Lecture 5 (theme 4) Flashcards
(18 cards)
What is an externalising disorder?
- A disorder with very obvious outward behavior like aggression, deviance and hyperactivity
- It is not a distinction in the DSM, but it is still useful.
What are comorbid disorders of ADHD
- ODD is highly comorbid with ADHD.
- Also, learning disabilities, depression, conduct disorders, substance use and anxiety.
Wat are the three “subtypes” or “current symptoms” of ADHD?
- C stands for both hyperactivity/impulsivity and attention deficit
- HI stands for hyperactivity/impulsivity with less inattention
- I stands for Inattention without hyperactivity/impulsivity
What are the Symptom, Age, Context, Limitations and Other Disorders criteria for diagnosing ADHD.
- Symptom criterion: 6 or more
- Age criterion: <12
- Context criterion: 2 or more
- Limitations criterion: hindrance in functioning
- Other disorders criterion: symptoms cannot be
explained by other disorders
What happens with ADHD symptoms as you grow up? (symptoms, gender and prevalence)
- Children are very hyperactive and impulsive, and usually only the inattention problems persist in life.
- Also there is less/no difference in prevalence between adult men and women.
- Only 15% of adults remains meeting diagnostic criteria, while 50% keeps having subclinical problems
How is a diagnosis of ADHD made (5)?
- Diagnostic interview with parent, child and teacher. This always happens
- Questionnaires
- Observations
- Neuropsychological assessment (intelligence test) always done.
- Physical examinations, to exclude physical causes and find problem for pharmacological treatment.
What 2 methods are used for treatment? What are the 3 steps in most treatment plans?
- Pharmacological treatment
- Behavioral/Psychosocial treatment. (Like parent training and other kinds of therapy)
1) psycho-education, 2) psychosocial treatment, 3) medication
What is behavioral management treatment for parent/classroom/peers? What is a problem?
- Behavioral Parent Training (BPT), parents learn to give structure and reinforce positive behavior while reducing bad behavior.
- Behavioral Classroom Management (BCM)
- Behavioral Peer Intervention (BPI),
- Effects of one of these treatments does not generalise to other situations
What is the most common Pharmacological treatment of ADHD, how does it work? What are the positive (2) and negative (4) effects?
- Ritalin is the most common, it blocks the reuptake of dopamine in frontal regions of the brain and basal ganglia.
- It is cheap and relatively effective for up to 2 years.
- But 30% doesn’t respond and it doesn’t improve educational outcomes. And long term effects are unknown and there are side effects.
What did the MTA study find about ADHD treatment after 14 months, 2 years and 8 years? What were the groups?
- A study about treatment
- with 4 groups: meditational treatment, behavioral therapy, combination, or community care.
- After 14 months they found that medication and combination groups had more reduction in symptoms, - but after 2 years this effect reduced
- and after 8 years the treatment didn’t matter any more and other things like SES and symptom severity at start mattered more.
What is the polygenetic model of ADHD causes?
- The polygenic model says that many genes are involved in ADHD and each has only a small effect.
- But only a few genes have been found.
What are 4 Environmental and Prenatal risk factors in ADHD
- Prenatal factors are substance abuse during pregnancy
- Birth complications can increase risk, like premature birth
- And also extreme neglect in early life.
- Exposure to heavy metals like Lead.
What are 4 characteristics of endophenotypes? What is their use?
- You want to know about the cause of a disorder
- But you only know the effect, the behavior
- Researchers look for endophenotypes that are in between the cause and the effect, which help to look for the cause. It comes before the phenotype.
- The endophenotype is heritable, co-segregate (genes tend to go together), state independent and more prevalent in non-affected family members compared to the population
What 5 phenotypes are found for ADHD, (prepotent responses, working memory, response variability, delay aversion and timing)
- The ability to suppress prepotent responses (inhibit motor movements) is slower in ADHD children.
- The ability to manipulate information in short term memory is worse in children with ADHD.
- ADHD children are sometimes much slower in reaction times and normal at other times.
- Delay aversion means that children with ADHD value a small reward now more than a larger delayed reward.
- Timing means that children with ADHD are worse at estimating units of time.
What did a longitudinal MRI study of ADHD brains show about ADHD?
- It showed that there is a delay in the maturation of the cortex.
What are these old ADHD theories: Barkley’s inhibition hypothesis, motivation model, Dopamine hypothesis, cognitive energetic model, dual pathway model
- Barkley’s inhibition hypothesis says All problems of ADHD are explained by inhibition problems
- Motivation model says The basic cause of ADH is Delay Aversion
- DA hypothesis says Dopamine abnormality is seen as the main cause of ADHD
- Cognitive energetic model says ADHD symptoms are caused by lower brain arousal.
- Dual pathway model tries to explain why some children have more HI and other have more I.
