ADHD

Question 1

ADHD is one of the most common psychiatric disorders in childhood and adolescence, how would we globally define it

Answer 1

Motoric and verbal hyperactivity
Problems maintaining focus in conversations and activities
Impulsive and erratic behaviours

Question 2

In what section of the DSM-5 is ADHD placed in

Answer 2

Neurodevelopmental disorders - brain based developmental disorder

Question 3

What can we say about the course of ADHD symptoms

Answer 3

They emerge in early childhood
They improve with age and brain maturation
About 1/3 of people retain a diagnosis in adulthood

Question 4

What are the two categories of ADHD and what specifiers can result from this

Answer 4

Categories: inattention & hyperactivity and impulsivity
Specifiers: ADHD-I, ADHD-H, ADHD-HI

Question 5

What is the spectra and subfactors of ADHD according to HiTOP

Answer 5

Spectra: disinhibited externalizing and antagonistic externalizing
Subfactors: antisocial behaviour

Question 6

How did George Still first conceptualize ADHD

Answer 6

Children who:
-lack self-control
-showed symptoms of overactivity/inattention in school
-have poor “inhibitory volition” and “defective moral control”

Framed as a disorder of aberrant development

Question 7

How does the worldwide influenza epidemic of 1917-1926 contribute to the history of ADHD

Answer 7

-Led to “brain injured child syndrome”
-Behaviour problems among children who survived encephalitis during the epidemic, & those who suffered birth trauma, head injuries or exposure to toxins
-The concept evolved into “minimal brain damage” and “minimal brain dysfunction”
Some children displayed similar behaviours with no evidence of brain damage or mental retardation

Question 8

Why was ADHD named hyperkinesis in the 1950s

Answer 8

Attributed to poor filtering of stimuli entering the brain
Led to the definition of hyperactive child syndrome
Motor overactivity seen as the main feature

Question 9

When were deficits in attention and impulse control seen as the primary symptoms of ADHD

Answer 9

By the 1970s

Question 10

What happened in the 1980s regarding ADHD

Answer 10

Increased interest in ADHD and increased use of stimulant medications

Question 11

What are ADHD controversies

Answer 11

Skepticism about the diagnosis - common to hear that ADHD is fake
Question of abnormal development or lag in development
ADHD being present in girls and women

Question 12

What are the general diagnostic categories in the DSM for diagnosing ADHD

Answer 12

Inattentive type diagnostic criteria
Hyperactive/impulsive type diagnostic criteria
Additional requirements for diagnosis
Classification

Question 13

The core characteristics of ADHD are inattention and hyperactivity-impulsivity. What is the major concern with using these two dimensions for defining ADHD

Answer 13

It oversimplifies the disorder - each dimension includes distinct processes

Question 14

True or false: attention and impulse control are closely connected developmentally although they are discussed separately

Answer 14

True

Question 15

Describe inattention in the context of ADHD

Answer 15

Difficulty during work or play, to focus on one task or to follow through on requests or instructions
Inability to sustain attention especially for repetitive, structured, and less enjoyable tasks

Question 16

True or false: kids with ADHD may be hyper focused on tasks that they enjoy

Answer 16

True

Question 17

Deficits in attention in ADHD can be seen in different types of attentions. What are those types of attention

Answer 17

Selective attention/distractibility
Sustained attention/vigilance
Alerting

Question 18

A teacher reports that one of her students appears to be very inattentive, drowsy, daydreamy, spacey, in a fog and easily confused. She also informed us that she suspects that the student may have a learning disability, processes information slowly, has trouble remembering things and has low academic achievement. She finishes by telling us that the student often reports often feeling anxious, apprehensive and appears to be socially withdrawn. What would you diagnose this student with

Answer 18

ADHD - predominantly inattentive specifier

Question 19

Some argue that the predominantly inattentive specifier of ADHD has 2 distinct subtypes. What are those subtypes

Answer 19

Formerly combined subtype
-recovered from behavioural (hyperactivity)
Always only has inattentive
-sluggish cognitive tempo

Question 20

How would be define hyperactivity and what are behaviours that we would expect to see

Answer 20

Hyperactivity: inability to voluntarily inhibit dominant or ongoing behaviour
Behaviours: fidgeting, touching everything in sight, running, excessive talking and pencil tapping, accomplishing little despite extreme activity
Can look like a manic episode

Question 21

Impulsivity is characterized as the inability to control immediate reactions or think before acting. What is the difference between cognitive impulsivity and behavioural impulsivity?

