Problem 1 – ADHD & ASD
• Attention deficit hyperactivity disorder (ADHD)- is a persistent pattern of inattention
and/or hyperactivity-impulsivity that is at a significantly higher rate than would be
expected for the child at that developmental stage.
• Hyperactivity- a higher than normal level of activity, excessive fidgetiness and by not
remaining seated when asked.
• Impulsivity- the act of reacting to a situation without considering the consequences.
The diagnosis of ADHD:
• Symptoms of both inattention and hyperactivity
• Attention deficit hyperactivity disorder, predominantly inattentive
presentation and attention deficit hyperactivity disorder, predominantly
hyperactive/impulsive presentations.
• If both inattentive and hyperactive/impulsive elements are present this
is known as a combined presentation.
• Children with ADHD can be distinguished from those with oppositional defiant
disorder/conduct disorder by the fact that the latter are likely to:
• Be more aggressive
• Live in families with a lower socioeconomic status
• Have parents who also exhibit antisocial behavior
DSM-5 Diagnosis criteria
An ongoing pattern of inattention and/or hyperactivity and impulsivity that interferes with
normal functioning or development, as marked by the following:
• Inattention. At least six of the following for at least 6 months:
• Not paying close attention to details or making careless mistakes
• Difficulty in maintaining attention in activities
• Does not listen when spoken to directly
• Ignores instructions
• Has difficulty organizing
• Dislikes or avoids tasks which require sustained mental effort
• Loses things needed for tasks
• Easily distractible
• Forgetful in daily activities
• Hyperactivity and impulsivity. At least six of the following for at least 6
months:
• High level of fidgeting
• Not sitting still or leaving seat when expected to sit
• Runs or climbs in situations where it is inappropriate
• Unable to engage in activities quietly
• Excessive talking
• Blurts out an answer before the question is finished
• Has difficulty awaiting their turn
• Interrupts or intrudes on others frequently
• Symptoms were present before the age of 12
• Symptoms are present in at least two settings
• Symptoms reduce the quality of educational, social or occupational ability
• Symptoms do not occur during schizophrenia or another psychotic disorder
and are not better explained by another mental disorder
The prevalence of ADHD
• 5 percent of school-age children and 2.5 percent of adults
• ADHD is more common in boys than girls
, • ADHD symptoms are not sex specific – but girls mostly have inattention &
boys hyperactivity
The consequences of ADHD
• Prone to temper outbursts, frustration, bossiness, stubbornness, changeable
moods, and poor self-esteem.
• Academic achievement is impaired = conflict with teachers and family.
• Predominantly inattentive symptoms suffer most in terms of academic
achievement
• associated with peer rejection and accidental injury.
o Comorbidity:
▪ oppositional defiant disorder (ODD) or conduct disorder
▪ learning disabilities – e.g., dyslexia
▪ depression & anxiety
Biological factors
• bio causes more important than psychological
• ADHD appears to be one of the most heritable psychiatric disorders
• Brains of children with ADHD are smaller than those of healthy comparison
children, and they develop more slowly.
▪ main areas affected being the frontal, parietal, temporal and occipital
lobes.
▪ Deficits in executive functioning and specifically have difficulty
inhibiting responses - normally controlled by the brain’s frontal lobes.
• Problems with dopamine transmission
▪ Struggle with rewards, especially long-term rewards – related to
inhibiting behavior
• Some symptoms can become less visible with adulthood bcuz the brain
develops – mostly hyperactivity & impulsivity, inattention stays
Psychological factors
• ADHD appears to run in families and this may have implications beyond the
fact that there is a genetic component to the disorder
• Interactions between parent and child – if parent has ADHD they will have
trouble dealing with a child who also has it
▪ Parent wouldn’t have patience = makes child’s symptoms worse
▪ Parents accidently reinforce behavior – child learns that this behavior
gets attention from parents (even if its negative) = do it more often
Prenatal factors
• Pregnant mothers smoking greater than 10 cigarettes per day were
significantly more likely to give birth to children with ADHD than non-smoking
mothers
o Nicotine affects dopamine functioning
Psychostimulants and ADHD:
• Psychostimulants are medications that increase central nervous system
activity.
• Common misconception of psychostimulants: paradoxical effect
- psychostimulants lead to restless, even frenetic, behavior when abused – is
a MYTH
• Usage and effects the most commonly prescribed psychostimulants are
known by the trade names of Ritalin, Dexedrine, Cylert, and Adderall.
