lecture 10 - neuropsychology ADHD Flashcards

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1
Q

what is the purpose of neuropsychology

A

-to understand the relationship between the brain and the behaviour

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2
Q

what is clinical neuropsychology

A

-sub field of neuropsychology
-explains functional behaviour and relate this to any underlying neuropathology in order to inform treatment, rehabilitation and education

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3
Q

what are neuropsychological assessments used for

A

-clinical purposes
-research

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4
Q

what are test batteries
what do they assess

A

a collection of tests / assessments

-they asses
-cognitive functioning,
-emotional processing
-psychosocial skills,
-motor development

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5
Q

neuropsychological assessment
-how are they standardised

A

Assessments are typically standardized
* Undergoes rigorous reliability and validity tests
* Can only be used by trained individuals
* Administered in a standardized way
* Evaluated and interpreted by trained individuals

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6
Q

what is assessed in a neuropsychological assessment.

and what can they be tested with

A

-Sensory perceptual functions (tactile, visual, auditory, etc.)
* Motor functions related to speed and strength
* Attention and problem solving skills
* Language and communication skills
* Learning and memory skills
* Executive functioning

can be tested with
-a fixed battery
-a flexible battery at the discretion of the neuropsychologist (piece together different tests etc)

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7
Q

how are sensory/ perceptual functions (tactile, visual, auditory) assessed

A

-example boccia bilateral coordination
-video shows girl being instructed to touch nose with alternating arms when eyes are closed,
-relies on sensory input, where her fingers are in space

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8
Q

how are motor functions related to speed and strength assessed

A

-measure strength using a dynamometer,
-a machine you can rip and squeeze as hard as you can to figure out how strong your grip is

-eg finger tapping test to look at speed, you tap anytime you see a light (old method)

-hand eye coordination , place one hand behind their back, put these little peg into their holes, can sense deficit motor , hand to eye movement

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9
Q

how are attention and problem solving skills assesed

A

-trials making test
-child is asked to take their pencil and draw lines to cross dots , these dots have letters and numbers
-ask child why number 1 and they go 1a, 2b, 3c, they have to keep track mentally requiring attention
-an attention and processing speed task,

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10
Q

how are learning and memory skills assessed

A

-was the task we did in class which was looking at a complex picture with shapes and patterns, and then asked to draw it after class (to see how much we could remember )

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11
Q

how is executive functioning assessed

A

continuous performance task
-looking at ability to inhibit responses and shift attention etc

-task in class, you clap every time you see a letter apart from the letter ‘X’

CPT and other tests of executive functioning
-used clinicall to screen to challenges with attention etc ADHD

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12
Q

what is ADHD
-what types are there

A

attention deficit hyperactivity disorder
-ADHD I - inattention
-ADHD-HI - hyperactivity/impulsivity
-ADHD-C - combined

ADD is not a diagnosis (attention deficit disorder)

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13
Q

ADHD - DSM 5 definition

A

ADHD categorized as a neurodevelopmental disorder because symptoms are present in childhood
* Even if diagnosis only occurs in adulthood

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14
Q

what is ADHD
-criteria
-which conditions must be met (DSM5)

A

Criteria:
* At least 6 symptoms for at least 6 months → for ages 16 and under
* At least 5 symptoms for at least 6 months → for ages 17 and older

Must meet the following conditions:
* Symptoms present before age 12
* Symptoms present in two or more settings
* Evidence that symptoms interfere with functioning
* Symptoms cannot be better explained by another disorder (e.g., anxiety, dyslexia)

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15
Q

ADHD- I symtoms
-more inattention related

A

Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
* Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace(e.g., loses focus, side-tracked).
* Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
* Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).* Is often easily distracted* Is often forgetful in daily activities.

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16
Q

ADHD-HI symptoms
-more hyperactive

A

Often fidgets with or taps hands or feet, or squirms in seat.
* Often leaves seat in situations when remaining seated is expected.
* Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
* Often unable to play or take part in leisure activities quietly.
* Is often “on the go” acting as if “driven by a motor”.
* Often talks excessively.* Often blurts out an answer before a question has been completed.
* Often interrupts or intrudes on others (e.g., butts into conversations or games)

17
Q

risk factors - genetic influences
-twin studies
-family studies

A

-twin studies
-genetic influences account for 70-90% of variance (if you have a twin with ADHD theres a 70-90% chance you may also have ADHD)

-family studies
-if you have an immediate family member with an ADHD diagnosis , you are 5x more likely to experience symptoms

Research has not established causative role for individual genetic variants yet
* There isn‘t one gene!
* Likely several genes with minor effects

18
Q

risk factors - environmental influence
-factors in early development , prenatal, perinatal and postnatal
-genetics

A

Possible harmful factors in early development reliably associated with ADHD
* Prenatal association’s
:* E.g., Smoking, alcohol, illicit drug use

  • Perinatal associations:
  • E.g., Low birth weight, preterm birth
  • Postnatal life:
  • E.g., Inadequate diet, major vitamin B deficit, exposure to industrially contaminated areas, some artificial colorings, depriving institutional environment,medical illnesses…
  • Genetic factors can influence exposure and susceptibility to environmental risks
19
Q

risk factors - interacting factors
genetic x environmental factors

A

ADHD risk is made up of many interacting genetic and environmental factors with different individuals affected in different ways, at different times and to different degrees
* E.g., two siblings share 50% genetics and may grow up in the same household but can still present differently

20
Q

ADHD theories
-Russel Barkley (1997)

