Attention-Deficit/Hyperactivity Disorder - PowerPoint PPT Presentation


Title: Attention-Deficit/Hyperactivity Disorder


1
Attention-Deficit/Hyperactivity Disorder
  • (ADHD)

2
Historical Context
  • George Sill
  • Inattentive, impulsive, overactive, lawless,
    aggressive
  • defect in moral character
  • 1917-1918 Encephalitis epidemic
  • Children left with similar characteristics
  • Similar pattern also noted in children with brain
    injury, birth trauma, and exposure to
    infections/toxins.
  • Focused on Hyperactivity
  • Formerly called hyperkinesis, hyperkinetic
    reaction, hyperkinetic syndrome

3
Historical Context (contd)
  • DSM-III
  • Focus shifted to deficits in attention
    impulsivity
  • Distinction between ADDH and ADD without H
  • DSM-III-R
  • Relabeled ADHD
  • ADD without H was dropped
  • 8 of 14 behaviorsdiagnosis
  • Any mix of inattention, hyperactivity, and
    impulsivitydiagnosis

4
Current Trends
  • 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
  • Based on factor analytic studies (empirical
    support)

5
Diagnostic Criteria
  • Problems with (1) attention, or (2) hyperactivity
    and impulsiveness.
  • Onset before age 7
  • Display symptoms for at least 6 months
  • Symptoms must
  • Be at odds with developmental level
  • Be pervasive AKA occur in at least 2 settings
    (only 1 settingsituational ADHD)
  • Not occur exclusively during course of PDD,
    schizophrenia, or other psychotic disorder
  • Not be better accounted for by another mental
    disorder

6
Diagnostic Criteria (contd)
  • Inattention6 (or more) of the following
  • 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

7
Diagnostic Criteria (contd)
  • Hyperactivity and Impulsivity6 (or more) of the
    following
  • Hyperactivity
  • 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

8
Diagnostic Criteria (contd)
  • Hyperactivity and Impulsivity6 (or more) of the
    following
  • Impulsivity
  • often blurts out answers before questions have
    been completed
  • often has difficulty awaiting turn
  • often interrupts or intrudes on others

9
Diagnostic Criteria (contd)
  • Subtypes
  • 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.

10
Inattention
  • Children and adolescents with ADHD
  • Pay less attention to their work
  • Appear able to concentrate in some situations,
    but are unable to focus attention in others.
  • Concentrate when interested and motivated, but
    not during repetitive, boring, routine
    situations.
  • 2 forms of attention
  • Selective attention
  • Sustained attention

11
Selective attention
  • The ability to attend to relevant environmental
    stimuli or not be distracted by irrelevant
    stimuli.
  • Distractionmore 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.

12
Sustained attention
  • Paying attention to a task over a period of time.
  • Examined using continuous performance tests.
  • Errors
  • Omissionnot reacting to target
  • Comissionreacting 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.

13
Hyperactivity
  • Taken from parent and teacher reports
  • Direct observation through actometers
  • Excessive movement of children with ADHD relative
    to normal children.
  • Situational specificity (Porrino et al., 1983)
  • ADHD boys gt normal boys
  • 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.

14
Impulsivity
  • Deficiency in inhibiting behavior.
  • Examined using Matching Familiar Figures Test
    (MFFT).
  • Generally, can discriminate children with ADHD
    from normal children.
  • Examined using Stop-Signal task.
  • Children with ADHD have greater deficits in
    Stop-Signal task than normal children.
  • Conclusion Deficits in inhibiting motor response
    is central to ADHD.

15
Comorbidity
  • Learning Disabilities
  • ODD and CD
  • Anxiety and Mood Disorders
  • Tourettes
  • Bipolar Disorder

16
Prevalence
  • School-aged population
  • Clinic cases 3 to 5
  • Parent and teacher report gt20
  • Sex ratio (boys girls)
  • 4-91

17
Etiology
  • Biological
  • Brain damage?minimal brain dysfunction
  • Delayed brain maturation
  • Brain dysfunction
  • Genetics

18
Etiology (contd)
  • Environmental toxins
  • Food additives
  • Sugar
  • Lead
  • Cigarette Smoking
  • Alcohol
  • Fluorescent lighting
  • Anticonvulsants
  • Theophylline

19
Etiology (contd)
  • Environmental and psychosocial factors
  • Diathesis-stress model
  • Parental and family influences
  • Best support for
  • Neurotransmitters
  • Genetic transmission

20
Associated Characteristics
  • Intelligence
  • Greater risk for LD
  • Academic problems
  • Executive functions

21
Associated Characteristics (contd)
  • Social and Conduct Problems
  • Personal characteristics
  • Social characteristics
  • Peers
  • Teachers
  • Family relationships

22
Associated Characteristics (contd)
  • Accidents and injuries
  • Adaptive Functioning
  • Problematic situations

23
Developmental Course
  • Infancy
  • Preschool
  • School age
  • Adolescence
  • Adulthood

24
Assessment
  • Criteria for a good assessment?
  • Interviews
  • Rating Scales
  • Direct Observations
  • Other

25
Treatment Pills or Skills?
  • Pharmacological
  • Behavioral
  • Combined
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Attention-Deficit/Hyperactivity Disorder

