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Summary Clinical Psychology 1.6 Problem 8
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- Erasmus Universiteit Rotterdam (EUR)
- Boek
- Psychopathology
Summary for problem 8 for clinical psychology
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Problem 8 – Hooley and Butcher & Davey & Nolen-HoeksemaNeurodevelopmental disorders: characterized by early onset (during childhood) and persistent course,
result of disruptions to normal brain development.
ADHD: ATTENTION DEFICIT/HYPERACTIVITY DISORDER
Clinical picture
- Characterized by a persistent pattern of difficulties sustaining attention and/or impulsiveness and
excessive/exaggerated motor activity.
- In order to meet the criteria for ADHD these problems have to be numerous, persistent and causing
impairment at home, school or workplace. The hyperactivity or inattention should be greater than
normal for child’s developmental stage.
- 2 diagnostic subtypes: ADHD – predominantly inattentive presentation OR ADHD – predominantly
hyperactive/impulsive presentation. If both is present then it’s combined presentation.
- Most cases are characterized by inattention (95%), whereas a smaller percent is characterized by
hyperactivity (36%).
- Lack of attention in academic, occupational or social situations, making careless mistakes, difficulty
maintaining attention until task is complete, having attention elsewhere and failing to take
instructions, tendency to shift from one task to another.
- Hyperactivity may manifest itself as excessive fidgeting and not remaining seated when asked. They
will exhibit excessive running/climbing or talking.
- Impulsivity manifests as impatience, constantly interrupting others before they finish what they’re
saying, desire for immediate rewards over delayed rewards. It can also result in accidents.
- It’s usually first recognized and diagnosed after the child begins schooling because learning and
adjustment at school is significantly affected.
- Their attentional deficits and hyperactivity make them prone to temper bursts, frustration,
bossiness, stubbornness, poor self-esteem etc. Because of these, they often have impaired
academic achievements.
- Children with ADHD score 7 to 15 point lower on IQ tests and show deficits on neuropsychological
testing that are related to poor academic functioning.
- They often show specific learning disabilities such as difficulties in reading or learning basic school
subjects.
- They are at higher risk of school problems including suspension or repeating a grade due to
behavioral problems.
- Symptoms of ADHD can also lead to social impairment. They might have difficulties getting along
with parents because they fail to obey rules. They can also be viewed negatively by their peers
because their behaviors are aggressive and disruptive.
- Children with predominantly inattentive symptoms tend to suffer most from academic achievement
whereas, ones with hyperactivity/impulsivity symptoms tend to suffer most from peer rejection and
accidental injury.
- In adulthood, problems include less success and safety at work, poorer interpersonal relationships,
poorer academic outcomes and poorer general life satisfaction.
Prevalence
- Worldwide estimates are 5% in school-age children and 2.5% in adults.
- It occurs in 9% of children and adolescents. It’s not the most prevalent but it is the most frequently
diagnosed by professionals. (parents are more likely to bring in their kid with ADHD than a kid with
a less disruptive disorder like social phobia)
- Even though ADHD occurs in childhood and adolescence, almost 50% of those will continue to meet
criteria in adulthood.
, - Approx. 4% of adults in the U.S. meet the criteria and they have high rates for being male, divorced
and unemployed (trouble finding work but also poor performance or being absent)
- Comorbidity: ADHD can lead to earlier onset of conduct disorder and ¼ of children with combined
presentation will later be diagnosed with conduct disorder. Anxiety and depressive disorders are
comorbid with a minority of children with ADHD.
- Rates might differ across cultures depending on how much they tolerate externalizing behavior.
- There is evidence that shows ADHD is more common in boys than girls but this may be because
boys are more likely to be referred for treatment.
Causes
Biological factors
- Available evidence points genetic involvement, ADHD appears to be one of the most heritable
psychiatric disorders. 20 twin studies report a mean heritability of 76%. Adoption studies also
suggest ADHD is more likely for the child if the biological parent has it.
- A gene linkage study revealed a region on chr.16 that has the most consistent link.
- Additional studies indicate a genes-environment interaction so what is inherited is only expressed
in certain environments: They found that children with 2 copies of the 10-repear allele of a DAT1
gene who were exposed to maternal prenatal smoking exhibit higher levels of hyperactivity and
impulsiveness. And children who possessed only 1 of the risk factors didn’t show high levels.
- Mothers who smoke more than 10 cigarettes a day are significantly more likely to give birth to
children with ADHD than non-smoker mothers. – exposure to nicotine
- Children with ADHD have smaller total brain volumes (with an aver. of 3.2%) and the main affected
areas are frontal, parietal, temporal and occipital lobes.
- ADHD is also associated with a global reduction in grey matter.
- Their brains mature 3 years more slowly.
- Other brain areas with decreased volumes are the frontal cortex, basal ganglia and cerebellum
- The maturational delays are most prominent in the prefrontal brain regions involved in executive
functioning and they predict the poor performance on tests of attention.
- Abnormalities in the cerebellum influence cortico-striatal-thalamo-cortico circuits and these circuits
are involved in choosing, initiating and carrying out complex motor and cognitive responses.
Psychological factors
- ADHD runs in families and this mean children with ADHD are more likely to be brought up by
parents who also have the disorder. This reinforces the possible role of inconsistent and ineffective
parenting of children with ADHD.
Treatment
- The most effective treatment: use of stimulant medication like Ritalin (methylphenidate). There’re
still disagreements going on but the use of medication has increased significantly over the years,
especially for adolescents.
- Stimulants have a quieting effect on children and just the opposite effect on adults.
- For children, stimulants decrease overactivity and distractibility, and increase alertness. So, they are
often able to function at school.
- Ritalin also lowers the amount of aggressiveness. Many kids who show unacceptable behavior in
class can function and progress in a relatively normal matter when they the drug.
- However, there are many side effects of Ritalin: decreased blood flow to the brain (can result in
impaired thinking and memory loss), disruption of growth hormone (leading to suppression of
growth in the body and brain), insomnia, psychotic symptoms and others.
- Although amphetamines don’t cure ADHD, they have reduced the behavioral symptoms in ½ to 2/3
of the cases.
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