A

-postulated that ADHD is a disorder related to executive function (EF)
-specifically inhibitory control- the ability to withhold a behaviour response
-believed that difficulties with attention were biproducts of inhibitory control deficits
i.e symptoms relate back to the same deficit

21
Q

Russell Barkley theory evidence

A

-stop signal tasks
eg CPT children with ADHD performed worse

1, habituate a response
eg ‘press the button every time a letter appears on the screen’
-participant practices the response

  1. Measure commission errors
    * e.g., “Refrain from pressing the button when the letter X appears”
    * Count the number of times the participant made a response when they should have withheld it
22
Q

criticisms with Russell Barkley’s theory

A

Stop Signal Tasks have high continuous demands:
* Child must continuously process information, remember instructions, prepare for their behavioural response

  • Higher intra-individual variability in ADHD groups:
  • Each participant’s performance is not consistent
  • Participants vary greatly from one another
23
Q

ADHD theories
-delay aversion theory

A

-the tendency to prefer smaller-immediate rewards instead of larger-delayed rewards

-eg marshmallow test of delayed on gratification
-but this could be worse for children who grew up poor ? they just learn to take what they get

24
Q

delay aversion theory
evidence
and findings
and conclusion

A

Sonuga-Barke et al. (2003)
* 156 children (3-6 years)

  • Given two tasks:
    1. EF test battery
    1. Choice delay task (tests delay aversion)
  • Computer game with a points system
  • Throughout the game, they had a choice:
  • Small-immediate reward – green square = 1 point
  • Large-delayed reward – blue square = 2 points
  • Can we predict which children are diagnosed with ADHD based on their performance?

Findings:
* ADHD – not more likely to choose the green square (small-immediate reward)
* Combining tests was able to predict 90% of the children with ADHD

  • Conclusions:
  • At least two mechanisms contributing to ADHD behaviours
25
Q

when can we see variability in ADHD

A

Variability in ADHD:
* Presentation of symptoms
* Onset of symptoms
* Development of symptoms
* Duration of symptoms
* Performance on different tasks (e.g., EF vs choice delay tasks)

What does variability look like in non-ADHD populations?
* Studying typical development is important for clinical research!

26
Q

variability in brain development
-grey matter and white matter development

A

studying the natural development of the brain provides insights into the process that lead to several deficits that a child might show and grow out of

-the graphs show there is variability with white matter and grey matter through your lives
white matter -increases towards as you get mid aged and then decreases as you grow old
gray matter decreases through life

27
Q

what age does white matter increase until and what does this mean

A

The brain is not yet done developing.
* White matter increases till mid-30s
* Could be due to myelination
* Frontal regions develop more slowly, which has control over attention and impulsivity.

28
Q

variability in frontal lobe development of children

A

variability in
-cortical thickness
-surface area
-volume
The inter-individual differences in development are large between children.

29
Q

how does variability cause concerns about diagnosing ADHD at a young age

A

-it causes concerns as we may not capture child’s individual trajectory

30
Q

ADHD across the lifespan
study
method and basic findings

A

Since children are still developing, can they grow out of symptoms? Shaw et al. (2013)
* Longitudinal study (childhood  adulthood)
* All participants were diagnosed with ADHD as children
* Evaluated neural correlates of symptoms across time

method
Two groups:
* Diagnosis with ADHD vs non-ADHD controls
* Evaluated neural correlates of symptoms across time

findings
-Inattentive symptoms were more like to be persist than hyperactive /impulsive symptoms
* 60% of patients no longer met criteria for ADHD

31
Q

ADHD across the lifespan
study
findings: variability in brain development causing the changes in adhd diagnosis
conclusion

A

Changes in cortical thickness in right and left hemispheres detected differences between groups
* Typical and Persisters – maintained the same developmental trajectory from childhood  adulthood
* Remitters – significantly different trajectory across time

Conclusions:
* ADHD can persist into adulthood(but not always)
* Inattention tends to persist
* Brain development might explain some inter- and intra-individual variability
* But 22-years-old may be too young to capture the full trajectory of ADHD

32
Q

how is ADHD being researched today
-brain networks

A

-looking at frontal lobe
-associated with executive functioning and adhd symptoms

33
Q

how is ADHD being researched today
-assessments and diagnosis

A

Despite brain imaging data, diagnosis doesn’t use neuroimaging information(yet)
* Reliance on:
* EF tests
* IQ test batteries
* Self-report questionnaires
* Issues with over-diagnosis of ADHD:
* Meta-analysis reports increased reports of ADHD (Kazda et al.,2021)
* Widens the ambiguity of symptoms
* Reliance on self-report alone leads to over-diagnosis

34
Q

how is ADHD being assessed today
maternal health

A

Maternal post-partum mental health challenges (after giving birth)
:* Related to ADHD symptoms when child is 8-9 years
* (Mulraney et al., 2019)

  • Maternal anxiety and sleep difficulties during pregnancy
    :* Related to ADHD symptoms when child is in preschool
  • (Vizzini et al., 2018)
35
Q

how is ADHD being researched today
-gut biome

A

Gut biome:
* Based on the gut-brain axis

Lower diversity of gut bacteria leads to:
*reduced production of neuroprotective factors
* higher likelihood of ADHD symptoms
* (Bull-Larsen & Mohajeri, 2019)

36
Q

how is ADHD being researched today
-cross cultural

A

Are there cultural aspects to symptoms reporting of ADHD?
* Do ADHD symptoms present similarly across countries?
* Small differences between cultures might be due to parenting differences

37
Q
A