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Title: Attention-Deficit/Hyperactivity Disorder


1
Attention-Deficit/Hyperactivity Disorder
  • (ADHD)

2
Historical Context
  • George Sill
  • Inattentive, impulsive, overactive, lawless,
    aggressive
  • defect in moral character
  • 1917-1918 Encephalitis epidemic
  • Children left with similar characteristics
  • Similar pattern also noted in children with brain
    injury, birth trauma, and exposure to
    infections/toxins.
  • Focused on Hyperactivity
  • Formerly called hyperkinesis, hyperkinetic
    reaction, hyperkinetic syndrome

3
Historical Context (contd)
  • DSM-III
  • Focus shifted to deficits in attention
    impulsivity
  • Distinction between ADDH and ADD without H
  • DSM-III-R
  • Relabeled ADHD
  • ADD without H was dropped
  • 8 of 14 behaviorsdiagnosis
  • Any mix of inattention, hyperactivity, and
    impulsivitydiagnosis

4
Current Trends
  • 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
  • Based on factor analytic studies (empirical
    support)

5
Diagnostic Criteria
  • Problems with (1) attention, or (2) hyperactivity
    and impulsiveness.
  • Onset before age 7
  • Display symptoms for at least 6 months
  • Symptoms must
  • Be at odds with developmental level
  • Be pervasive AKA occur in at least 2 settings
    (only 1 settingsituational ADHD)
  • Not occur exclusively during course of PDD,
    schizophrenia, or other psychotic disorder
  • Not be better accounted for by another mental
    disorder

6
Diagnostic Criteria (contd)
  • Inattention6 (or more) of the following
  • 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

7
Diagnostic Criteria (contd)
  • Hyperactivity and Impulsivity6 (or more) of the
    following
  • Hyperactivity
  • 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

8
Diagnostic Criteria (contd)
  • Hyperactivity and Impulsivity6 (or more) of the
    following
  • Impulsivity
  • often blurts out answers before questions have
    been completed
  • often has difficulty awaiting turn
  • often interrupts or intrudes on others

9
Diagnostic Criteria (contd)
  • Subtypes
  • 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.

10
Inattention
  • Children and adolescents with ADHD
  • Pay less attention to their work
  • Appear able to concentrate in some situations,
    but are unable to focus attention in others.
  • Concentrate when interested and motivated, but
    not during repetitive, boring, routine
    situations.
  • 2 forms of attention
  • Selective attention
  • Sustained attention

11
Selective attention
  • The ability to attend to relevant environmental
    stimuli or not be distracted by irrelevant
    stimuli.
  • Distractionmore 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.

12
Sustained attention
  • Paying attention to a task over a period of time.
  • Examined using continuous performance tests.
  • Errors
  • Omissionnot reacting to target
  • Comissionreacting 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.

13
Hyperactivity
  • Taken from parent and teacher reports
  • Direct observation through actometers
  • Excessive movement of children with ADHD relative
    to normal children.
  • Situational specificity (Porrino et al., 1983)
  • ADHD boys gt normal boys
  • 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.

14
Impulsivity
  • Deficiency in inhibiting behavior.
  • Examined using Matching Familiar Figures Test
    (MFFT).
  • Generally, can discriminate children with ADHD
    from normal children.
  • Examined using Stop-Signal task.
  • Children with ADHD have greater deficits in
    Stop-Signal task than normal children.
  • Conclusion Deficits in inhibiting motor response
    is central to ADHD.

15
Comorbidity
  • Learning Disabilities
  • ODD and CD
  • Anxiety and Mood Disorders
  • Tourettes
  • Bipolar Disorder

16
Prevalence
  • School-aged population
  • Clinic cases 3 to 5
  • Parent and teacher report gt20
  • Sex ratio (boys girls)
  • 4-91

17
Etiology
  • Biological
  • Brain damage?minimal brain dysfunction
  • Delayed brain maturation
  • Brain dysfunction
  • Genetics

18
Etiology (contd)
  • Environmental toxins
  • Food additives
  • Sugar
  • Lead
  • Cigarette Smoking
  • Alcohol
  • Fluorescent lighting
  • Anticonvulsants
  • Theophylline

19
Etiology (contd)
  • Environmental and psychosocial factors
  • Diathesis-stress model
  • Parental and family influences
  • Best support for
  • Neurotransmitters
  • Genetic transmission

20
Associated Characteristics
  • Intelligence
  • Greater risk for LD
  • Academic problems
  • Executive functions

21
Associated Characteristics (contd)
  • Social and Conduct Problems
  • Personal characteristics
  • Social characteristics
  • Peers
  • Teachers
  • Family relationships

22
Associated Characteristics (contd)
  • Accidents and injuries
  • Adaptive Functioning
  • Problematic situations

23
Developmental Course
  • Infancy
  • Preschool
  • School age
  • Adolescence
  • Adulthood

24
Assessment
  • Criteria for a good assessment?
  • Interviews
  • Rating Scales
  • Direct Observations
  • Other

25
Treatment Pills or Skills?
  • Pharmacological
  • Behavioral
  • Combined
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