ADHD
Attention Deficit Hyperactivity Disorder– Persistent, age innaproppriate symptoms of inattention, hyperactivity and impulsivity that cause impairment
1902
George Still said ADHD kids had inhibitory violition and defective moral control
1917- 1926
Brain injured child syndrome: kids who survive encephalitis or head injury show behaviour problems
1950s
Hyperkenesis: poor filtering of stimulus which was later called hyperactive child syndrome
1970s
Deficits in attention and impulse control were recognized
2 main characteristics
Inattention
Hyperactivity- impulsivity
Inattention
Difficulty to focus on one task or follow through with requests
Attentional Capacity
Amount of info we can remember and attend to in a short time
Selective attention
Concentrate on relevant stimuli without distraction
Distractibiltiy
Deficit in selective attention
Sustained Attention
Vigilence- Maintain persistent focus over time
Alerting
Initial reaction to stimulus
Impulsivity
Unable to control immediate reactions and thinking before acting
3 types of impulsivity
Cognitive
Behavioral
Emotional
3 subtypes
Predominantly inactive
Predominantly Hyperactive- impulsive
Combined
Which subtype is the rarest
Hyperactive- impulsive
Which sub group is most common
Combined type
6 DSM requirements
Prior to age 12 More often and severe than peers More than 6 months Occurs across all settings Produce significant impairment Not due to significant life stressor
2 DSM limitations
Developmental insensitive
Categorical view
6 impaired executive functions
Organize, prioritize, activate Focus, shift and sustain attention Regulate alertness, effort and processing speed Manage frustration and emotions Working memory and recall Monitor and regulate action
ISIS
Initiate
Shift
Inhibit
Sustain
Positive illusory bias
Exaggeration of one’s competence
What percentage of kids also have speech and language impairments?
30- 60 %
How many kids also have motor coordination problems?
30- 50%
Developmental Coordination Disorder
Motor incoordination and delays in achieving motor milestones
What percentage of kids also have tic disorders?
20%
% with a co- occuring disorder
80
% that meet criteria for ODD
50
% that eventually develop conduct disorder
30- 50
Gene implicated in ADHD, ODD, CD
COMT
% experience severe anxiety
25
% that will experience depression
20- 30
Prevelence
6-7% in NA
5% worldwide
% for boys and girls
2-4% girls
6-9% boys
Where are rates highest and lowest
Highest in South america and africa
Lowest in japan and china
% that suffer into adolescence
50%
Amount of relatives that also have the disorder
1/3
% that have a parent with ADHD
60%
% heretitability
75%
Gene involved in dopamine regulation
DRD4
Frontostriatal Circuitry
Prefrontal cortex and basal ganglia
Goodness of Fit
Match between temperament and parenting style
When were stimulants introduced
1930s
How many kids with ADHD recieve treatment
less than half
3 components of the primary approach
Stimulants
Parent training
Educational intervention