Chapter 7: The Preschool Period - Emergence of ADHD and Learning Disorders

Vocabulary flashcards covering ADHD and Learning Disorders concepts, criteria, etiology, development, comorbidity, and interventions drawn from the lecture notes.

Attention-Deficit/Hyperactivity Disorder (ADHD)

A neurodevelopmental disorder characterized by persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning; DSM-IV-TR recognizes three subtypes: Combined Type, Predominantly Inattentive Type, and Predominantly Hyperactive-Impulsive Type.

DSM-IV-TR Criteria A1: Inattention

Six or more symptoms of inattention for at least 6 months that are maladaptive for age (e.g., careless mistakes, difficulty sustaining attention, not listening, poor organization, distractibility).

DSM-IV-TR Criteria A2: Hyperactivity/Impulsivity

Six or more symptoms for at least 6 months that are maladaptive for age (e.g., fidgeting, leaving seat, running or climbing in inappropriate settings, talking excessively, impulsive answers, difficulty waiting turn).

ADHD Combined Type

ADHD presentation meeting both inattention and hyperactivity/impulsivity criteria for the past 6 months.

ADHD Predominantly Inattentive Type

ADHD presentation meetingCriteria A1 (inattention) but not A2 (hyperactivity-impulsivity) for the past 6 months.

ADHD Predominantly Hyperactive-Impulsive Type

ADHD presentation meeting Criteria A2 (hyperactivity-impulsivity) but not A1 (inattention) for the past 6 months.

Age of Onset (DSM-IV-TR)

Symptoms must be present before age 7 according to DSM-IV-TR; DSM-V proposed change to extend onset to age 12.

Setting Requirement

Symptoms must cause impairment in two or more settings (e.g., home and school), though some cases may appear in only one.

Prevalence of ADHD

Wide variation across cultures (roughly 1% to 20% worldwide in school-age children); prevalence can decline with age and differs by assessment methods and settings.

Gender Differences in ADHD

Boys are more frequently diagnosed; girls often underidentify, especially with the inattentive type; gender differences may reflect referral patterns and diagnostic criteria.

Comorbidity with ADHD

ADHD commonly co-occurs with oppositional defiant disorder (ODD), conduct disorder (CD), anxiety, mood disorders, and learning disorders.

ADHD and Learning Disorders (LD) comorbidity

Many children with ADHD have learning difficulties; estimates suggest 19–26% of children with ADHD meet criteria for LD, with up to 80% showing some learning problems.

Etiology: Biological Context

ADHD has a biological basis with strong genetic influence (heritability estimates ~0.75–0.97); brain circuitry involving frontal-striatal pathways implicated.

Genetic Factors in ADHD

High heritability evidenced by twin studies; about 75–97% of symptom variance attributed to genetic factors; family studies show elevated ADHD prevalence in relatives.

Neurobiology of ADHD

Neural involvement includes prefrontal-striatal-thalamocortical circuits; reduced blood flow to right frontal areas; cerebellar involvement; caudate nucleus differences; possible DMN dysregulation.

Neurotransmitters in ADHD

Dopamine and norepinephrine systems are central; transporter genes for these neurotransmitters and serotonin transporter genes (5HTTLPR) have been linked to ADHD subtypes.

Barkley’s Integrative Developmental Model

An integrative model where behavioral inhibition is foundational; impaired inhibition leads to deficits in executive functions such as working memory, internal speech, affect regulation, and reconstitution.

Behavioral Inhibition

The capacity to delay a motor response (response inhibition) and to resist interference (interference control); foundational for developing executive functions.

Executive Functions in Barkley’s Model

Four components: nonverbal working memory, internalized speech, affect (emotion) regulation, and reconstitution (high-level planning and problem solving).

Nonverbal Working Memory

Holding information on-line to guide future actions; supports planning and sustained attention.

Internalized Speech

Self-talk that converts overt talking into private inner dialogue; supports self-instruction and self-control.

Affect Regulation

Self-regulation of emotions, enabling dampening or intensification of emotional responses to sustain goal-directed behavior.

Reconstitution

High-level mental operations for analysis, synthesis, and flexible problem solving.

Dual Pathway Model (Sonuga-Barke)

Two dissociable deficits in ADHD: dorsal/Executive dysfunction and ventral/motivational dysfunction with delayed reward processing.

Reward/Motivation Dysfunction in ADHD

Dysfunction in reward processing leading to difficulty delaying gratification and preference for immediate rewards.

