teachings & parents

What are negative peer relationship consequences of ADHD?

Higher rates of rejection, impressions are stable and immediate (once other kids make an impression on an ADHD kid, it is very likely to stick), positive illusory bias

What is illusionary bias?

over-estimated competency (perceived vs. actual)

What are the 3 types of Causal Risk Factors?

Pregnancy/Birth/Early Dev., Genetics, Neurobiological

What does pregnancy/birth/early dev entail as a risk facotr?

malnutrition, neurological trauma, low birthweight

What is the heritability of ADHD and is it pleiotropic or polygenetic?

H² = .75, polygenetic

What is the Fronto-striatal Network?

Connections between PFC (decision-making) and Striatum (motivation and rewards processing)

What are the 2 evidence-based interventions for ADHD?

Parent Training + Stimulant Medication

What do parents tend to have when raising an ADHD child?

elevated stress, psychopathology, and poor parenting skills

What is one effect on the prognosis and development comorbidity for ADHD?

Parenting

What are 2 Behavioral Interventions at Home for ADHD?

Structure + Clear Communication

What does structure at home entail?

- Morning routine, after school, evening, bedtime
- Chart behavior (daily report cards)
- Token economy with incentives and consequences (have child participate in selection process, hierarchical reinforcements daily vs. weekly levels)

To ensure a child’s attention: ____ and ____

say the child’s name and make eye contact

When parenting a child with ADHD, which is more effective: commands or questions?

Clear, concrete, and concise commands

Should you follow through with consequences for a child with ADHD?

Yes. State consequences and follow through.

What is labeled praise?

Conveys clear expectations and delivers concrete reinforcement; increases behavior that is praised

What are examples of labeled praise?

Good job cleaning up! Thank you for sharing with me! I like how you’re building so quietly! (not just good job! Or Thank you!)

What is Positive Attending?

Reflecting and expanding on conversations, non-verbal tools (eye contact, facial expressions)

What are examples of Positive Attending?

→ C: I threw out the trash P: And it was super heavy too!
→ C: I’m building a fort P: It has two levels and five windows!

What are Triage Problem Behaviors?

- Separate child behaviors that are irritating vs. attention-seeking
- teach, practice, and model selective ignoring of negative behavior (sometimes “in vivo/while it’s happening”)
- Behaviors previously reinforced (parental attention) will get worse before better
- Emphasize consistency of selective ignoring and unintended consequences if employed inconsistently

What is an extinction burst?

Rapid succession of unwanted behavior before it stops

What is an example of selective ignoring?

Leaving the room or not reacting to a child’s behavior