Chapter 8: Attention Deficit Hyperactivity Disorder

What are the 3 types of attention deficits and how do they relate to ADHD? Which type is the primary attention deficit in ADHD?

1. Attentional capacity: how much we can remember

   → Not usually a problem in ADHD

2. “Distractability” or selective attention: being able to concentrate on relevant stimuli while ignoring irrelevant stimuli for a long period of time

   → Children with ADHD struggle with this

3. Sustained attention: the ability to maintain persistent focus on (often repetitive or boring) tasks over a long period of time

   → The primary attention deficit in ADHD

What is ADHD characterized by?

Inattention and hyperactivity/impulsivity

How many symptoms must be present in order to be diagnosed with ADHD?

6 or more

In order to be diagnosed with ADHD, do you have to display symptoms in both inattention and hyperactivity/impulsivity?

No! A child can display 6 or more symptoms only in inattention, 6 or more symptoms only in hyperactivity/impulsivity, or a combination of 6 symptoms from both categories

How long must symptoms be present prior to diagnosis?

6 months or more

In order to be diagnosed with ADHD, how many settings must symptoms be present in?

2 or more settings

How does ADHD relate to developmental considerations?

In order to be diagnosed with ADHD, symptoms must be inconsistent with a child’s developmental level

In order to be diagnosed with ADHD, what age must symptoms be present before?

Age 12

What is considered to be the most influential cause of ADHD?

Biological and neurodevelopmental considerations

Is there a difference in rates of ADHD diagnoses in males vs. females? How does this change when considering childhood diagnoses vs. adolescent diagnoses?

1. About 4-6 males are diagnosed with ADHD for every 1 female in childhood

2. About 2 males are diagnosed with ADHD for every 1 female in adolescence

How might symptoms of ADHD be impairing?

1. Completing chores

2. Remembering homework

3. Stigma

4. Difficulty making friends

5. Risk-taking behaviors

What is the most common comorbid disorder with ADHD?

Oppositional Defiant Disorder/Conduct Disorder

What are the 3 most common comorbid disorders with ADHD?

1. Oppositional Defiant Disorder/Conduct Disorder

2. Anxiety Disorder

3. Depression

What is the rate of comorbidity between ADHD and ODD/CD?

More than 50%

How do comorbid anxiety disorders impact the symptoms of ADHD?

Symptoms of anxiety make symptoms of ADHD worse

Are ADHD diagnoses as simple as “diagnosis: attention deficit hyperactivity disorder?”

No! ADHD is diagnosed with consideration of subtypes

What are the 3 subtypes included in an ADHD diagnosis?

1. ADHD-PI: predominantly inattentive

   → 6+ inattentive symptoms

2. ADHD-HI: predominantly hyperactive/impulsive

   → 6+ hyperactive/impulsive symptoms

3. ADHD-C: combination

   → Combination of symptoms

Which ADHD subtype is least commonly diagnosed? What age group is usually diagnosed with this subtype?

ADHD-HI: predominantly hyperactive/impulsive

→ Most commonly diagnosed in preschoolers

Which ADHD subtype is most commonly diagnosed?

ADHD-C: combination

Is Attention Deficit Disorder or ADD included in the DSM?

No, there is no such thing!

What can you assume is meant when someone describes a child as having Attention Deficit Disorder or ADD?

People often (mistakenly) use ADD to refer to what would be correctly identified as predominantly inattentive ADHD

What does DIAL refer to in ADHD? What does each letter stand for?

DIAL can be used to remember the cognitive characteristics associated with ADHD

1. Distorted self-perceptions

2. Intellectual

3. Academic performance

4. Learning disorders

How are distorted self-perceptions associated with the different subtypes of ADHD? How do comorbid disorders relate to this?

1. Distorted perceptions such as overestimating competence or inflated sense of self-esteem are more common in predominantly hyperactive/impulsive ADHD subtypes and comorbid diagnoses of ODD/CD

2. Distorted perceptions such as underestimating competence or low sense of self-esteem are more common in predominantly inattentive ADHD subtypes and comorbid diagnoses of anxiety/depression

What are the intellectual capabilities of most children with ADHD? How do they tend to score on IQ tests and why?

No, most children with ADHD have average intellectual abilities

→ However, they tend to score about 5-6 points lower on IQ tests, highlighting their deficits in maintaining sustained attention

What is true about the relationship between ADHD and learning disorders?

They are hard to distinguish from one another, inflating comorbidity rates

How can ADHD result in medical concerns?

ADHD can lead to increased risk-taking behavior and accidental injuries

What 2 main areas of a child’s social life might be impacted by their ADHD and how?

1. Relationships with peers: Child often rejected by peers for their hyperactive/impulsive behaviors (ex. stealing another child’s toy) → leads to trouble maintaining friendships

2. Relationships with family: Parents often become burnt out trying to deal with a child’s hyperactive/impulsive behaviors and respond to them negatively (ex. anger or punishment) → leads to making the child’s symptoms of ADHD worse

How does goodness of fit relate to parenting a child with ADHD?

