what are core symptoms of ADHD?
Hyperactivity
Difficulty concentrating
Acting impulsively
how is ADHD characterised?
by a pattern of behaviour, present in multiple settings (e.g. school and home) that can result in performance issues in social, educational or work settings
what is the diagnostic criteria for ADHD in the DSM-5?
show a persistent pattern of inattention and/or hyperactivity-impulsively that interfere with functioning
-inattention: 6 or + symptoms for children up to age 16, 17+ 5 symptoms, need to be present for at least 6 months
fails to give close attention to detail, trouble holding attention
-hyperactivity & impulsivity: 6 or more symptoms of H-I, has to be present for least 6 months to an extent that it is disruptive & inappropriate for the person’s developmental level
-following conditions must be met: several inattentive or HI symptoms present before age 12, symptoms present in two or + settings, clear evidence that symptoms interfere with quality of school, social or work functioning, symptoms not happening during the course of schizophrenia/psychiatric disorders.
-3 kinds of ADHD
what are the three kinds of ADHD?
-combined presentation: if enough symptoms of both 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.
-presentation may change over time as well!
why is creating subtypes of ADHD good?
-specialise treatments
-better labelling -> associate more towards types of presentations
-shows ADHD can change over time, is also a spectrum
what are the main differences of diagnoses criteria between the DSM-3 and DSM-5?
-DSM- 3 published in 1994, DSM-5 in 2013
-symptoms must be present before 12 in DSM-5, 7 in DSM-3
-several symptoms need to be present in more than one setting (5) than just some impairment in more than one setting (3)
-new descriptions in the DSM-5 added to show what symptoms might look like at older ages
-17+ only 5 symptoms are needed instead of 6 needed for younger children
what is the prevalence of ADHD?
6-7% of children when diagnosed via DSM Criteria (Willcutt, 2012) and 1-2% when diagnosed with ICD-10 (Cowen, 2012)
-ADHD ratio of males to females 3:1
~30–50% of people diagnosed in childhood continue to have symptoms into adulthood
-Between2–5% of adults have the condition (Kooij et al., 2010).
what are common co-morbidities with ADHD?
36% show autistic traits
50% meet the conditions for Developmental Co-ordination Disorder
65% - 80% show social interaction difficulties
25%-50% show symptoms of dyslexia
25% show anxiety
what did Salmon et al 2006 show regarding co-morbidities?
-In a Swedish sample with ADHD ~87% had another condition. The prevalence rates for 2 or more conditions was ~67%.
-The most common comorbid condition was conduct disorder (~25%) and oppositional defiant disorder (~50%).
-“In Summary ADHD without additional co-morbidity is rare, arguably may not exist at all”
What did Jensen et al., 2007 find in the MTA study?
the multimodal treatment study of children with ADHD
-A large randomised trial with children (n=579)
-Demonstrated efficacy of psychostimulant
medication combined with behavioural intervention
-Only one third of children (31%) in the study had only a diagnosis of ADHD
-34% had ADHD and an anxiety disorder
limit - ignores dyslexia, language disorder and other ‘SEN’ diagnoses
what are three psychological theories of ADHD?
- Executive Dysfunction
- State Regulation
- Dynamic Development
what is executive dysfunction used to explain?
deficits in “higher-order” cognitive processes e.g. planning, sequencing, reasoning.
what did Seidman et al., 2005 & Castellanos, 1997 find using brain studies?
Anatomical (Seidman et al., 2005) and functional studies show differences in prefrontal cortex and fronto-parietal and fronto-striatal circuits in children with and without ADHD (Castellanos, 1997; Giedd et al., 2001; Lou et al., 1989).
what does the executive dysfunction theory propose?
ADHD symptoms are the result of a reduction in executive control.
Caused by abnormalities in the structure, function and biochemical operation of the fronto-parietal and fronto-striatal neural networks.
The theory can explain impulsivity and inattention but has largely ignored the hyperactivity element of ADHD.
How does Barkley 1997 explain that executive function is a top down process?
The central role of behavioral inhibition:
Russell Barkley’s original model, also known as the Behavioral Inhibition Model (BBIM)
-hinges on a primary deficit in three components of behavioral inhibition:
Inhibiting an initial “prepotent” response: The inability to stop the automatic, immediate reaction to an event.
For example, a child with ADHD may immediately shout out an answer in class rather than waiting their turn.
Stopping an ongoing response: The difficulty in pausing an activity that is already in progress to consider the next action.
Controlling interference: The failure to resist distraction, which enables a period of delay between an event and the response.
summarise the EF - top down process
The cascade of impaired executive functions
Once behavioral inhibition is impaired, it compromises four other executive functions that rely on it to develop:
Non-verbal working memory: This is the ability to hold and mentally visualize things, including past events and future actions, to guide behavior.
Internalization of speech (verbal working memory): The capacity to use “self-talk”—your inner voice to regulate yourself.
Self-regulation of affect, motivation, and arousal: The inability to manage one’s own emotional reactions.
Reconstitution (planning and problem-solving): This is the ability to analyze and synthesize information to break down tasks and create new strategies.
what is the state regulation model?
bottom up process
-theory states that a non optimal energetic state could explain performance deficits in children with ADHD
-based on research using the Cognitive Energetic model of sanders (Sanders 1983)
what occurs within the state regulation model?
In this model, the efficiency with which a task is performed is considered to be a product of elementary cognitive states and their energy distribution.
Behavior and task performance are dependent on the current energetic state of the organism (a distinction is made between phasic (called “arousal”) and tonic aspects of arousal (called “activation”)
Children and adults with ADHD struggle with adjusting arousal states
what are key components of the state regulation model?
Energetic pools: The model posits that the efficiency of a task performance depends on three “energetic pools,” which are poorly regulated in individuals with ADHD:
Arousal: A short-term physiological response to a stimulus, influenced by its intensity or novelty.
Activation: The long-lasting physiological readiness to act, or a general state of alertness.
Effort: The deliberate allocation of energy to compensate for a non-optimal state of arousal or activation to meet task demands.
Intra-individual variability: A common finding in ADHD research is inconsistent performance on tasks over time.
poor focus versus hyperfocus
how would people conclude the state regulation mode?
task performance depends on arousal and activation levels of the subject -> effort is needed to meet task demands and compensate for sub-optimal state of arousal -> the theory argues that ADHD symptoms may increase or decrease depending on the situation.
what is the Dynamic Developmental Theory of ADHD?
attempts to explain the behavioural manifestations of ADHD.
-The data supporting this theory is based on animal data.
-The theoretical underpinning of this theory is behaviourism.
what does the Dynamic developmental theory of ADHD suggest?
there are 2 main behavioural mechanisms underpinning many of the symptoms of ADHD:
altered reinforcement of novel behaviour
deficient extinction of inadequate behaviour.
-efficacy of reinforcer is greater if the delay between the response and the reinforcement is smaller rather than larger
In ADHD, the critical window of opportunity for the reinforcer to take effect is _______ than for normal children.
smaller
This leads to socially desirable behaviour not being reinforced in time, contributing to ADHD symptoms.
What is the Special Educational Needs Code of Practice published by the DfES (2001) regarding mainstream schools?
-Provision for pupils with special educational needs is a matter for the school as a whole
- Responsibilities include the governing body, head teacher, SENCO or SEN team, and all staff
The division of responsibilities is decided based on the school’s circumstances and priorities.
