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ADHD
a neurodevelopment disturbance; has lifelong implications
characterized by an early onset in childhood and persistent
ADHD subtle delays
in language, motor, and social development
two factors the DSM-5 recognizes in ADHD
(1) inattention and (2) hyperactivity-impulsivity
signs of inattention
careless mistakes in school/work
seems to not listen when spoken to / fails following instructions
difficulty in organizing activities
distracted by external factors
attention is situational
signs of hyperactivity-impulsivity
fidgets with hands / feet / squirms in sweat
runs about inappropriately / excessively talks
difficulty waiting one’s turn / interrupts or intrudes on others
diagnosis of ADHD
presence of several symptoms before age 12 and display of symptoms for at least six months
only given when symptoms are at odds with developmental expectations
symptoms must be pervasive, they must occur in at least 2 settings (ex: home and school)
selective attention
ability to focus on relevant stimuli and not be distracted by irrelevant stimuli
attentional alerting
ability to immediately focus on something of importance
sustained attention
continuing to focus on a task or stimulus over a period of time
hyperactivity
children with ADHD are described as always on the run, driven by a motor, restless, fidgety, and unable to sit still
motor excess and restlessness, more likely to occur in highly structured situations that demand children to sit still
impulsivity
deficiency in inhibiting behavior, hold back, or in controlling behavior which appears as acting without thinking
child may interrupt others, cut in line, engage in dangerous behaviors
patience or restraint are not well accomplished
emotion regulation and reactivity
display difficulties with ADHD
low frustration tolerance, impatient / quick to anger
easily excited to emotional reaction more generally
ADHD, frequently viewed as
a disorder of performance rather than a deficit in knowing what to do
children with ADHD
show significant difficulties in social behavior, social information processing, and peer relationships
what core features of ADHD present challenges in social functioning
inattention (linked to social difficulties) , hyperactivity, impulsivity
social difficulties in ADHD
not listening, being distracted, slow behavioral style - get in the way of child’s ability to attend to peers effectively or to notice or respond to social cues appropriately
children with ADHD may demonstrate
deficits in social problem-solving and perspective-taking skills, which can undermine their ability to understand & solve everyday social dilemmas
what contributes to heightened peer difficulties
some children with ADHD who display an aggressive, native style of social interaction
exhibited by physical/verbal aggression toward others
rule breaking, hostile controlling behavior
what style frequently co-occur with ADHD
negative aggressive style, reflects oppositional defiant disorder (ODD) or conduct disorder (CD)
positive self bias
some children with combined presentation: inattentive & hyperactivity (ADHD-C) have a stable self perception regarding their social competence, behavioral conduct, and academic competence
ADHD-PI
predominantly inattentive presentation
ADHD-PHI
predominantly hyperactive/impulsive
ADHD-C
combined presentation; showing both inattentive and hyperactive factors
after only a few social exchanges
peers may view the child with ADHD as disruptive & unpredictable and react with rejection and withdrawal
How do peers react to impulsive and hyperactive children?
respond negatively to impulsive and hyperactive children.
What happens to kids with just attention problems?
usually ignored or neglected by their peers.
Why do children with ADHD struggle to make and keep friends?
children with ADHD often face rejection or neglect because they have trouble with skills needed for friendships, such as emotionally connecting and expressing care.
How does a lack of friends affect children’s social skills?
means fewer opportunities to develop social competence and empathy, and to be protected from bullying.
What do peer problems predict for children?
psychological issues and academic difficulties in children.
When can negative family exchanges begin for children?
occur as early as the child's preschool years, with mother-child relations often being more difficult than father-child interactions.
How do ADHD and co-occurring symptoms affect family dynamics?
Families of adolescents with ADHD, especially those with depression and aggressive behavior, experience more arguments and negative interactions than usual
How do broader family characteristics affect child-parent relationships in ADHD?
Factors like interparental conflict, parental depression, and stress can negatively impact child-parent relationships in families with ADHD.
What genetic risks do parents of children with ADHD face?
Parents of youth with ADHD are often at genetic risk for various problems, including symptoms of ADHD themselves.
What do parents of young people with ADHD report regarding parenting?
high levels of parenting stress, and the relationship between family functioning and ADHD is likely bidirectional.
problems associated with ADHD
allergies and asthma (but inconsistent data)
inability to fall asleep, night awakening, fewer hours of sleep. involuntary movements during sleep
sleep difficulties may be due to?
co-occurring symptoms : anxiety and depression; medication may also interfere with sleep
What do children with ADHD suffer more
accidental injury ( broken bones, head lacerations, bruises, lost teeth, poisonings) which is related to inattention and impulsivity
: What behaviors do parents observe in children with ADHD in risky situations?
often inattentive in risky situations and are unmindful of the consequences of their actions.
