Neurodevelopment - ADHD

Question 1

ADHD Clinical Features + Diagnoses #1

Answer 1

Persistent inattention and/or hyperactivity-impulsivity

Question 2

ADHD Clinical Features + Diagnoses #2

Answer 2

Symptoms must be developmentally inappropriate and impair functioning

Question 3

ADHD Clinical Features + Diagnoses #3

Answer 3

Symptoms present in 2 or more settings for 6+mos

Question 4

ADHD Clinical Features + Diagnoses #4

onset?

Answer 4

Onset must be before age 12

Question 5

ADHD Clinical Features + Diagnoses #5

Answer 5

Interferes with social, academic, or occupational functioning

Question 6

ADHD Clinical Features + Diagnoses: best practice assessment requires…

Answer 6

• Collateral information (e.g., teacher interviews, report cards)
• This makes retrospective adult diagnosis more complex and challenging

Question 7

ADHD - common byproducts

Answer 7

• Fidgeting, tapping
• Difficulty listening
• Making mistakes

Question 8

3 ADHD types

Answer 8

1. Hyperactive (talk a lot, always “on the go”)
2. Inattentive (daydream a lot, has to use reminders)
3. Combined

Question 9

ADHD Prevalence - Children vs. Adults

Answer 9

• (Children): ~7-8%
• (Adults): ~4.5%

Question 10

Gender & Diagnosis: Childhood - who is more diagnosed than who?

Answer 10

• Boys diagnosed 2-3x more often than girls
• Historical diagnostic models were based on hyperactive boys + move overt

Question 11

Gender & Diagnosis: Female Presentation often missed due to…

Answer 11

• Predominantly inattentive symptoms (“daydreamy”)
• Symptoms are internalized (anxiety, low self-esteem) vs. externalized (disruptive)
• Masking: tendency to suppress H/I behaviours due to societal expectations (e.g., perfectionism, people-pleasing)

Question 12

ADHD Course & Outcomes

Answer 12

• About 2/3 of children continue to have impairing symptoms into adulthood
• Hyperactivity may lessen, but inattention & executive dysfunction often persist

Question 13

ADHD Course & Outcomes - risk if left untreated

Answer 13

• Includes poor job fit, academic underachievement, and relationship issues
• Higher risk for accidents, injury, substance misuse, and comorbidities (anxiety, depression)
• Associated with an average 7.5-year reduction in life expectance

Question 14

ADHD Course & Outcomes - benefits of treatment

Answer 14

• Medication is highly effective and mitigates risks.
• Associated with a reduced risk of death (~19%), overdose (~50%), and motor vehicle accidents (~38%)

Question 15

ADHD Comorbidities - Sensory Oversensitivity

Answer 15

• Common to have more intense reactions to sights, sounds, textures
• Can exacerbate distractibility & emotional reactivity

Question 16

ADHD Comorbidities - Emotional Dysregulation

Answer 16

• Higher than in the general population
• Central feature or consequence?
• Not a DSM criterion but distinct from (though may be amplified by) comorbid mood disorders

Question 17

ADHD Comorbidities - Differential Diagnoses: vs ODD

Answer 17

Defiance (“I won’t”) vs inability to sustain effort (“I can’t”)

Question 18

ADHD Comorbidities - Differential Diagnoses: vs anxiety

Answer 18

Inattention due to internal worry vs external distraction

Question 19

ADHD Comorbidities - Differential Diagnoses: vs ASD

Answer 19

Social issues from disengagement vs impulsivity; tantrums from broken routines vs poor self-control

Question 20

ADHD Causes: Biological & Genetic

associated with _ system genes?