Answer 21

Cognitive: disorganization, hurried thinking, need for supervision
Behavioural impulsivity: difficulty inhibiting responses when situations require it

Question 22

What is the primary attention deficit in ADHD

Answer 22

Inability to engage and sustain attention and follow through on directions or rules while resisting salient distractions

Question 23

True or false: ADHD predominantly hyperactive-impulsive is rare and may be a distinct subtype of ADHD-HI

Answer 23

True

Question 24

Which type of ADHD presentation is most likely to be referred for treatment

Answer 24

Combined presentation (ADHD-HI)

Question 25

Children with ADHD-H and ADHD-HI are more likely to display:

Answer 25

-problems inhibiting behaviour -problems with behavioural persistence -aggression, defiance, peer rejection, suspensions, placement in special education classes

Question 26

ADHD is more common among girls or boys and what is the ratio

Answer 26

Boys - about 2.5M:1F

Question 27

ADHD has been found in all countries and cultures although rates vary. What countries have the highest, lowest and medium prevalence rates.

Answer 27

Highest: South America and Africa Lowest: Japan and China Middle: European countries and North America

Question 28

Cultural differences may reflect _____ and _____ for ADHD symptoms

Answer 28

Cultural norms; tolerance

Question 29

What are the associated cognitive deficits that can be seen with ADHD

Answer 29

Cognitive processes: working memory, planing and anticipation Language processes: verbal fluency, communication Motor processes: allocation of effort, response inhibition, coordination and sequencing Emotional processes: self-regulation of arousal level, mature moral reasoning

Question 30

What are the associated outcomes of ADHD

Answer 30

Poor academic and vocational performance: less schooling and lower status More interpersonal problems Problematic parent-child relationships Higher rates of accidents - broken bones, car accidents, speeding tickets Initiate sexual activity at an earlier age Reduced life expectancies

Question 31

True or false: the majority of children with ADHD do not have a co-occurring psychological disorder

Answer 31

False

Question 32

What are the common comorbidities with ADHD in children

Answer 32

Oppositional Defiant Disorder (ODD) - most common Conduct Disorder (CD) Anxiety Disorders Mood disorders Substance use (SUD)

Question 33

What is a common predisposing cause for ADHD, ODD, and CD

Answer 33

Genetics and shared environment

Question 34

Around what age do hyperactivity-impulsivity symptoms become more visible and significant

Answer 34

3-4

Question 35

True or false: children demonstrating a persistent pattern of hyperactive-impulsive and oppositional behaviour for at least 1 year are likely to continue to have difficulties later in childhood

Answer 35

True

Question 36

What would we expect to see in the course of ADHD around elementary school

Answer 36

Symptoms become especially evident Oppositional defiant behaviours may increase/develop Around 8-12 years old, defiance and hostility become a problems Increased problems with self-care, personal responsibility, chores, trustworthiness, independence, social relationships, academic

Question 37

What is homotypic and heterotypic continuity

Answer 37

Homotypic continuity: having a disorder at one time point predicts having the same disorder at a later time point Heterotypic continuity: have a disorder at one time point predicts having a different disorder at a later time point

Question 38

True or false: By adolescence, some children will have outgrown the disorder but most of the clinic-referred elementary children will not have outgrown it and their symptoms may be getting worse

Answer 38

True

Question 39

If ADHD progresses into adolescence what are impairments that we would expect to see

Answer 39

Emotional, behavioural and social functioning

Question 40

What would we see in adolescence for the children who met diagnostic criteria for ADHD in childhood

Answer 40

More likely to exhibit oppositional defiant behaviours Anxiety and depression Involvement with the juvenile justice system

Question 41

The Avon Longitudinal Study of Parents and Children shows support for homotypic and heterotypic continuity. What exactly did they find

Answer 41

Homotypic: ADHD at 7.5 was associated with ADHD at 14 Heterotypic: ADHD at 7.5 was associated with other externalizing disorder, GAD, PTSD, MDD Of all disorders, ADHD showed the most cross-domain effects

Question 42

A review of prospective studies was done by Cherkasova et al. 2021 looking at the course of ADHD in adulthood. What did they find?

