Attention Deficit Hyperactivity Disorder (ADHD).ppt

Attention Deficit/ Hyperactivity Disorder (AD/HD)History: Early Conceptualizations of ADHDnEmphasis on attention vs. hyperactivity changed AD/HD History:DSM-IIInAttention Deficit Disorder with or without hyperactivitynAttention deficits were the focus (not hyperactivity)AD/HD History: DMS-III-RnAttention Deficit Hyperactivity DisordernMix of inattention and hyperactivitynAttention was somewhat primaryAD/HD History: DSM-IVnAttention Deficit/Hyperactivity DisordernFactor analytic studies resulted in two factors: attention and hyperactivityAD/HD Diagnostic Criteria: InattentionnMakes careless mistakesnDifficulty sustaining attentionnDoes not seem to listen when spoken to directlynDoes not follow through on instructions, fails to finish worknDifficulty organizing tasksnAvoids sustained effort tasksnLoses thingsnEasily distractednOften forgetfulAttentionnSelective Attention (Distractibility): attention to relevant stimulinSustained Attention (Vigilance): attention to a task over a period of time – Continuous Performance TestnAttention capacity-amount of information in short-term memoryAD/HD Diagnostic Criteria: Hyperactivity/ImpulsivityHyperactivitynOften fidgets with hands or feet or squirmsnOften leaves seatnOften runs about or climbs excessivelynDifficulty engaging in activities quietlynOften “on the go”, “driven”nTalks excessivelyImpulsivitynBlurts our answersnDifficulty waiting turnnFrequently interruptsDimensions of ImpulsivityCognitive ImpulsivitynDisorganizationnHurried thinkingnNeed for supervisionBehavioral ImpulsivityAD/HD SubtypesnAttention Deficit/Hyperactivity Disorder: predominantly inattentive typenAttention Deficit/Hyperactivity Disorder: predominantly hyperactive-impulsive typenAttention Deficit/Hyperactivity Disorder:nCombined typeProblems with AD/HD CriterianSymptoms are not developmentally sensitivenJust below threshold problemnCriteria for age of onset is questionablenCriteria of symptoms for 6 months may be too short for preschoolersAD/HD: PrevalencenPrevalence rates: 2-12%nMore common in malesnCultural variation in ratesAD/HD: Co morbiditynOppositional Defiant DisordernConduct DisordernAnxiety DisordernDepressionEtiology AD/HD: NeurologicalnAbnormal Brain Structure- normal brain is assymetrical with right side being somewhat larger than left.In AD/HDn-Smaller right frontal area; ornLeft and right sides equal sizenAbnormal Functioning- underactive frontal-striatal area (dopamine and norepinephrine)Etiology AD/HD: GeneticThere is strong evidence for genetic influence.nFamily studies: between 10 and 35% of first degree family members are likely to have AD/HD.nTwin Studies: Concordance rate identical twins (65%) is about twice that for fraternal twins .nSpecific Gene Studies: dopamine transporter gene, gene that codes for dopamine receptor gene, and multiple interacting genes on several chromosomesEtiology AD/HD: Environmental InfluencesNot influenced by:nParental management of the childnDiet, allergies, leadCan complicate:nFamily interactions and stressEtiology AD/HD: Russel Barkley TheorynSelf-Regulation begins with behavioral inhibition.nThose with ADHD are not able to inhibit their responses Treatment AD/HD: MedicationnMedication is the most effective treatmentnDr. Charles Bradley’s accidental discoveryTreatment AD/HD:MedicationPsychostimulantsnMethylphenidate (Ritalin)nAmphetamine (Dexedrine)nMagnesium Pemoline (Cylert)Side Effects PsychostimulantsnGrowth delay (time limted)Treatment AD/HD: MedicationnTricyclic Antidepressants (Inimpramine)-effectivenSide effects-effects on heart rate and blood pressurenCaffeine –some effectiveness-further study neededWhy Are Stimulants Effective?nBarkley’s theorynAlter fronto-striatal brain activity through effect on neurotransmitters dopamine, norepinephrine and epinephrineTreatment AD/HD: BehavioralParent management training:nTaught about AD/HDnTaught behavioral control techniquesSchool-based Educational Interventions:nBehavior modification applied in the classroomTreatment: School-based InterventionsnBehavior Modification applied in the classroom: reward systems, consequences for off task behavior, developing cuesTreatment: Individual TherapynBehavior TherapynCognitive-Behavioral Self-Control TrainingnIndividual CounselingnSocial Skills TrainingTreatment: Multimodal Intervention Study DesignnNational Studyn600 children ages 7-9nRandomly assigned to: --Medication alone --Psychosocial/behavioral tx. alone --Combination Treatment -- Routine Community Care (Control) Treatment: Multimodal Intervention ResultsnFor AD/HD Symptoms:--Meds alone & Combined Treatment>Psychosocial/Behavior &Routine Community CarenFor Other Areas of Functioning:--Combined treatment> Rountine community Care--Meds. Alone=Routine Community Care。