• Psychostimulant alternatives:
, ▪ Strattera- norepinephrine reuptake inhibitor, is the only non stimulant
medications approved – has severe side effects
▪ Clonidine- can lead to decreases in aggressive behavior,
▪ Antidepressants- may affect ADHD symptoms directly for unknown
reasons
Short-term and long-term effects of psychostimulants on ADHD symptoms
Hyperactivity/Impulsivity Inattention/Learning
Short-term Dramatic improvements; More work completed, but
less active and more no change in grades or
focused; fewer social standardized tests scores
problems
Long-term No demonstrated benefit No demonstrated benefit
Side effects: decreased appetite, increased heart rate, sleeping difficulties, increase in
motor tics
Article:
Most appropriate intervention:
• for preschoolers → parent training
• for school-age children with moderate impairments → group parent training
programmes and classroom behavioural interventions
• for school-age children with severe impairments → combined with stimulant
medication
• for middle school/adolescent children → multimodal interventions: integrate
home and school treatment strategies + social skills training
• for adults → stimulant medication, CBT
Autistic Spectrum Disorder (ASD)- an umbrella term that refers to all disorders that display
autistic-style symptoms across a wide range of severity and disability
• From early infancy, some children will exhibit a spectrum of developmental
impairments and delays that include social and emotional disturbances,
intellectual disabilities, language and communication deficits, and the
development of stereotype or self-injurious behavior patterns.
• Savant syndrome - the phenomenon on extraordinary proficiency in
one isolated skills in individuals with multiple cognitive disabilities, it
appears to be closely linked to autistic spectrum disorder and is
frequently found in Asperger’s syndrome
• Asperger’s syndrome - impairment in social interaction, and the
development of restricted, repetitive patterns of behavior, interest and
activities, a diagnostic category no longer used in DSM-5
Triad of impairments
Lack of reciprocal social interaction
• trouble initiating the interaction
• non-verbal communication
Impairments in communication
• trouble maintaining eye contact
• echolalia - the immediate imitation of words or sounds that have just been heard
• pronoun reversal - an impairment in communication in which an individual refers
to himself or herself as ‘he’, ‘she’ or ‘you’,
, Impairments in imagination and flexibility of thought
• need for sameness
• restricted, repetitive and stereotyped patterns of behaviour and interests
• specific and detailed interests
• stereotyped (self-stimulatory) body movements
Theory of mind (TOM) deficit:
• Is the ability to understand one’s own and other people’s mental state and it is
not difficult to see that if a child has deficits in such abilities they will often
react in inappropriate ways to peer and family
Prevalence of ASD
- 0.05% of population
- 80% males
- Increased diagnosis in recent years – due to extension of criteria
DSM-5 Summary Table:
• Ongoing deficits in social activities as marked by the following (all 3):
• Social situation deficits - for example, abnormal social approach or
failure to initiate or respond to social situations
• Nonverbal communication behavior deficits - for example,
abnormalities in eye contact or poorly integrated verbal and nonverbal
communication
• Inability to develop, maintain or understand relationships
• Restricted and repetitive patterns of behavior, interest or activity, as marked
by at least two of the following:
• Repetitive motor movement, use of objects or speech
• Inflexibility and strong adherence to routine
• Abnormally intense fixated interests
• Hyper- or hyporeactivity to sensory input or unusual
• interest in sensory aspects of the environment
• Symptoms start in early development
• Symptoms cause significant impairment in important areas of functioning
• Symptoms are not better accounted for by intellectual disability or global
development delay
Sally-Anne false belief task - an imaginative procedure that has been used many times to
assess theory of mind abilities in a range of clinical populations
Empathizing-systemizing theory = a theory of the social and communication difficulties
experienced by individuals with autistic spectrum disorder
- Superior skills in systematizing & finding patters – how they navigate the world
Haloperidol = an antipsychotic medication most commonly used in the treatment of autism
Risperidone = a drug treatment for children with autism
Modeling = the process of demonstrating a required behavior to clients before prompting
them to imitate it
Parent-implemented early intervention = using parents as effective trainers to teach children
with intellectual disabilities basic self-help and communication skills
Consequences
- Trouble socializing & social interaction issues
- Difficulty inhibiting complex behaviors
- Trouble with planning & organization
Causes
- 90% heritable in twins (mostly mz twins)
