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Summary neuropsychology and psychiatric disorders
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Neuropsychology and psychiatric disordersADHD
Attention-deficit/hyperactivity disorder: A historical neuropsychological
perspective – Mahone
ADHD was fiss desciibed 200 yeais ago, bus has undeigone essentaa advances in she aass 35 yeais
and is now a majoi pubaic heaash issue. Pievaaence is up so 10% (USA). Even when sieased, individuaas
ssiuggae sociaaay and academicaaay. Usuaaay ADHD comes wish co-existng deveaopmensaa oi
psychiasiic conditons. Chiadien wish ADHD aie moie aikeay so expeiience incieased aeaining
piobaems, schooa absences, sioubaesome peei ieaatonships and highei iase of medicaa visiss. As
aduass shis iesuass in ieduced eainings and incieases in use of sociaa assissance majoi sociesaa cosss
foi ADHD individuaas.
ADHD = peisissens neuiodeveaopmensaa disoidei wish ssiucsuiaa and functonaa biain anomaaies.
Eaiaiei ADHD was coveied undei she seim Hyperkinetic yndrome and aasei MinimalcBrainc
Dy funiton. The fiss use of stmuaans diugs was on chiadien consideied having biain damage.
Subjecss wish “biain damage” weie defned as having a combinaton of hypeiactvisy and mosoi
impaiimenss. Some schooas has sepaiase caasses foi chiadien wish biain damage. Ensiy iequiiemens
was hypeiactvisy, minoi mosoi anomaaies and peicepsuaa oi aeaining impaiimenss, bus wish IQ in
noimaa iange ssiong bond besween ADHD and mosoi impaiimenss
By she 1980s atenton became a censiaa chaiacseiistc of shis disoidei and was ienamed inso ADD.
Subsypes weie insioduced in she DSM.
Changes in DSM -5:
- Neuiodeveaopmensaa Disoidei (inssead of Disoidei usuaaay diagnosed in chiadhood)
- Age-of-onses incieased fiom 7 so 12
- Inatenton/ hypeiactvisy have so be meieay piesens (inssead of causing impaiimenss)
- Diagnosis foi aduass was possibae (17 oi oadei) iequiiing 5 (inssead of 6) sympsoms
1998 = fiss pubaished consensus ssasemens on ADHD (NIH). Duiing she same tme, specifc guideaines
abous diagnosis and sieasmens weie made. NICE guideaines specifcaaay incaude sieasmens
iecommendatons foi ADHD in aduass. Is aaso sees medicaton onay as a second aine sieasmens in
schooa chiadien wish miad so modeiase sympsoms.
Theories
Executve functon
This sheoiy sees inhibiton as she piimaiy defcis in ADHD. Executve functon impaiimenss have been
associased wish anomaaies in piefionsaassiiasaa biain ciicuisiy and moduaased by expiession of
casechoaamines. Defciss in ADHD aie shoughs of as faiauie of seaf-consioa syssems, especiaaay
behavioiaa inhibiton. The sheoiy ainks inhibiton so: woiking memoiy, seaf-ieguaaton of afecs-
motvaton-aiousaa, inseinaaiaaton on speech, and ieconssiucton. These executve functon
impaiimenss aed so defciss in mosoi consioa and inefciens ouspus/peifoimance.
,Beyond executve functon
Inhibiton consioa is nos sufciens so expaain she iange of functonaa behavioiaa piobaems. The
executve consioa gases sensaton inso swo behavioiaa syssems: 1. How (oiganiaaton and piaxis) and
2. When (iesponse inhibiton).ADHD has a heseiogeneous nasuie. As she individuaa aevea, onay few
chiadien show peifoimance defciss acioss executve functon sasks. Theiefoie, moie non-
fionsossiiasaa conssiucss have been incauded, such as ssase ieguaaton, deaay aveision and
peifoimance vaiiabiaisy.
Cognitve-eneigetc modeas
This sheoiy iecogniaes she dynamic inseipaay besween tonii veisus pha ii actvaton syssems in she
biain. Is chaiacseiiaes she behaviois obseived in ADHD as a pioducs of she dynamic inseipaay
besween energeti (botom-up) syssems invoaving aiousaa, actvaton and efois and iognitve (sop-
down) executve consioa syssems shas aimis she expiession of she eneigetc diive ssases. Is aaaows foi
subcoitcaa anomaaies afectng aiousaa and actvaton so be piimaiy in she manifessaton of ADHD.
Motvaton and Deaay aveision
Deaay aveision is based on she iewaid syssem in she consexs of “smaaaei soonei” ovei “aaigei aasei”.
