ADHD

DSM Criteria #

Age of onset: <= 12 years Pervasiveness: symptoms present in >=2 settings

6 symptoms per category for children up to 16 years old, 5 symptoms for 17+

Core Symptoms #

Inattention:

failure to pay attention to details

Hyperactivity and impulsivity

Variability #

ADHD is best thought of dimensionally, since symptoms can present very differently:

types of symptoms
severity of symptoms
nature and degree of impairment
settings that symptoms present
- example: only have inattention during school, but can focus when playing video games

Diagnosing ADHD #

typically done using parent and teacher rating scales combined with a clinical interview to assess onset
observation is valid but not practical due to cost
evaluate functioning in key developmental domains such as interpersonal relationships, academic progress, family dynamic
treatment planning: collect context and impact of symptoms

Gene Environment Interactions #

Genetic liability: heritability is .6-.9 (highly heritable)

Play a larger role than environment Experiential activators (i.e. environmental risk factors): prenatal alcohol, maternal stress during pregnancy, postnatal lead

Mechanisms of ADHD (Endophenotype) #

Attention #

Ability to maintain performance over time

Not related to orienting ability (aligning attention to single source of information)

Executive Function #

Executive function is a set of cognitive processes that allow an individual to produce meaningful, goal oriented behavior by selecting relevant thoughts and actions.

Executive function includes three main components:

Working memory enables the ability to keep multiple things in the mind at once.
Response suppression enables the ability to interrupt a response if the situation calls for it. For example, children should be able to wait their turn to get food during recess (initial response: immediately run out and play)
Set shifting (cognitive flexibility) enables the ability to shift mental focus within or between tasks, and alternate between tasks

Motivation and reinforcement #

specific reward system impairment; sharp decrease in interest after long wait times

Temporal information processing #

greater variability in estimating and perceiving time

Treatment and Intervention #

Medication: symptom management (but not cure)

requires existing support from parents/mentors, and willingness to improve symptoms
greatest effect on ADHD symptoms Parent management training: use operant conditioning to reward positive behavior and discourage others Teacher/peer directed interventions: evidence-based intervention where children are paired with other kids with ADHD who have been successful with managing symptoms Psychoeducation: tell parents what ADHD is, encourage compassion+motivation to implement strategies Adolescent-directed behavior treatment:
teach kids executive control skills and how to apply them to daily life
provide regular monitoring and reinforcement
promote autonomy via healthy relationship with parents
greatest effect on functional impairment

ben's notes