Define the term Developmental Disorders.
- those conditions that are manifested in clinically significant ways during children’s developing years and are a source of concern to families and the educational system
What are three areas of controversy in the area of Developmental Psychology?
- The growing number of children diagnosed with a disorder
- The growing number of children on medication
- The change of reference for autism spectrum disorders in the DSM-5
What is an important consideration when looking at the concept of normality or abnormality?
- take into account the developmental period of the child
How was there a change of reference of Autism Spectrum Disorders in DSM-5?
- Changed in DSM-5
- Aspergers was separate
- Pervasive developmental disorders have all been put together
- Autism, Aspergers now put on a continuum
- Conduct & Oppositional Defiance moved into a separate category
What are two different ways that behaviours manifest in disordered children
- Social Withdrawal, Anxiety, Depression
How do boys and girls differ in their behavioural manifestation of childhood disorders?
- Girls - typically more internalising
- Boys - typically more externalising
When can a diagnosis of ADHD be made?
“When hyperactive behaviours are extreme for the developmental period, persistent across conditions, and linked to significant impairments in functioning, the diagnosis of ADHD may be appropriate”
Give a conceptual understanding of the DSM-5 Criteria for ADHD?
6 or more behaviours listed under
- Inattention &/or
- Hyperactivity and Impulsivity
- typically manifests before age 12
- consistent across multiple settings
- reduce quality of functioning
- not exclusive during a psychotic disorder
- not better explained by another disorder
- there are three subtypes for diagnosis
(exam: think about the way this disorder manifests)
What are the three subtypes of ADHD?
- Predominantly Inattentive Subtype
- Predominantly Hyperactive Type
- Combined type
can switch between types
What are three characteristics of Attention-Deficit/Hyperactivity Disorder?
￼ Difficulty interacting with peers
What is the prevalence of ADHD?
- 3-7% of school-age children meet criteria
- Difficult to diagnose prior 4-5y
- ~4% adults ADHD
- (4.4% = Kessler et al., 2006; males, divorced, unemployed, non-hispanic white)
What did Hoza et al., 2010’s study look at, and what were the findings?
- looked at different aspects of childs behaviour
- the study followed children for 6 years
- found a viscious cycle of
- Social Skills (reduced)
- Inflated view of self
- these behaviours predicted poor outcomes
Why might it be difficult to diagnose ADHD prior to age 4-5yrs?
- diagnostic criteria requires 2 or more settings
- difficult as the child is not yet in school
- behaviour may be perceived as appropriate for that developmental age
What were some of the findings in Polanezyk et al., (2007) - which pooled estimates of prevalence worldwide (gender, age, geographical location?
- Males had higher prevalence (44 studies) than females (40 studies)
- consistent finding
- Male more likely to exhibit externalising
- Females - internalising
- yes there is a gender difference but must be
- More prevalent in children (43 studies) than adolescents (23 studies)
- Huge geographical differences in prevalence
- may be due to culture differences in what are considered normal/abnormal behaviour
- financial status of country
Does the comorbidity of externalising & internalising ADHD behaviours differ?
- Externalising behaviours
- overlap with conduct disorders
- Internalising behaviours
- overlap with Anxiety & Depression
- ~30%adolescents may have comorbid intellectual disability(Jensenetal.,1997)
What did Kessler (2006) show about adult ADHD & other disorders
- much more likely to have other comorbid disorders
- mood disorders
- anxiety disorders
- substance use disorders
- impulse control disorder
Kessler et al., 2006
What did￼ the NIMH Multimodal Treatment Study of ADHD (MTA) illustrate?
What are the likely comorbid disorders with ADHD?
The overlap of co-occuring disorders
- ADHD alone - 31.8%
- Oppositional defiant disorder 39.9%
- Anxiety disorder - 38.7%
- Conduct disorder - 14.3%
- Tic Disorder - 10.9%
- Mood Disorder - 3.8%
n = 579
no need to memorise numbers for exam - just the disorders
What evidence points toward a genetic basis for ADHD?
What system is suspected to contribute to this disorder?