Answer 20

• Strong genetic heritability (one of the highest in psychiatry)
• Runs in families; associated with dopamine system genes

Question 21

ADHD Causes: Neurobiological influences (3)

Answer 21

• Slightly smaller total brain volume
• Delayed cortical maturation, especially in frontal regions (responsible for executive functions; e.g., planning, inhibition)
• Impaired function in brain networks for attention and self-control

Question 22

ADHD Causes/Exacerbating Factors: Sleep & Cognition

Answer 22

• Sleep problems are common especially in children with ADHD
• Inattention and hyperactivity worsen with poor sleep (bidirectional relationship)
• Sleep-focused interventions show promising results
• Working memory and inhibitory control often most impaired

Question 23

ADHD Causes: Environmental Risk Factors

Answer 23

• Prenatal exposure to smoking and alcohol
• Maternal stress and low birth weight
• Family conflict and parenting style may exacerbate symptoms
• Food additives and toxins NOT strongly supported

Question 24

Classic ADHD Theories - #1

Answer 24

Traditional Executive Function (EF) Models (e.g., Barkley)

Question 25

1. Traditional Executive Function (EF) Models (e.g., Barkley): **type of model? primary deficit?**

Answer 25

* A **"Top-Down"** failure model * **Primary Deficit: Behavioral Inhibition**

Question 26

Traditional Executive Functional Models - **cascades into other deficits**

Answer 26

1. Working memory 2. Self-regulation 3. Problem solving + planning

Question 27

Traditional Executive Function Models - **brain links?**

Answer 27

**Prefrontal-Striatal Circuits (Dopamine system)**

Question 28

Classic ADHD Theories - #2

Answer 28

Attention/Arousal Dysregulation Models (e.g., Sergeant)

Question 29

Attention/Arousal Dysregulation Models (e.g., Sergeant) - **type of model? primary deficit?**

Answer 29

* A **"Bottom-Up"** failure model * Primary Deficit: **Poor regulation of Arousal, Alertness, & Activation**

Question 30

Attention/Arousal Dysregulation Models - **leads to...**

Answer 30

**"Unstable cortical arousal":** * **Under-Aroused** → **Inattention** * **Compensating** → **Hyperactivity & Sensation-seeking**

Question 31

Attention/Arousal Dysregulation - **brain links?**

Answer 31

**Brainstem/Locus Coeruleus** (Norepinephrine system)

Question 32

Classic ADHD Theories - #3

Answer 32

Dual Pathway Models (e.g., Sonuga-Barke)

Question 33

Dual Pathway Models (e.g., Sonuga-Barke) - **integrates? explains**

Answer 33

* Integrates classic models * Explains heterogeneity (diversity/variability)

Question 34

Dual-Pathway Models - **pathway 1:**

Answer 34

* **"Cool"** * **"Top-down"** * **Cognitive pathway** * **Executive Function deficits**

Question 35

Dual-Pathway Models - **pathway 2**

Answer 35

* **"Hot"** * **"Bottom-up"** * **Motivational pathway** * **Delay Aversion** (preference for immediate rewards)

Question 36

Classic ADHD Theories - #4

Answer 36

Reinforcement Learning Models

Question 37

Reinforcement Learning Models - **builds on which pathway? explores why...?**

Answer 37

* Builds on the **"hot" motivational pathway** * Explores why **reward sensitivity and decision- making are atypical**

Question 38

Reinforcement Learning Models - **focus on atypical...**

Answer 38

atypical **dopamine signaling** (how the brain learns from rewards and consequences)

Question 39

Reinforcement Learning Models - **ADHD is WHAT?**

Answer 39

ADHD is **heterogeneous**; it is not one thing and can result from multiple, overlapping pathways

Question 40

The Relatability Problem (What ADHD Isn’t)

Answer 40

"Relatable" symptoms can confuse common traits with a clinical disorder

Question 41

ADHD Treatment: Core Modalities

Answer 41

1. Stimulants 2. Psychosocial interventions

Question 42

Medications (Stimulants):

Answer 42

* First-line treatment (e.g., Ritalin, Adderall, Dexedrine) * Function: **Increase availability of dopamine & norepinephrine** * Effect: **Highly effective at reducing core symptoms** (inattention, hyperactivity, impulsivity) * Side effects: **appetite loss, sleep issues, irritability**

Question 43

Psychosocial Interventions:

Answer 43

* Parent training in behavior management (for younger children) * Classroom-based behavioral programs Executive Function Skills Training: * Uses strategies to improve core deficits like working memory, planning, & inhibition * Real-world practice is crucial for transferring skills to daily life

Question 44

ADHD Treatment: overview of what medication vs psychosocial can do?

Answer 44

* Medication → Manages core neurobiological symptoms; Helps the brain focus * Psychosocial → Builds real-world skills & functioning; Teaches what to do with that focus