What factors contribute to difficulties in automobile-related behaviors for adolescents with ADHD?
motor incoordination, defiant and aggressive behavior, inadequate parental monitoring,
and impulsivity are involved in the challenges faced by adolescents with ADHD regarding driving.
How does the age of onset and presentation differ for girls with ADHD?
often have a later age of onset and are more likely to be diagnosed with the predominantly inattentive presentation compared to other presentations.
how does the disorder impact relationships with teachers
can be directive and controlling toward children with ADHD
What is the impact of ADHD combined with depression?
often leads to poorer outcomes than either disorder alone, resulting in greater social functioning impairments and higher rates of suicidality, especially in girls.
gender differences in ADHD
boys consistently outnumber girls; probably reflect a bias due to boys greater aggressive & antisocial behavior
diagnostic criteria : biased toward males behaviors observed more (excessive running, climbing, leaving seat in classroom)
girls are identified to be more on the basis of inattentive and disorganized behaviors
symptoms of girls with ADHD ages 6-12
executive function deficits, academic problems, negative peer evaluations
high rates of anxiety, mood disorder, conduct problems
less hyperactive, fewer externalizing symptoms, and lower intelligence
How does severity of symptoms affect ADHD diagnosis and treatment in girls?
more likely to be diagnosed and receive treatment for ADHD if they show severe hyperactivity, impulsivity, or conduct problems,
proving concerns that they may be misdiagnosed or underrated unless they exhibit significant impairment.
How does the prevalence of ADHD differ between boys and girls?
ADHD is diagnosed more frequently in boys than in girls, and its symptoms tend to decline during adolescence.
In which social classes is ADHD most commonly observed?
ADHD appears across all social classes, but higher rates are sometimes associated with lower socioeconomic status (SES).
What disparities exist in the diagnosis and treatment of ADHD among racial and ethnic groups?
Racial and ethnic disparities may lead to underdiagnosis and undertreatment of ADHD in African American and Hispanic/Latinx youth.
How do minority children fare in ADHD diagnosis and treatment?
less likely to receive an ADHD diagnosis and treatment compared to their peers.
What barriers do minority youth face in accessing ADHD care?
financial barriers, cultural factors, and language barriers, making it more difficult to access accurate information, care, and diagnosis for ADHD.
What broader societal factors influence ADHD diagnosis in minority groups?
Social disadvantage and education policy can affect ADHD diagnosis and treatment access.
ADHD: developmental course
emerges early for many children ; examining first yr of life is critical
children do not necessarily “outgrow” ADHD
can be understood only by observing the persistence of symptoms into adolescent and adulthood
What temperament traits are seen in children who become hyperactive and aggressive by age 8?
These children often display an early difficult temperament, being more active and less cooperative by ages 3 to 4.
How do early behaviors relate to later hyperactivity and aggression?
Children who are hyperactive and aggressive at age 8 tend to show increased activity and challenging behavior as early as age 3 to 4.
What are the first signs of ADHD?
may include motor or language delays and difficult temperamental tendencies.
When are most cases of ADHD referred for diagnosis?
between the ages of 6 and 12, often due to school demands for attention, rule-following, social interaction, and behavior regulation.
How does inattention symptoms change during childhood for children with ADHD?
deficits may become more obvious, with some children showing increasing inattention while hyperactivity/impulsivity decreases, while others may experience consistent low symptoms.
What factors can influence the trajectory of ADHD in children?
Child characteristics, family risk factors, and other influences can predict how ADHD symptoms develop over time.
What additional problems may emerge in childhood for children with ADHD?
Issues may include self-regulation problems, poor social relationships,
low academic achievement,
and clinical-level oppositional behaviors, conduct problems, and internalizing symptoms.
How do ADHD symptoms change in adolescence?
primary symptoms, especially hyperactive/impulsive behaviors, decrease in many cases, which may lead to the diagnosis of ADHD no longer applying.
What problems are children with ADHD at risk for during adolescence?
Poor school achievement and reading problems
Internalizing issues, conduct disorder, and antisocial behavior
Drug use or abuse, social problems, and accidents
Symptoms of eating disorders and teenage pregnancy; issues that can significantly challenge family relationships due to noncompliance and conflicts over rules.
What are the long-term effects of ADHD in adulthood?
Impaired social relationships
Depression and low self-concept
Antisocial behavior and personality issues
Drug use and educational/occupational disadvantages
How does ADHD affect girls differently, and what are the implications of late diagnosis?
