lecture 10 - neuropsychology ADHD Flashcards
(37 cards)
what is the purpose of neuropsychology
-to understand the relationship between the brain and the behaviour
what is clinical neuropsychology
-sub field of neuropsychology
-explains functional behaviour and relate this to any underlying neuropathology in order to inform treatment, rehabilitation and education
what are neuropsychological assessments used for
-clinical purposes
-research
what are test batteries
what do they assess
a collection of tests / assessments
-they asses
-cognitive functioning,
-emotional processing
-psychosocial skills,
-motor development
neuropsychological assessment
-how are they standardised
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
what is assessed in a neuropsychological assessment.
and what can they be tested with
-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)
how are sensory/ perceptual functions (tactile, visual, auditory) assessed
-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
how are motor functions related to speed and strength assessed
-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
how are attention and problem solving skills assesed
-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,
how are learning and memory skills assessed
-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 )
how is executive functioning assessed
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
what is ADHD
-what types are there
attention deficit hyperactivity disorder
-ADHD I - inattention
-ADHD-HI - hyperactivity/impulsivity
-ADHD-C - combined
ADD is not a diagnosis (attention deficit disorder)
ADHD - DSM 5 definition
ADHD categorized as a neurodevelopmental disorder because symptoms are present in childhood
* Even if diagnosis only occurs in adulthood
what is ADHD
-criteria
-which conditions must be met (DSM5)
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)
ADHD- I symtoms
-more inattention related
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.
ADHD-HI symptoms
-more hyperactive
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)
risk factors - genetic influences
-twin studies
-family studies
-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
risk factors - environmental influence
-factors in early development , prenatal, perinatal and postnatal
-genetics
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
risk factors - interacting factors
genetic x environmental factors
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
ADHD theories
-Russel Barkley (1997)
-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
Russell Barkley theory evidence
-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
- 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
criticisms with Russell Barkley’s theory
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
ADHD theories
-delay aversion theory
-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
delay aversion theory
evidence
and findings
and conclusion
Sonuga-Barke et al. (2003)
* 156 children (3-6 years)
- Given two tasks:
- EF test battery
- 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