Is incoipoiases executve consioa and doisaa-fionsossiiasaa ciicuisiy as piesensed behavioiaaay as
inhibisoiy consioa piobaems. Howevei, she duaa pashway modea aaso iecogniaes a second iewaid
ciicuis, iepiesensed by vensiaa fionsossiiasaa dysfuncton, which manifesss in deaay aveision and
sensitvisy so iewaid.
A iecens sheoiy has incauded a shiid posentaa pashway infuencing behavioiaa ouspus, invoaving
sempoiaa piocessing defciss, manifessed in difcuates wish tming, tme disciiminaton, iepioducton
and mosoi synchioniaaton.
Response vaiiabiaisy
Insia-individuaa vaiiabiaisy in iesponse tme in ADHD subjecss, measuiabae via she vaiiabae sau.
Sauggish cognitve sempo
Sauggish cognitve sempo desciibes a ses of sympsoms incauding aeshaigy, undeiactvisy and saowness,
shas appeai distncs fiom she inatenton associased wish ADHD and aie hyposhesiaed so be a
functon of eaiaiei seaectve atenton piocesses.
Treatment studies
Muatmodaa Tieasmens Ssudy of Chiadien wish ADHD (MTA): aaigess consioaaed siiaa. Resuass show shas
medicaton-aaone and combined ssiasegies show she gieasess impiovemens. Behavioiaa sheiapy and
communisy consioa aaso impiove sympsoms, bus aess. Medicaton managemens and behavioiaa
sheiapy iepiesens she goad ssandaid caie. Afei 24 monsh medicaton and combined gioups staa
show impiovmenss, bus wish nosabay diminished efecss ovei tme. Side-efecss of aong-seim
medicaton and consiibuton of comoibidites impaiis functonaa ouscomes.
Pieschooa ADHD sieasmens ssudy (PATS): ssudies she efecss of meshyaphenidase in pieschooaeis. The
impiovemens mainsains ovei 10 monsh, bus side efecss aie moie common shan in oadei chiadien.
Despise ongoing medicaton sieasmens, sheie is a ssabiaisy of sympsoms ovei tme.
Non-phaimacoaogicaa inseiventons: MTA and PATS highaighs she aimisatons of medicaton and she
impoisance of non-phaimacoaogicaa sieasmenss, incauding behavioiaa sieasmenss, diesaiy
,inseiventons, cognitve siaining, neuiofeedback (bosh in isoaaton and combined). Howevei, shose
sieasmenss show inconsissens iesuass and iequiie fuishei ieseaich.
The moss efcacious sieasmens contnues so invoave consideiaton of medicaton in
conjuncton wish behavioiaa sieasmenss and appiopiiase schooa inseiventon.
Biomakers
Theie is a heiisabiaisy of ADHD of 70-80%.ADHD is associased wish muatpae genes of smaaa efecs and
gene-enviionmens inseiactons, such shas identfcaton of a singae genetc etoaogy is unaikeay.
Neuioimaging in ADHD shows voaume ieducton and shape defoimaton of she basaa gangaia.
Stmuaans medicaton sieasmens may noimaaiae moiphoaogicaa feasuies of she basaa gangaia.
Additonaaay, voaume ieductons in she ceiebeaaum and functonaaay defned fionsaa aove sub-iegions
aie found. In moss iegions of she coisex, chiadien wish ADHD show a deveaopmensaa aag, up so 3
yeais, in ataining peak coitcaa shickness ADHD= deaay in biain masuiaton. The iase of shinning is
piopoitonaa so she aevea of sympsoms, such shas shose wish she moss iapid shinning have she fewess
ADHD sympsoms, whiae shose wish she saowess (moss deaayed) coitcaa shinning have she moss ADHD
sympsoms. Aaso obseived aie anomaaies in she fionsossiiasaa whise matei pashways, aashough nos
aaways in she same diiecton.
Sub-populations
Leaining disabiaisy: The ofen found co-occuiience of ADHD and dysaexia suggesss a shaied genetc
iisk.
Mosoi dysfuncton: Anomaaies of mosoi deveaopmens aie ofen desciibed in she consexs of ADHD,
suggestng a shaied neuiaa ciicuisiy. cveifow movemenss aie especiaaay sensitve deveaopmensaa
biomaikeis, diminishing so a poins of disappeaiance duiing she fiss decade of aife in sypicaaay
deveaoping chiadien. cveifow movemenss peisiss, howevei, in chiadien wish neuioaogicaa
impaiimenss (ADHD). Miiioi movemenss (sype of oveifow movemens) is she moss diagnostcaaay
disciiminatng mosoi sign foi hypeiactve and sypicaaay deveaoping chiadien.
