4: Development of ADHD

Question 1

Whats the prevalence?

Answer 1

Children: +- 3-7% (1 in every school class)
Adults: +- 2.5%

(No increase in prevalence over the last 30 years)

Question 2

What can you say about comorbidity?

Answer 2

= high

Differentation can be challenging because many disorders cause inattention/hyperactivity

Question 3

What does ADHD look like throughout the life span? Symptoms and impairment?

Answer 3

Preschool: behavioral problems, hyperactivity
School-age: academic and social problems, low self-esteem, oppositional behavior
- Adolescent: planning, behavioral and social problems, low self-esteem, addiciton
- Student: cognitive under-functioning, difficulty finding job, performance anxiety, substance abuse
- Adult: low self-esteem, job probs, substance abuse, relational probs

Question 4

What are the two symptom clusters in DSM?

Answer 4

Inattention & Hyperactivity/impulsivity

> Heterogenity!

Question 5

What are causes of ADHD?

Answer 5

A multifactorial disorder:

• genetic factors
• prenatal factors
• interactions with environment

Question 6

Later in life, childhood ADHD is a risk factor for? (7)

Answer 6

• Traffic incidents
• Substance abuse
• Aggression/delinquency
• Sexual risk-taking
• Gambling problems
• Financial risk taking
• Food related risk taking

Question 7

Later in life, childhood ADHD is a risk factor for?

Answer 7

• Traffic incidents
• Substance abuse
• Aggression/delinquency
• Sexual risk-taking
• Gambling problems
• Financial risk taking
• Food related risk taking

Question 8

Is ADHD forever?

Answer 8

Some kids ‘grow out’ of ADHD, many do not. > prevalence decreases with age
20-45% meet full criteria as adults
25-48% have impairing symptoms

Question 9

Is ADHD delayed development?

Answer 9

Could be cause: birthdate effect: more often diagnosed in youngest children in the class

Question 10

Does adult onset ADHD exist?

Answer 10

DSM: symptoms before age 12

- Discussion: some say no, some say yes

Question 11

What’s the Functional Working Memory (WM) Model?

Answer 11

ADHD symptoms are the result of overwhelmed demands on impaired working memory.

Question 12

What does the WM model predict?

Answer 12

• WM demands are often too high for kids with ADHD
• Kids with ADHD seek for behavioral ways to compensate
• Hyperactivity stimulates their brain.

Question 13

Empirical evidence for WM model?

Answer 13

Better WM performance in kids with ADHD with higher activity level

More difficult tasks, kids with ADHD move more.

Question 14

Whats the Delay Aversion Theory?

Answer 14

ADHD symptoms as a choice to avoid delay, because delay is seen as aversive.

Question 15

Whats the dual pathway model?

Answer 15

ADHD explained by impairment in:

1. executive functioning
2. motivational/reward systems

Question 16

Implications of the Dovis et al. study on dual pathway model?

Answer 16

• Kids with ADHD need additional motivation, especially on long tasks (>5 min)
• Nevertheless, their performance is worse relative to children without ADHD
• Strategies to diminish working memory demands should be applied

Question 17

Implications of the Dovis et al. study on dual pathway model?

Answer 17

• Kids with ADHD need additional motivation, especially on long tasks (>5 min)
• Nevertheless, their performance is worse relative to children without ADHD
• Strategies to diminish working memory demands should be applied

Question 18

Treatment for executive pathway?

Answer 18

Diminish demands:

• divide tasks in multiple steps
• provide structure
• use to-do lists
• keep instructions short and repeat them
• ignore motor activity
• prevent distraction

Question 19

Treatment for motivational pathway?

Answer 19

Increase motivation

• use reward systems
• reinforce desired behavior immediately
• make desired behavior explicit
• create attractive tasks
• anticipate for problems