- Heritability estimates = ~70-80% (Thapar et al., 2007)
- suspected connection with Dopaminergic System
- Candidate Genes
- DRD4 (dopamine receptor gene)
- DAT1 (dopamine transporter)
- Move toward epigenetics
- Genetic*Environmental Studies Req’d
What paper published in the Lancet created controversy around ADHD?
- Williams et al., (2010)
- provided evidence that there was a genetic basis for ADHD & that it was not a purely social construct
- response of people (media backlash)
- because they said “direct evidence
- message of the paper was lost
Is there a neurobiological factor in ADHD?
- Structural Differences in ADHD
- ADHD =
- Smaller right PFC
- executive function, regulation, inhibition
- Smaller Caudate Nucleas
- Smaller Globus Pallidus E.g. Castellanos et al., 2002
- both parts of basal ganglia (involved in regulation, selection, initiation of behaviours)
STRUCTURE = FUNCTION
What behaviours are associated with Dopamine?
reward, gratification, attention
What neural differences exist in ADHD compared to a typical brain?
Neural Differences in ADHD
- Less activation in frontal areas during tasks
- Reduced striatal activation during inhibition tasks
Environmental Factors in ADHD?
- ￼Low birth weight?
- Perinatal Factors inc. nicotine and alcohol
- 22% mothers of ADHD children smoked one pack/day
- 8% mothers of non-ADHD children smoked one pack/day
- Environmental Factors
- Food Preservatives? (not proven)
- Lead Paint? (no evidence)
causal no - contributory yes
What Pharmacological Treatments have been used for ADHD?
- Most common – methylphenidate – prescribed since 1960s
- In 2006, 2.5 million US children taking stimulant medication (10% of all boys)
- Double-blind, placebo-controlled study. In 75% of ADHD children, stimulants:
- Reduce disruptive behaviour
- Improve Concentration
- Improve goal-directed activity
- Improve Classroom behaviour
- Improve social interactions
- Reduce aggression
- Reduce Impulsivity
What is an important consideration when looking at medication for a child with ADHD?
- consider developmental stage of the child
- sensitive periods
- medication may give them an opportunity to learn during these periods
Which study looked at alternative treatments for children with ADHD?
The Multi-Modal Treatment of Children
with ADHD Study
- Tested at Baseline - Treated for 14months – tested Periodically up to 24 months.
- Community Standard Care
- Medication Alone
- Psychosocial Treatment
- Combined Medication & Psychosocial Treatment
What did the Multi-Modal ADHD study find with regard to
- Parent Rated Inattention
- Teacher Rated Inattention
- Parent Rated Hyperactive/Impulsive Symptoms
- no difference between Combined & Medication alone
- no difference between Behavioural & Community Standard Care
Combined & Medication alone were more effective than either
Behavioural & Community Standard Care
What do the findings in the Multi-Modal ADHD study suggest?
Medical management is effective
& can have a positive impact on child during critically developing years
What did the mutli-modal study show with regard to percentage ‘normalised’ behaviour 14 months later?
- The combined medical & behavioural interventionshad the highest success rate
- followed closely by medical management alone
- then behavioural
- then community care
Controls - 88%
Combined - 68%
Medical Management - 56%
Behavioural - 34%
Community Care - 25%
What are the implications of the mulit-modal ADHD study with regard to medication?
- Is medication the way forward?
- Three year follow-up – no significant differences (Arnold et al., 2007)
- Individual Differences
- Side effects of medications
What are some other psychological interventions for ADHD?
- Parent-Teacher Training
- Points System
- Teachers understand needs of child
- Peer tutoring
- Teachers provide daily report
Designed to accommodate limitations NOT challenge behaviour.
MTA study provides support for intensive, behavioural intervention
Is sleep a factor in ADHD?
- Sleep problems may be increasing in modern society
- Estimated 30-40% children obtain inadequate sleep
- children manifest sleep deprivation differently than adults (almost opposite
- Sleep < 7.7h (10th percentile) associated:
- Higher hyperactivity/impulsivity scores (9.7 vs. 7.8).
- Higher attention deficit score (17.3 vs. 14.5)
- No difference in inattention
- 7.7 hrs not enough - children ahould be getting 10 hours