Developmental Course: Toddler/Preschool

Early patterns of hyperactivity-impulsivity differentiate and may predict ADHD emergence in later years; parental stress is high in preschool.

Developmental Course: Middle Childhood

Inattention and organizational problems emerge; hyperactivity-impulsivity often declines; comorbidity with ODD/CD increases.

ADHD Across Life Stages

ADHD commonly persists into adolescence and adulthood for many individuals; symptom expression may shift (e.g., restlessness internalized).

MTA Study (Medication vs. Behavioral vs. Combined vs. Community Care)

Large randomized trial showing medication often improves ADHD symptoms more than behavioral treatment; combined treatment not superior to medication alone; medication plus behavior better than behavior alone.

Stimulants for ADHD

First-line medications (e.g., methylphenidate, amphetamines, Pemoline) that rapidly reduce core ADHD symptoms; generally well tolerated with manageable side effects.

Atomoxetine

Non-stimulant ADHD medication (SNRI) with benefits for some individuals; often used when stimulants are unsuitable.

Neurofeedback

EEG-based training to self-regulate brain activity; evidence shows moderate benefit in some trials for ADHD, with ongoing research.

Behavioral and Cognitive-Behavioral Therapy (CBT) for ADHD

Behavioral strategies (e.g., contingency management) and cognitive strategies (self-instruction, self-monitoring) to improve organization, planning, and self-control.

Parent Training for ADHD

Behavioral parent training emphasizes consistent discipline, positive reinforcement, and strategies to improve parent-child interactions.

RTI: Response to Intervention

A multi-tier approach to LD identification and intervention that emphasizes progressive levels of intervention before special education placement; contrasted with IQ–achievement discrepancy models.

Learning Disorders (LD)

Heterogeneous group of disorders involving difficulties in acquiring/using listening, speaking, reading, writing, reasoning, or mathematics; not due to sensory or intellectual deficits; central nervous system involvement often implicated.

NJCLD vs DSM-IV-TR LD definitions

NJCLD defines LD as heterogeneous disorders with significant academic difficulties; DSM-IV-TR categorizes LD into Reading Disorder, Mathematics Disorder, and Disorder of Written Expression with criteria focused on specific deficits.

Reading Disorder (RD) Subtypes

Three empirically supported RD subtypes: Word Recognition (dyslexia), Reading Comprehension, and Reading Fluency.

Garden Variety RD (GRD)

RD defined by a discrepancy between reading achievement and IQ that aligns with overall reading difficulty; used to illustrate the limitations of the discrepancy model.

Phonological Processing Deficit in RD

Core impairment in decoding written language; deficits in phonological awareness, phonemic segmentation, and rapid phoneme manipulation affect reading ability.

Phonological Awareness

Understanding that words consist of distinct sounds (phonemes); a key precursor to successful reading development.

Phonemic Awareness

Ability to identify and manipulate phonemes within words; essential for decoding and spelling.

Phonological Training for RD

Interventions targeting phonological processing can improve reading outcomes and even shift brain activation toward left-hemisphere networks.

RD and Genetics

Strong genetic component to reading achievement; twin studies show substantial heritability and chromosome 6 regions implicated in reading disorders.

RD and Behavior Problems

RD alone does not cause behavior problems; comorbidity with ADHD can explain observed associations; early reading failure can also influence behavioral issues.

RD and Social Skills

LD often linked with poorer social skills and peer relationships; meta-analytic evidence shows elevated social difficulties in LD.

RD and Emotional Problems

RD associated with internalizing problems like low self-esteem, anxiety, and depression, particularly in girls.

Educational Interventions for LD

Assessment leading to an individualized educational plan (IEP); mainstreaming/inclusion; phonological training; multisensory and explicit instruction; school-wide RTI approaches.

Piagetian View on Underachievement (Box 7.7)

Underachievement can stem from deliberate disengagement or motivation, not just cognitive deficit; teacher expectations influence student engagement.

Differential Teacher Treatment (Weinstein)

Teachers’ differential behavior toward high- vs. low-achieving students shapes self-perception and future learning engagement.

Grade Retention Effects

Holding a child back can have lasting negative socioemotional effects and may worsen anxiety, inattention, and disruptive behavior.

Dilemmas in ADHD Assessment: Report Validity

Discrepancies between parent, teacher, and self-reports pose challenges; multi-informant and triangulation approaches are recommended to improve validity.