ADHD Flashcards
(38 cards)
There’s a skepticism about ADHD and the Pharmaceutical industry, why?
Lot of money to be made in medication around ADHD
-> 2.5 billion $ spent on ADHD
How is ADHD real? (2)
(1) Prevalence similar worldwide
-> Use of mediation to treat ADHD 5x higher in N. America BUT prevalence is the same
(2) ADHD associated with marked impairment (pb with peers/school, mortality…)
ADHD: Categorical or Dimensional?
DSM treats ADHD as categorical but research suggests it’s dimensional
Assessment of ADHD (3)
(1) Rating scales and interviews: Parent/Teacher report (!!) critical for diagnosis
(2) Diagnostic interviews
(3) Symptom rating scales: Strong focus on OBSERVABLE signs of ADHD
Usually, we do NOT ask younger kids to self-report, why? (3)
(1) Children tend to underreport their own symptoms
(2) + Positive bias/Positive illusory bias (report higher self-esteem than warranted by behavior)
(3) + Quality of life rated better than others
What’s a famous semi-structured interview for ADHD?
Kiddie SADS
- Interview with people in the family
- Evaluates difficulty sustaining attention on tasks or play activities/remain seated…
What’s a famous rating scale for ADHD?
SNAP-IV ADHD rating scale
Might have a parent and a teacher fill them out.
-> 18 items = 18 symptoms of ADHD
How does the diagnosis of ADHD change if we use the ‘AND’ or ‘OR’ rule?
(1) If look at parent/ teacher alone, you see more predominantly diagnoses of EITHER PI and PH (less combined type and more PI/PH)
(2) When combined using the “or” rule -> many of those cases become combined
Sluggish Cognitive Tempo/Cognitive Disengagement Syndrome (CDS) correlation
High positive correlation with ADHD-PI
-> 50% of Inattentive ONLY, have this Cognitive Disengagement Syndrome
Cognitive Disengagement Syndrome: Proofs (6)
(1) Symptoms coherent among themselves (highly correlated w each other and other symptoms of ADHD)
(2) High internal reliability: Pple tend to respond to them in a similar way
(3) Reasonable test-retest reliability over short time periods
(4) Significant stability and invariance over long periods (2-9 years)
(5) Low-to-moderate relationships between parent and teacher ratings (similar to other disorders)
(6) Are evident cross-culturally
… of Inattentive ONLY, have the Cognitive Disengagement Syndrome
50%
Cultural difference and importance of ADHD (individualistic vs collectivistic)
If a culture value of group harmony (more collectivistic), ADHD might be way more problematic (vs individualistic society)
Symptom presentation of ADHD varies by gender (2)
(1) Community samples: boys more likely to be diagnosed w ALL subtypes of ADHD (but gap wider for ADHD-C & HI)
(2) Girls overrepresented in the Inattentive category
-> Interaction between expectation (gender socialization) and differences due to underlying factors
Developmental course of ADHD
- Should be present from BIRTH (although no valid measure before age 3)
- Beyond elementary school, outward hyperactivity might continue to decline slightly (but still higher than people without ADHD)
Long term outcome/Prognosis - ADHD
If symptoms last for a YEAR OR MORE in PRESCHOOL-AGE KIDS => significant warning for sustained challenge across time.
Previously thought that symptoms of ADHD resolved in adolescence: Is it true?
Not really:
1/3 of child diagnosed in childhood will continue to meet criteria throughout adulthood
Adult Outcomes of ADHD (Klein et al., 2012)
- 207 boys recruited with hyperactiviy
- When the ADHD boys were 18, they recruited comparison participants (matched for age + parental occupation)
- Followed up with probands and comparisons when they were 41 years old
Results?
(1) But compared to comparison group, ADHD group had lower SES and lower IQ (diff might be inflated by that)
(2) ADHD pple LESS likely to:
- Finish high school
- Complete graduate degree
- Lower income
- More divorce
- More incarceration
- More deceased
Etiology of ADHD
Mostly caused by genetics, but maintained and exacerbated by environmental influences
(1) ~75% heritability
(2) the other 25% -> environmental influences
=> E.g. maternal use of cigarets/alcohol during pregnancy… toxins/stressors increase risk of ADHD (not sure causal but association)
Medication for ADHD (2)
Stimulants
- Dextroamphetamine (Dexedrine)
- Methylphenidate (Ritalin, Concerta)
Fast acting drugs: within minutes, clinical effects
What does the ADHD medication do?
Increase activity in the prefrontal cortex
-> Increases dopamine: helps with inhibition
ADHD medication: Side effects (5)
- Reduced appetite
- Weight loss
- Slowing of growth
- Difficulty falling asleep
- Increased heart rate
What are the cons of the ADHD medication? (4)
(1) 20% of children may NOT improve with medication use (non-responders)
(2) May not help academic performance, peer relationships, or family functioning in all kids
(3) Beneficial effects may not be maintained over time and will stop once medication is stopped
(4) Tolerance may also occur, in large % of cases leading to reduced efficacy over time at the same dosage
Types of behavioral treatment (5)
(1) Parent management training
(2) Behavioral classroom management
(3) Behavioral peer interventions
Other:
(4) Cognitive interventions: Cognitive techniques that children can use to control attention and behavior (e.g., verbal self-instruction, problem solving)
(5) Organizational skills training – can help with impairment related to ADHD (e.g., school failure) - benefits in academic domain
Parent Management Training def
Goal = Supporting caregivers managing challenging child behaviour & promoting positive behaviors
-> Slow approach to learning strategies; Very parent-focused
-> Relatively short program: 10-15 sessions.
