Transcript Personality and Emotional Self

Attention-Deficit/Hyperactivity
Disorder
(ADHD)
Historical Context
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George Sill
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1917-1918 Encephalitis epidemic
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Inattentive, impulsive, overactive, lawless, &
aggressive
“defect in moral character”
Children left with similar characteristics
Similar pattern also noted in children with brain
injury, birth trauma, and exposure to
infections/toxins.
Focused on Hyperactivity
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Formerly called “hyperkinesis,” “hyperkinetic
reaction,” & “hyperkinetic syndrome”
Historical Context (cont’d)
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DSM-III
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Focus shifted to deficits in attention & impulsivity
Distinction between ADDH and ADD without H
DSM-III-R
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Relabeled ADHD
ADD without H was dropped
8 of 14 behaviors=diagnosis
Any mix of inattention, hyperactivity, and
impulsivity=diagnosis
Current Trends
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DSM-IV
 Relabeled attention-deficit/hyperactivity
disorder
 Two factors making up three subtypes
Predominantly inattentive type
 Predominantly hyperactive type
 Combined type (most often described and
investigated
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Based on factor analytic studies (empirical
support)
Diagnostic Criteria
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Problems with (1) attention, or (2) hyperactivity
and impulsiveness.
Onset before age 7
Display symptoms for at least 6 months
Symptoms must:
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Be at odds with developmental level
Be pervasive AKA occur in at least 2 settings (only 1
setting=situational ADHD)
Not occur exclusively during course of PDD,
schizophrenia, or other psychotic disorder
Not be better accounted for by another mental disorder
Diagnostic Criteria (cont’d)
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Inattention—6 (or more) of the following:
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often fails to give close attention to details or makes
careless mistakes.
often has difficulty sustaining attention
often does not seem to listen when spoken to directly
often does not follow through on instructions and fails to
finish
often has difficulty organizing tasks and activities
often avoids, dislikes, or is reluctant to engage in tasks
that require sustained mental effort
often loses things necessary for tasks or activities
is often easily distracted by extraneous stimuli
is often forgetful in daily activities
Diagnostic Criteria (cont’d)
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Hyperactivity and Impulsivity—6 (or more) of the
following:
Hyperactivity
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often fidgets with hands or feet or squirms in seat
often leaves seat in classroom or in other situations in
which remaining seated is expected
often runs about or climbs excessively in situations in
which it is inappropriate
often has difficulty playing or engaging in leisure
activities quietly
is often "on the go" or often acts as if "driven by a motor"
often talks excessively
Diagnostic Criteria (cont’d)
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Hyperactivity and Impulsivity—6 (or
more) of the following:
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Impulsivity
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often blurts out answers before questions
have been completed
often has difficulty awaiting turn
often interrupts or intrudes on others
Diagnostic Criteria (cont’d)
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Subtypes:
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If both A1 and A2 for past 6 months, then
Combined Type.
If A1, but not A2 for past 6 months, then
Predominantly Inattentive Type.
If A2, but not A1 for past 6 months, then
Predominantly Hyperactive-Impulsive
Type.
Inattention
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Children and adolescents with ADHD:
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Pay less attention to their work
Appear able to concentrate in some situations, but
are unable to focus attention in others.
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Concentrate when interested and motivated, but not
during repetitive, boring, routine situations.
2 forms of attention:
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Selective attention
Sustained attention
Selective attention
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The ability to attend to relevant environmental
stimuli or not be distracted by irrelevant stimuli.
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Distraction=more likely when tasks are boring,
distasteful, or difficult.
Researchers found no evidence that children with
ADHD are more distractible than normal children.
Researchers also found that placing children with
ADHD in environments with reduced irrelevant
stimuli was not effective.
Sustained attention
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Paying attention to a task over a period of time.
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Examined using continuous performance tests.
Errors:
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Omission—not reacting to target
Comission—reacting to non-target
Researchers found that children with ADHD make more of both
error types & are slower than normal children.
However, research has inconsistently shown a performance
decline as length of task increases.
Taken together, researchers question inattentiveness as central
to ADHD diagnosis.
Hyperactivity
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Taken from parent and teacher reports
Direct observation through actometers
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Excessive movement of children with ADHD relative to normal
children.
Situational specificity (Porrino et al., 1983)
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ADHD boys > normal boys
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Overall
Reading & mathematics at school
Playing on weekends
Sleeping
Conclusion: Differences between children with ADHD and
normal children are most noticeable during sedentary or highly
structured situations.
Impulsivity
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Deficiency in inhibiting behavior.
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Examined using Matching Familiar Figures Test (MFFT).
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Examined using Stop-Signal task.
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Generally, can discriminate children with ADHD from normal
children.
Children with ADHD have greater deficits in Stop-Signal task than
normal children.
Conclusion: Deficits in inhibiting motor response is central to
ADHD.
Comorbidity
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Learning Disabilities
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ODD and CD
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Anxiety and Mood Disorders
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Tourette’s
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Bipolar Disorder
Prevalence
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School-aged population
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Clinic cases: 3 to 5%
Parent and teacher report: >=20%
Sex ratio (boys: girls)
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4-9:1
Etiology
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Biological
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Brain damageminimal brain dysfunction
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Delayed brain maturation
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Brain dysfunction
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Genetics
Etiology (cont’d)
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Environmental toxins
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Food additives
Sugar
Lead
Cigarette Smoking
Alcohol
Fluorescent lighting
Anticonvulsants
Theophylline
Etiology (cont’d)
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Environmental and psychosocial factors
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Diathesis-stress model
Parental and family influences
Best support for:
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Neurotransmitters
Genetic transmission
Associated Characteristics
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Intelligence
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Greater risk for LD
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Academic problems
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Executive functions
Associated Characteristics (cont’d)
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Social and Conduct Problems
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Personal characteristics
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Social characteristics
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Peers
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Teachers
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Family relationships
Associated Characteristics (cont’d)
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Accidents and injuries
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Adaptive Functioning
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Problematic situations
Developmental Course
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Infancy
Preschool
School age
Adolescence
Adulthood
Assessment
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Criteria for a good assessment?
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Interviews
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Rating Scales
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Direct Observations
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Other
Treatment: Pills or Skills?
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Pharmacological
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Behavioral
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Combined