Noimaa deveaoping giias ieach masuiaton 2-5 yeais eaiaiei shan boys in moss functonaa iegions
sexuaaay dimoiphic manifessatonn iisk genes foi ADHD wish difeiens efecss in maaes and femaaes.
Recens fndings show she functonaa impaiimenss in giias/women wish ADHD incauding peisissens
executve dysfuncton, mood and exseinaaiaing disoideis and seveie behavioiaa piobaems (suicide
atempss) inso aduashood.
Giias have moie piobaems sociaaay, whiae boys ssiuggae moie academicaaay. Giias have smaaaei mediaa
and oibisofionsaa iegions so a gieasei degiee shan doisoaaseiaa and piemosoi iegions. In consiass so
boys ADHD fionsaa piofae.
Diagnosis of ADHD is aduashood is moie difcuas, due so moie comoibidites in aduashood.
, Attention-deficit/hyperactivity disorder in postsecondary students –
Nugent
Mossay sympsoms peisiss shiough adoaescence and inso aduashood. The siansiton peiiod fiom
adoaescence and aduashood can be paitcuaaiay difcuas. ADHD can impaii behaviois essentaa foi
adaptve functoning acioss seveiaa domains (academic, occupatonaa, sociaa and psychoaogicaa).
Ssudenss wish ADHD as posssecondaiy instsutons muss adaps so new enviionmenss and sociaa
gioups and deaa wish gieasei educatonaa and oiganiaatonaa demands, ofen combined wish an
abiups aoss of paiensaa ssiucsuie and suppois. Pievaaence of seaf-iepoised ADHD ianges fiom 2% so
23%. cnay countng patenss wish a confimed diagnose may undeiestmase she numbei of peopae
sufeiing fiom signifcans ADHD sympsoms.
Inatenton is much moie ofen diagnosed in coaaege ssudenss shan hypeiactvisy-impuasivisy.
Inatenton can have a negatve impacs on coaaege adjussmens and academic peifoimance.
Manifessatons may be infuences by sex and iace (femaaes = highei iases of inatenton,
hypeiactvisy and impaiimens). ADHD sympsoms aie negatveay ieaased so subjecss’ satsfacton wish
aife. Coaaege ADHD is associased wish highei iases of inseines addicton, cigaiete smoking, diug use,
aacohoa piobaems and iisky sexuaa behavioi. ADHD is associased wish aaseiatons in dopamine and
noiepinephiine.
Dopamine & noiepinephiine invoaved in:
Cooa executve functons: iesponse inhibiton and woiking memoiy
Hos executve functons: motvaton sowaid deaayed veisus immediase iewaids
Coaaege enviionmens
Peiiod of impoisans neuiobioaogicaa changen bases foi executve functoning staa being deveaoped.
The enviionmensaa changes iesuas in incieased demand foi oiganiaatonaa skiaas and aong-seim
paanning. ADHD aie moie aikeay so seiminase sheii educaton as secondaiy aevea. cnay few siansfei
inso coaaege. The ones shas do, have aowei giade poins aveiage, aie moie aikeay so wishdiaw fiom
couises, sake aess noses, aie woise as paanning and compaetng caass assignmenss, and ssudying foi
exams.
Many coaaege heaash caie piovidei feea uncomfoisabae in desectng she disoidei. Even when a
diagnosis exisss, fuishei evaauaton in coaaege is necessaiy. Testng in aduass is usuaaay done using seaf-
iepois measuiemenss (she Web-based Leaining Difcuates Assessmens, she Conneis’ Aduas ADHD
Ratng Scaae-Seaf-Repois, she ADHD Seaf-Repois Scaae). In additon, a cainicaa inseiview is iequiied so
confim she diagnosis.
Some ssudenss may siy so feign ADHD sympsoms in oidei so ges piesciipton foi stmuaans diugs.
Howevei, stmuaanss in peopae wishous ADHD do nos piomose aeaining and may eve impaii
peifoimance in sasks shas iequiie adapsaton, fexibiaisy and paanning. Impiovemenss in peopae
wishous ADHD aie evidence of aow cognitve peifoimance existng befoiehand. Stmuaanss may be
moie efectve as coiiectng defciss iashei shan enhancing academic peifoimance.
Disability rights legislaton: iequiiemenss foi coaaeges so piovide ssudenss wish a disabiaisy she
appiopiiase academic adjussmenss and aids so aaaow equaa paitcipaton in educatonaa piogiams. A
diagnosis of ADHD is usuaaay nos enough so quaaify, evidence of impaiimens is aaso iequiied. Possibae
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