What is ADHD?
Symptoms:
- Persistent pattern of inattention or hyperactivity/impulsivity.
- There are groups of children who have both of these types.
- Group of kids who only have inattention or impulsivity.
- Key symptoms occur in childhood: up until 6 and 12 is where you can identify
symptoms.
Typical symptoms:
- Short attention span.
- Have high impulsivity. Way of diverting attention elsewhere.
- Young children have intellectual disabilities (comorbid factors) or conduct
disorders.
- First manifestations of symptoms is by the age of 6.
- 5 in 100 kids will have ADHD diagnosis.
Diagnosis:
- Have a predominant inattention type (meet 6 of the symptoms): may have 2 or 3
symptoms of hyperactivity.
- Predominant hyperactive impulsive type (meet 6 of symptoms).
ADHD diagnostic criteria:
- Symptoms are present in two or more settings.
Subtypes:
Combined presentation:
- Need 6 symptoms from each category.
Predominantly inattention type:
- Found in middle school.
Predominantly hyperactivity type:
- Drop as they get older.
Prevalence:
- 3-5%.
- Half will carry ADHD into adulthood.
- Greater risk in males compared to females.
,3
, - Drop as they get older.
Prevalence:
- 3-5%.
- Half will carry ADHD into adulthood.
- Greater risk in males compared to females.
- World wide prevalence rate (2.5%).
- Male female ratio is 3:1.
- 50% of children referred to mental health clinics in US are referred for ADHD-
related problems.
Developmental cause:
- Persistent across lifespan in most cases.
- Severity will have an impact on treatment, long term prognosis will be different
(whether they'll show progress in adulthood).
- Inattention remains stable; hyperactivity declines with age.
Kessler et al (2005):
- Wanted to identify predictors.
- Sample of 3197 18-44 year old.
- Results: childhood ADHD severity and childhood treatment (especially with
drugs) predicted persistence.
Biederman et al (2011):
- 11 year follow up.
- Predictors of severity of ADHD.
- 110 boys compared to 105 boys without ADHD.
- 70% of kids carried on with that diagnosis. There was partial persistence (22%),
impaired functioning (15%) or remitted but treated (6%).
- Predictors: severe impairment of ADHD, psychiatric comorbidity and exposure
maternal psychopathology.
Neurocognition:
- There's a wide range of cognitive domains assessed with those with ADHD.
- Response inhibition: you'd ask a kid 'every time you see a 0, press the button'.
Numbers aren't presented clearly, child wouldn't press a button when they saw a
but because of high levels of impulsivity they would press the button. Measure
number of errors, speed.
- Delay aversion: you ask the individual 'if you complete this puzzle within, you'
give them a £5 voucher- any less a chocolate bar'. ADHD children will go for th
short term gain (reward) rather than looking at what they can benefit from the £5
- Executive functioning: Gambling task. See lots of cards on the screen and tap on
the cards and you'll see 10$. Identify the rule/pattern (don't tell this to the
participant). Ability to plan things and manage things. ADHD children would
press everything.
- Psychological deficits are presumed to be linked to dysfunction of frontal-striata
cerebellar circuits.
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