62% exhibiting some ADHD symptoms and greater lifetime risks for mood, anxiety, and antisocial disorders compared to peers.
Increased interest in adults diagnosed later in life, who often report a history of childhood ADHD symptoms.
This supports the view of ADHD as a chronic lifelong condition for many individuals
the course and outcome of ADHD vary
some children overcome disorder; others continue to show different kinds and degrees of problems
what variables predict outcome of ADHD
genetic factors influence continuity
poor education outcome appears associated with early deficits in attention, intelligence, academic skill, internalizing symptoms
parents’ child-rearing practices/ parent-child interaction
age of onset
continuance of antisocial behavior
especially associated with family disturbance and the child’s aggression and conduct problems
what variables predict adolescent/adult outcomes of childhood ADHD
severity of symptoms
aggression; conduct problems
general intelligence / academic ability & performance / social functioning
family adversities, socioeconomic status
parents ADHD and psychiatric disorder
impairments in executive functions and inhibition
well documented in ADHD
How do executive function deficits relate to ADHD?
Planning and organizing tasks
Inhibiting impulsive responses
Maintaining attention and focus
These impairments lead to challenges in self-regulation and task completion.
adolescent and adulthood
symptoms may diminish / change
can have academic, social, conduct disorder, substance abuse & more
longer-term problems may be associated with co-occurring diagnosis
executive functions: Barkleys model
behavioral inhibition viewed as consisting of 3 abilities;
inhibit prepotent responses : likely to be reinforced or have a history of reinforcement
interrupt prepotent responses : that are already under way and proving ineffective
protect from interference : ability to inhibit competing stimuli (thought of as freedom from distraction)
How does behavioral inhibition contribute to self-regulation?
helps by:
Preventing prepotent (automatic) responses
Stopping ineffective responses
Hindering distractions
These processes set the stage for effective executive function
What is nonverbal working memory, and how does it function?
is part of the memory system that allows individuals to hold sensory motor information "online" for controlling subsequent responses.
It involves the memory of actions and is crucial for coordinating behavior.
How does internalization of speech relate to working memory?
can be seen as verbal working memory, enabling individuals to:
Mentally reflect on rules and instructions
Internalize guidance for behavior
This process aids in self-regulation and decision-making.
What processes are involved in the self-regulation of affect, motivation, and arousal?
that help individuals adapt their emotions and motivation, such as:
Lessening feelings of anger
Adjusting motivation and arousal levels
This adaptability is essential for effective self-control and behavioral responses.
What is reconstitution, and how does it aid behavior?
allows individuals to analyze and synthesize verbal and nonverbal units. This process enables:
Breaking down actions and thoughts
Recombining them to construct novel and creative behaviors or sequences
This ability is crucial for flexible problem-solving and adaptive behavior.
what result is adaptive
when inhibition, executive function and self regulation are intact
How does Reward Sensitivity impact ADHD behavior?
involves an altered response to rewards, leading to:
Increased motivation for immediate rewards
Difficulty with tasks lacking immediate reinforcement
This can contribute to impulsivity and challenges in goal-directed behavior.
What are Temporal Processing Deficits in ADHD?
refer to difficulties in estimating and managing time. may struggle with:
Perception of time passing
Planning and completing tasks within a time frame
This can lead to challenges in meeting deadlines and task completion.
What is Delay Aversion, and how does it relate to ADHD?
is the tendency to prefer immediate rewards over delayed gratification. In ADHD, this can result in:
Impulsive decision-making
Difficulty in tasks requiring patience or long-term planning
The preference for immediate rewards may exacerbate challenges associated with temporal processing deficits.
What is the Arousal Theory in relation to ADHD?
linked to low arousal / under-arousal of the central nervous system
seek out stimulation through hyperactive behaviors to reach an optimal level of arousal, contributing to symptoms of hyperactivity and impulsivity.
How do executive function deficits relate to ADHD?
involve difficulties with:
Planning and organizing tasks
Inhibiting impulsive responses
Maintaining attention and focus
These impairments lead to challenges in self-regulation and task completion.
What is the Dual-Pathway Model of ADHD?
posits that ADHD symptoms arise from two primary pathways:
Executive Function Deficits: Impairments in planning, organization, and impulse control.
Delay Aversion: A preference for immediate rewards over delayed gratification, leading to impulsivity.
What role does Delay Aversion play in the Dual-Pathway Model of ADHD?
contributes to ADHD by leading individuals to:
Prefer immediate rewards, resulting in impulsivity
Struggle with tasks requiring patience
a possible third pathway involves Temporal Processing Deficits, where individuals have difficulty estimating time, further complicating task management and self-regulation.