A child with ADHD will fare better with parents who are patient, understanding of, and accommodating to the child’s hyperactive/impulsive symptoms as opposed to parents who react with frustration, anger, and punishment

Does bad parenting cause ADHD?

No, but it can be an influencing factor

Does feeding a child too much sugar or artificial foods dyes cause ADHD?

No! This is pseudoscience

Does ADHD run in families?

Yes! It can be inherited genetically

Is individual counseling an effective practice to treat ADHD?

No! Individual counseling offers no positive benefits for managing the symptoms of ADHD

What are some example of pseudoscience in ADHD treatment?

Elimination diets, neurofeedback/biofeedback, and megavitamins

What is the recommended approach when treating ADHD?

Using a combined approach!

What are the 3 most effective treatment methods for ADHD, and what aspects of ADHD do they address?

1. Medication: biological

2. Parent Management Training (PMT): environmental (behavioral)

3. Educational Interventions: environmental (cognitive-behavioral)

What is the most effective individual treatment for the symptoms of ADHD? How often is it effective?

Medication! It’s effective about 80% of the time

Medication for treating ADHD is safe, but what is the caveat that comes with this?

If medication isn’t at the proper dose, people can experience side effects such as headaches or stomach aches

→ These side effects typically go away when the proper dose is discovered

What are the cautions that come with using mediaction to treat ADHD?

1. The long-term outcomes of using ADHD medication on children are not well documented

2. (Temporary) side effects

3. Short-term effect of the medication … lasts about 8-12 hours

4. Not to be used on it’s own

What did the MTA study do, and what did it tell us about how to approach the treatment of ADHD?

The MTA study compared the effectiveness of different (and combined) approaches in treating ADHD … all treatment methods showed improvements, but…

→ Medication-only group showed improvements only in decreasing the symptoms of ADHD, not in other areas

→ Combined group showed improvements in multiple areas (ex. peer/family relationships), highlighting the importance of using a combined approach when treating ADHD

What is Parent Management Training (PMT)? What does it teach (and to whom)? What does it address? What does it utilize?

A behavioral (operant) approach that teaches …

behavior management strategies to parents …

to address noncompliant, aggressive, and tantruming behaviors in their children with ADHD …

by utilizing reinforcement

What is the format of Parent Management Training (PMT)?

Instruction from a trained facilitator in small groups, including roleplaying, practice, and homework

What are some examples of lessons that might be taught through Parent Management Training (PMT)?

1. Attending to behavior (through observation)

2. Delivering effective praise

3. Setting clear expectations

4. Using a token system

5. Employing reductive strategies (ex. warnings or response cost)

How must instructions be given in effective educational interventions for ADHD?

Instructions need to be given clearly, briefly, often, and visibly

How must consequences be reinforced in effective educational interventions for ADHD?

Reinforcing consequences need to happen

1. MORE immediately

2. MORE frequently

3. MORE meaningfully (matching interests)

4. with MORE changes in rewards

5. having MORE anticipation (maintaining motivation during long tasks)

6. MORE visibly

How must goal attainment be structured in effective educational interventions for ADHD?

Goal attainment must be public between the child and teacher to foster accountability

What are the 5 steps in implementing a token economy?

1. Defining target behaviors

2. Select tokens

3. Select rewards for reward menu

4. Schedule when tokens will be received and exchanged

5. Plan for response cost

How must behaviors be defined and targeted in a token economy?

Behaviors must be specifically (and operationally!) defined, and the most major behaviors in that setting should be targeted

What is an example of something we can use as tokens in a token economy?

Pom poms or marbles

What is the importance of selecting back-up rewards such as a reward menu?

Using a reward menu offers a schedule of reinforcement and allows the child to choose when they are reinforced!

→ This keeps kids engaged regardless of whether they prefer delayed or immediate gratification!

What is response cost in token economies? How can this backfire?

Response costs are used as a punisher and take away a token that has already been earned when a child does an unwanted behavior

→ This can backfire because it creates the potential for all tokens to be removed and can negatively impact motivation

In token economies, has response cost been empirically supported to be beneficial for children with ADHD?

Yes!

What 2 warnings should we follow when using response costs in token economies?

1. Always maintain a reserve

2. Children should be earning significantly more tokens for appropriate behavior than they lose for inappropriate behavior

What is self-monitoring? What is the goal?

A child evaluates themselves at predetermined intervals (ex. every 10 minutes) on questions such as “Am I working?” or “How well did I do?” without fear of consequence

→ Goal: facilitating on-task behavior and self-accountability

What are the rules for earning points when a child and a teacher both complete evaluations of the child?

The child earns points based on how well their rating matches the teacher’s rating

1. When the rating of a child and teacher matches → the child earns X points plus 1 bonus point

2. When a child’s self rating is off by 1 point from the teacher’s rating → the child earns the rating they gave themselves

3. When a child’s self rating is off by more than 1 point from the teacher’s rating → the child earns no points

What are some examples of antecedent accommodations that can be used to support children with ADHD?

1. Extra time on assessments

2. Distraction-reduced location

3. Flexible seating options

4. Choice! (ex. colored pens or different types of assignments)

5. Breaks