Week 6: ADHD Flashcards
(36 cards)
Attention in psychology
- A mechanism for information selection
- We receive too much information at the time
- Helps us select the information we need now so that it can be further processed
- Helps us navigate the world
- Shapes our entire experience
Attention: limited resources
- Our cognitive resources are limited, and we cannot process all the information at the same time
- We need to be selective, and attention is our gatekeeper/ guides the processing of information
Types of attention (3)
Selective, sustained, divided
Selective attention
when focusing on one source of info, but ignoring/ suppressing others
Sustained attention
when focusing on the task (may not be exciting but takes a long time)
divided attention
when we try focus on 2 tasks at one time
General selective attention struggle
- Filter the information so that an individual can focus on the task
- … while still allowing behaviourally important stimuli to get through the filter
Corbetta and Shulman (2002)
- … while still allowing behaviourally important stimuli to get through the filter
ADHD Overview
Persistent pattern of inattention and / or
hyperactivity-impulsivity that interferes with or
reduces the quality of functioning in daily life
Asherson et al. (2022)
* The most diagnosed childhood psychiatric disorder
Heterogeneity of clinical profiles (doesn’t look the same for everyone)
- Preschoolers: motor restlessness, aggressive and disruptive behaviours
- Adolescents and adults: disorganized, impulsive and inattentive symptoms
- Hyperactive symptoms – decrease with age
- Inattention – remain
- Females – mostly inattentive
Luo et al. (2019)
- Adolescents and adults: disorganized, impulsive and inattentive symptoms
ADHD in DSM-5 (3 types)
– Inattentive ADHD
– Hyperactive-impulsive ADHD
– Combined
Inattention
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
- Often has trouble holding attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- 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 has trouble organizing tasks and activities.
- 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.
Hyperactivity and impulsivity
- 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 has trouble waiting their turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or
games)
DSM-5 Diagnostic Criteria: Innatentional
Six or more symptoms of inattention for children
up to age 16 years, or five or more for adolescents age 17
years and older and adults; symptoms of inattention have
been present for at least 6 months, and they are inappropriate
for developmental level
In addition, the following conditions must be met:
* Several inattentive or hyperactive-impulsive symptoms were present
before age 12 years.
* Several symptoms are present in two or more settings, (such as at
home, school or work; with friends or relatives; in other activities).
* There is clear evidence that the symptoms interfere with, or reduce
the quality of, social, school, or work functioning.
* The symptoms are not better explained by another mental disorder
(such as a mood disorder, anxiety disorder, dissociative disorder, or
a personality disorder). The symptoms do not happen only during
the course of schizophrenia or another psychotic disorder.
DSM-5 Diagnostic Criteria: Hyperactivity and Impulsivity
Six or more symptoms of
hyperactivity-impulsivity for children up to age 16 years, or
five or more for adolescents age 17 years and older and
adults; symptoms of hyperactivity-impulsivity have been
present for at least 6 months to an extent that is disruptive
and inappropriate for the person’s developmental level
In addition, the following conditions must be met:
* Several inattentive or hyperactive-impulsive symptoms were present
before age 12 years.
* Several symptoms are present in two or more settings, (such as at
home, school or work; with friends or relatives; in other activities).
* There is clear evidence that the symptoms interfere with, or reduce
the quality of, social, school, or work functioning.
* The symptoms are not better explained by another mental disorder
(such as a mood disorder, anxiety disorder, dissociative disorder, or
a personality disorder). The symptoms do not happen only during
the course of schizophrenia or another psychotic disorder.
three kinds (presentations) of ADHD can occur according DSM-5
- Combined Presentation: if enough symptoms of both criteria
inattention and hyperactivity-impulsivity were present for the past 6
months- Predominantly Inattentive Presentation: if enough symptoms of
inattention, but not hyperactivity-impulsivity, were present for the
past six months - Predominantly Hyperactive-Impulsive Presentation: if enough
symptoms of hyperactivity-impulsivity, but not inattention, were
present for the past six months.
- Predominantly Inattentive Presentation: if enough symptoms of
COMORBIDITIES
- Initial interest in “isolated deficits” so comorbidities were seen “problematic”
- Different estimates across studies
- Depending on diagnostic criteria
- Higher rates in referred samples than in population studies– Clinician’s illusion
– Multiple deficits increase the chance of referral
Van Bergen et al. (2023)
Van Bergen et al. 2023 findings on comorbidity
About 1 in 4 children with diagnosed with one of these conditions may have more than one.
Children with dyslexia = 3x more likely to have dyscalculia (compared to those without)
Children with ADHD = 2x more likely to have dyscalculia
- likely caused by shared genetic risk factors (rather than causal mechanism) = conditions should be tackled separately and genetic origins doesn’t meant interventions will not work.
(Over 77% of children with a disorder only have 1)
Other Comorbidities, Drechsler et al. (2020)
- Autism spectrum disorder 70-85%
- Developmental coordination disorder 30-50%
- Depression and anxiety disorders: 0-45%
RISK FACTORS: Heritability
Heritability 0.7-0.8
– Higher than for personality, temperament, depression
– Similar to: schizophrenia, bipolar disorder, autism spectrum disorder
– Several gene candidates identified
Risk factors: Environmental
– Prenatal maternal distress
– Pre-term birth / low birth weight (lecture 2)
– Social disadvantage and adversity
– Lead exposure
Nigg et al. (2020)
Prevalence estimates
- 8-12% children worldwide (Luo et al., 2019)
- 5-7% children worldwide (Asherson et al., 2022)
- 3-4% children worldwide (Nigg et al., 2020)
- 5% children and 2.5% adults worldwide (Pievsky & McGrath, 2018)
ADHD - dimensional
- Should be seen as a continuum
- Core symptoms and comorbid features are dimensionally distributed in the population
- Clinically referred children with subthreshold ADHD symptoms – similar amount of functional deficits and
comorbid symptoms but tend to: (a) come from higher social class families, (b) experience fewer family conflicts, (c) experienced fewer perinatal complications, (d) are older, (e) are more often female
Drechsler et al. (2020)
Gender differences
- Boys / men more likely to be diagnosed than girls/ women
- Females more likely to be diagnosed with predominantly inattentive form
Luo et al. (2019) - Representative survey from Denmark (1995-2010) shows:
– Decrease in the gender ratio from 7.5:1 to 3:1 at early school and from 8.1:1 to 1.6:1 in adolescentsDrechsler et al. (2020) - getting more equal in increasing age
- Females more likely to be diagnosed with predominantly inattentive form
What happens to children with ADHD diagnosis when they grow up?
- 15% of individuals diagnosed with ADHD as
children continue to meet full criteria at age 25,
though 65% are in partial remission (Pievsky &
McGrath, 2018)- Other studies suggest persistence rates of 50-80% (Asherson et al., 2022)
