What are the three subtypes of ADHD?
- Predominantly Inattentive
- Predominantly Hyperactive/Impulsive
- Combined
What are some Behavioural symptoms of hyperactivity?
- Squirms and fidgets
- Can’t stay seated
- Runs/climbs excessively
- Can’t play/work quietly
- On the go/“Driven by a motor”
- Talks excessively
What are some Behavioural symptoms of impulsivity?
- Blurts out answers
- Can’t wait turn
- Intrudes/interrupts others
What are some inattentive symptoms of ADHD?
- Careless
- Doesn’t listen (not out of defiance just because they zone out)
- No follow through
- Forgetful in daily activities
- Can’t organize
- Avoids/dislikes tasks requiring sustained mental effort
- Loses important items
- Difficulty sustaining attention in activity
- Easily distractible
Is it likely that an individual with a specific subtype of ADHD exhibits symptoms from only that category?
No, it is likely that the individual will exhibit some inattentive symptoms and some hyperactive symptoms they are just sit more dominantly in one category as opposed to the other
What are the requirements for a clinical diagnosis of ADHD?
- Present before 12years of age
- Occur across two or more settings
- Maladaptive/interfere and inconsistent with developmental level (social, academic, occupational)
- Not better explained by another disorder
Why is it important in diagnosing ADHD that individuals have symptoms in two or more settings?
It’s not something in the environment that is causing ADHD it are the characteristics of the individual therefore it is vital that they are getting impaired in a range of situations/ across all areas in their life
Why is it that ADHD symptoms need to be present before age 12 in order to reach an official diagnosis? Why is this?
- If its a neurodevelopmental disorder than symptoms should theoretically arise early in life
- It used to be in the requirements they present before 7 and they usually do however, sometimes because there is a certain level of inattentiveness developmentally normal in young children the age got raised to better predict this subtype
How much of a biological/ genetic basis does ADHD have?
-Highly Heritable (runs in families, passed down through male line 80% of the time)
- Brain structure and functioning (children’s brains with ADHD develop at a slower rate, there is also differences in the levels of neurotransmitters)
• Begins in childhood
• Developmental in Nature
What types of studies are used to show that ADHD is not as environmentally based as people used to think?
- Identical twins vs fraternal twins. Identical twins more likely to both have ADHD than fraternal.
- Adoptive parent versus biological parent. If biological parent has ADHD than kid more likely to have it also as opposed to modelling the adoptive parent.
What areas does ADHD cause issues in?
- Behaviour
- Cognitive functioning
- Social functioning
Do people with ADHD have a hard time with emotional regulation?
Yes
How does ADHD look across the life span?
- Symptom profiles often vary across the lifespan of a person
- People can also change between subtypes
- Children tend to have more of the impulsive/ hyperactive symptoms
- While adults tend to have more of the inattentive symptoms. Align with the natural process of slowly down/ having less energy as we age.
Can people lose ADHD as they age?W
- In short no it’s a life long disorder
- However, some people while they still have tendencies their symptoms may get less severe with time
- Or it may be that their still symptomatic but they have learnt copying strategies which mean there is no longer much impairment in their life from the disorder
What is often found when people with ADHD leave school?
- School is a very bad place for people with ADHD
- Therefore, once individual leave school they often feel a lot better about their life’s. They can choose to do into careers that are well suited to people with ADHD or where there tendencies are even celebrated! i.e. hyperactive ADHD type often go into adventure tourism
A 9 year old with ADHD is typically behaving more like a…
6 year old
Imagine the social issues this would cause. And also the knock on effect on well being if a child has no friends.
What did the study by Marakovitz & Campbell, 1998 show about ADHD across the span of childhood?
By 6 years of age:
- Approximately half no longer present with behavioral difficulties
- Approximately 1/3 meet criteria for AD/HD (non-remitters)
By 9 years of age:
-2/3 of the “non-remitters” at age 6 met criteria for AD/HD
In those that met symptom criteria for ADHD what did Gordon et al. (2006) show about impairment? What did Healey et al. (2008) show?
- When imposing impairment criteria in a group of school aged children (6-17 years), only 33%met the full diagnostic criteria for ADHD.
- Healy et al. used various impairment cut points (ranging from the 75th to 90th percentile) and reduced the number of preschool children (3-4 years) meeting criteria for ADHD by 46–77%.
Basically the idea is that lots of people have symptoms, very few meet diagnostic criteria because there needs to be significant impairment to their life.
What is harder to evaluate: the symptomatic requirement of ADHD or the impairment side?
- Impairment, it’s a lot more subjective
- Criteria for symptoms is clear. You need 6 or more of those in the list
When do you seek help for ADHD?
Severity: Clearly in excess of what would be expected for age
Chronicity: Not a transient disturbance or reaction
Pervasiveness: Situationally, Feedback from others
Interference with functioning: Family, School, Social
Why do we have to be careful drawing a line of when to seek help for ADHD?
Because many are symptomatic we need to ensure that only those significantly impaired are using the help resources.
What medications are used in the treatment for ADHD?
Stimulants (e.g., methylphenidate, amphetamine)
Non-stimulants (e.g.,Atomoxetine/Strattera)
These are based around the dopaminergic system. They are now improved to be long acting so that children don’t have to take one again in the afternoon that hasn’t worn off by the time they sleep.
Do medications solve ADHD?
No, stop taking the medications then the symptoms resume. That’s why psychological interventions are also key to ADHD management.
What psychosocial interventions exist?
- Parent Education
- Parent Training (teach parents skills to help their children to better regulate themselves)
- School-based interventions
- Child-focus interventions (particular as child gets older and becomes more responsible for themselves, involves reminding the child to stop, think and focus although is highly individualized to the child according to what motivates and is going to work for them)
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Lecture 1- Normal versus Abnormal Development18
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Lecture 2- DSM-V Classifications and Evidence Based Practice20
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Lecture 3- Working with Children and Families35
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Lecture 4- ADHD28
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Lecture 5- ODD/CD26
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Lecture 6- Childhood Anxiety13
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Lecture 7- Childhood Depression22
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Lecture 8- Autism Spectrum Disorder17
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Lecture 9- Engage, Self-Regulation Training for Preschoolers27
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lecture ?1