Answer 42

There was a wide range of ADHD diagnosis persistence All the studies in the review observed high rates of symptomatic persistence Doesn’t remit, or it continues in a form not captured by criteria Hyperactivity is less relevant for adults Adults may be able to better mask or make symptoms less relevant

Question 43

Relative to control groups, adults with childhood-diagnosed ADHD had significant impairments in:

Answer 43

Educational functioning Occupational functioning Mental and physical health ASPD Criminality Substance misuse

Question 44

What are the mental health problems associated with ADHD in adulthood

Answer 44

SUD Mood disorder Anxiety disorders - most common PDs especially ASPD NSSI Suicide attempts

Question 45

What is the “failure model” as an explanation for heterotypic continuity

Answer 45

- Impulsivity/hyperactivity/inattention lead to higher levels of interpersonal conflict, rejection, lack of support, and poor skills development - Increased risk of subsequent depression and other forms of psychopathology - Difficulties in social interactions significantly predicts depression - Peer rejection mediates the relationship between aggression and depression

Question 46

What is the “shared etiopathogenic factors” as an explanation for heterotypic continuity

Answer 46

- Irritability in childhood is shared among CD, ODD, depression and anxiety disorder - Genetic or constitutional factors that influence children’s irritability levels in early childhood as expressed in ADHD also predispose them to anxiety and depression in adolescence and/or adulthood - Familial risk for psychopathology explains both

Question 47

True or false: ADHD does not run in families

Answer 47

False; about 1/3 of children with ADHD have the disorder

Question 48

What can we say about adoption studies looking at ADHD

Answer 48

Rates of ADHD are higher in the biological parents of the children with ADHD compared to the adoptive parents

Question 49

What have ADHD twin studies found

Answer 49

There is heritability for HI and IA behaviours; not the disorder itself

Question 50

Say a woman showed up for her gestational check-in and doctors realize that the baby’s nervous system may be compromised due to the mother’s use of cigarettes, alcohol and various other drugs during pregnancy. Would this make the baby at a more elevate risk of developing ADHD

Answer 50

Yes

Question 51

ADHD in both parents and kids contribute to _________ interactions, which may negatively impact the child’s developmental course. This demonstrates a ____ and ____ rGE

Answer 51

Reciprocal negative Passive Evocative

Question 52

Interactions between children and parents who both have ADHD is characterized by _______ from parents and children

Answer 52

Negative behaviour

Question 53

Parents with ADHD who have children with ADHD show low levels of ____ and higher levels of ____

Answer 53

Low levels: involvement and positive parenting High levels: negative parenting and inconsistent discipline

Question 54

True or false: children with ADHD are less compliant, more oppositional, and less often able to follow parental requests through to completion

Answer 54

True

Question 55

Emotional regulation difficulties are common in ADHD. What is emotion regulation?

Answer 55

All efforts to influence what emotions we have, when we have them, and how we experience and express them with attempts to promote adaptive, goal-oriented behaviours

Question 56

A prospective longitudinal study from age 5 to 13 looked at how emotion regulation can predict the course of ADHD. What did they find

Answer 56

Poor ER, especially poor positive ER predicted increase in inattention symptoms over time Good ER predicted a decrease in inattention symptoms across time

Question 57

The neuroanatomy of ADHD focuses on which brain areas

Answer 57

PFC and Striatum

Question 58

Volumetric reduction were seen in which brain areas in ADHD

Answer 58

PFC ACC Caudate Corpus callous Cerebellum

Question 59

Although reduced activation of the brain is not always seen in ADHD, where would we expect to see reduced activation when it does occur?

Answer 59

PFC and Striatum

Question 60

What can we say about dopamine’s function in ADHD

Answer 60

Overall (metabolites in the blood, imaging) results are inconsistent

Question 61

A study by Durston et al. 2003 did a “go/no-go” study in the context of ADHD. What did they find

Answer 61

Kids with ADHD made more errors overall on the no-go task - they couldn’t inhibit the response Kids with ADHD showed increased activation in the right inferior parietal lobe and posterior cingulate gyrus on the no-go trials Kids without ADHD showed more activation in the right caudate nucleus and globes pallidus on the no-go trials

Question 62

True or false: ADHD can also be conceptualized as a multi-hit system

Answer 62

True