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35 Cards in this Set
- Front
- Back
Attentional Capacity |
the amount of info that can be remembered and attended to for a short time i.e. directions or a phone number - not a deficit for ADHD |
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Selective Attention |
Ability to focus on relevant stimuli and not be distracted by irrelevant stimuli - doesn't see a difference between relevant and irrelevant stimuli ( it all seems relevant) |
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Sustained Attention |
Ability to maintain persistent focus on a task over a period of time, or when fatigued |
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Inattention |
- not focused on demands or details - "careless" mistakes, seeming not to listen - difficulty organizing - distractible, forgetful - sluggish, slow to respond, staring into space, underactive/lacks energy |
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Hyperactivity |
- constantly in motion, "on-the-go" - more likely to occur in situations where the child is required to sit still and regulate his/her behavior - actigraph indicates no difference in activity level in the morning, but more active at night |
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Impulsivity |
- "Acting without thinking" - Often perceived as careless, irresponsible, immature, lazy and rude |
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Predominantly Inattentive Presentation |
6+ of 9 inattentive symptoms |
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Predominantly Hyperactive-Impulsive Presentation |
6+ of 9 hyper-impulsive symptom |
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Combined Presentation |
6+ inattentive symptoms and 6+ hyperactive-impulsive symptoms |
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ADHD: DSM5 Crtieria |
-several symptoms must be present before age 12, for older adolescents and adults - 5 required - present for 6 months - inconsistent with developmental level - several symptoms must occur in at least several settings - symtoms do not occur exclusively during the course of other psychotic disorders |
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Social Behavior Relationships of ADHD |
- not well-liked by peers - those with inattentive p are more likely to be *neglected* by their peers - those with hyperactive-impulsive p are more likely to be *rejected* by peers - family relations impacted |
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Health, Sleep and Accidents of ADHD |
- sleep difficulties - greater accidental injuries than other children (driving) |
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Executive Functioning ADHD |
- deficits in cognitive processes necessary for goal-directed behavior - deficits in working, verbal self-regulation, inhibition behavior, motor control, planning |
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Adaptive Functioning |
- lower level of self-care and independence than expected given their level of intellectual ability - failure to perform known skills |
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Academic Achievement |
- lower than control children - many have learning disabilities |
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ADHD epidemiology |
- 9% of children - threefold increase in the US since the 1970s - ADHD combined presentation most common - boys more than girls (2:1) (girls- inattenttive) - diagnosis decreases from childhood onward - occurs in all social classes, some report higher levels in lower SES - symptoms are same across cultures, but prevalence may vary to cultural norms |
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ADHD comorbid disorders |
- specific learning disorder (15-40%) - oppositional defiant disorder and CD - ODD 50%, CD 30-56% - ADHD --> ODD --> CD -substance use disorders (predictor of smoking) - disruptive mood dysregulation disorder - anxiety 25% |
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ADHD Infancy and Childhood Course |
Those with reduced behavioral inhibition and effortful control and with elevated novelty-seeking may be at risk of ADHD - early onset may be associated with worse outcomes Childhood is the stage when most ADHD cases are diagnosed |
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ADHD Course in Adolescence |
Hyperactive symptoms become less obvious while others persist - gross motor areas of the brain may develop early while inhibition areas may develop later than in normally-developing kids |
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ADHD Course in Adulthood |
A "substantial proportion" of children with ADHD remain relatively impaired into adulthood 65% of boys diagnosed in late childhood no longer met full criteria for ADHD as adults |
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ADHD Theories |
- Under-arousal in kids with ADHD - Motivational deficit: high preference for immediate gratification over delayed reward - behavioral inhibition deficits - self-regulation deficits |
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ADHD Neurobiological Causes |
Frontal lobe: significant reduction in the thickness of right dorsolateral and orbitofrontal cortex Basal ganglia: growth peaks much later than in typically developing children, usually between 10-17 --> less pruning NTs: dopamine and norepinephrine |
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ADHD Gentic Causes |
ADHD runs in families and children show greater similarity to biological than adoptive parents |
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Is there a gene for ADHD? |
maybe one or more associated with the dopamine system dopamine receptors are prevalent in prefrontal cortex and basal ganglia, areas responsible for attention and inhibitory control people with lesions in these areas display ADHD symptoms |
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ADHD Causes from Birth complication and prenatal risk |
- low birth weight, injury at birth - prenatal smoking and alcohol |
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ADHD psychosocial causes |
- affect severity, continuity and nature of symptoms - family factors are some of the most influential psychosocial factors Bidirectional: more hostile, intrusive parenting |
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ADHD Assessment |
Consider: Developmental history, info from diff settings, diff diagnosis Interviews: parents, parent-child interactions, teachers Rating Scales: assess symptoms + concurrence with other disorders Additional Measures: standardized tests of intelligence, procedures to evaluate inattention and impulsivity |
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ADHD medications |
Stimulants: increase dopamine activity in underactive brain regions Non-stimulants: (SNRIs) block reuptake of norepinephrine; low risk of misuse - focus on alleviating core systems and reduce co-occuring symptoms (aggressive, noncompliant, opp behavior) - effective for kids and somewhat for older |
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Concerns about ADHD meds |
not permanent fixes not effective for 10-20% of children; even if behaviors are alleviated, behavior is only comparable to other children (%) adverse side effects: sleep, appetite, pains, irritability, jitteriness Over-prescribed to control behaviors "quick fix" - concern for inappropriate prescription |
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ADHD psychosocial treatments |
Behavior Management Parent Training Multimodal Psychosocial Therapy Working Memory Training |
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Behavior Management |
- immediate, tangible rewards - more focus on key functional domains (social relationships and school performance) |
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Parent Training |
effective for 25% of kids - bring behavior under parental control, strengthen desirable behaviors, set clear expectations, consistently discipline - can improve parent-child relationships |
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Multimodal Psychosocial Therapy (MPT) |
•Educationalskills training: Time management,listening comprehension •SocialSkills training: Basic interactionskills, dealing with conflict |
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Working Memory Training |
•Mayreduce inattentive symptoms |
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Mosteffective treatment |
•combinationof pharmacological and psychosocial treatments –92%of children with ADHD receive only medication; only 26% participate inpsychosocial intervention |