Term
ADHD has a high comorbidity w/
Prevalence of ADHD in school age kids...
Gender differences |
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Definition
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Term
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Definition
*Tends to continue into adulthood
*But can be diagnosed years late |
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Term
| ADHD can increase the risk of 2 other psychopathologies... |
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Definition
1. ASPD
2. Substance Abuse D/O |
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Term
| How would you go about Dx ADHD for adults? 4 Ways |
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Definition
1. Aptitude-Attn/Conc. (via the WAIS)
2. Emotional functioning (MMPI, BDI)
3. Interviews of family, teachers
4. Examine past records, report cards |
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Term
| Childhood rating scales for ADHD. |
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Definition
*Conners, CBCL
*Informant data: Parent, teachers
*Self-report
*Cross-situational reports |
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Term
4 Neuropsych assessments for ADHD
Some institutions perform this assessment: |
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Definition
1. Attn: Continuous performance tests, tasks
requiring attn to detail, divided attn, response
inhibition, speed/accuracy trade off
2. Executive function: Planning, organization
3. IQ, Memory, Cog. Skills
4. Rule out learning disability
*On/Off Ritalin/Adderall |
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Term
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Definition
*Non-Specific
*Familial component w/Dx of ADHD, Substance Abuse, MDD, Anxiety |
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Term
| Neurological etiology of ADHD |
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Definition
*Hypofrontality
*Basal ganglia dysfunction
*ACC dysfunction |
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Term
| Neurochemical etiology of ADHD |
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Definition
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Term
| Core deficit of ADHD Theory and Evidence (3) |
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Definition
*Underarousal: ADHD is a product of underarousal (manifesting itself as difficulty staying alert) and activity is a way to keep the neurological sys awake.
*In other words ADHD individuals have a greater tolerance for arousal
1. Stimulation seekers
2. Do better in novel situations
3. EEG data (underarousal) |
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Term
| Biological Treatment for ADHD |
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Definition
*Ritalin, Adderall
*Side effects: Increased jitteriness, Decreased
appetite, addiction, dosing
*Desirable effects: decreased impulsivity and HI,
increased attn
*Possibly some antidepressants: Wellbutrin |
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Term
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Definition
Aimed at: Social and academic performance
Behavioral tx: Token economy
Parent Mgmt training |
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Term
| What is the best treatment for ADHD? |
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Definition
Combined.
Meds work well, but don't target the secondary
problems |
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Term
| Barkly's 6 Criteria for ADHD |
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Definition
1. Parent/Teacher complaint of impulsivity,
inattn, overactivity, or poor rule-governed
behavior. Probs must be cross-situational
2. At least 2 SD above the mean on inattn or
hyperactivity on behavioral scales
3. Onset by 6 y.o (suggesting develop/neuro
prob)
4. Lasts at least 12 mo
5. IQ>85
6. Excluding Language delay, sensory handicap,
or severe psychopathology |
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Term
| Why is ADHD linked to negative family interactions? |
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Definition
| Sxs of ADHD are directly opposed to the parental goals of the parents |
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Term
| ADHD children are predisposed to what (in regards to parental relationship) (3) |
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Definition
1. Non-compliance
2. Greater structure, direction, and encouragement
3. Angry parents |
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Term
| 2 Research findings in regards to ADHD children and parents |
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Definition
1. More interaction w/parents
*E.G. More requests for help, more suggestions,
more directions, more commands b/c the child
is not on task
2. Have higher levels of conflict
*Positively: Conflict decreases w/age as does
parental commands |
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Term
| Meds affect of family interactions in ADHD |
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Definition
Controlling, directing, and neg. parental behaviors
decrease when a child is on stimulant meds
Parent responsiveness and the use of rewards
increases when kid is on meds, too |
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Term
| Typical hierarchy of responses to ADHD |
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Definition
1. Ignore disruptive behavior
2. Frequent commands/directions
3. Repeated directives/threats
4. Physical discipline, loss of privileges, threats
5. Giving up
*Parents perform tasks, tasks left undone, help
child finish |
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Term
In regard to the parental hierarchy w/ADHD how does it change over time?
Ultimate effect of this? |
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Definition
Parents start w/#5
Undermining a warm parent-child relationship |
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Term
| ADHD as a neurodevelopment d/o |
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Definition
Maybe kids w/ADHD are just late in developing brain regions assoc. w/attn and executive function
Some kids may not ever fully develop these regions |
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Term
| Why do some kids outgrow ADHD? |
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Definition
*Late to catch up
*Possibly related to DRD 1, and DRD 4 genes
*These polymorphisms assoc. w/DA and NE
*DA transporter also plays are role |
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Term
| Study examining DRD 1 and DRD 4 |
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Definition
N=105 ADHD
N=103 NMLs
8-16 yrs
The groups were matched on IQ, SES
fMRI |
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Term
| 4 Examples of Externalizing D/O |
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Definition
1. ODD
2. CD
3. ADHD
4. Maybe Encopresis |
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Term
Externalizing D/O are related by:
2 Externalizing D/O w/high comorbidity |
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Definition
Impulsivity
1. ADHD and CD |
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Term
FH and children w/CD
FH and children w/ADHD |
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Definition
1. SA and ASPD
2. Attentional and Learning Probs |
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Term
FH and children w/CD
FH and children w/ADHD |
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Definition
1. SA and ASPD
2. Attentional and Learning Probs |
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Term
Antisocial Behaviors and:
*Toddlerhood
*Preschool |
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Definition
*Irritable, difficult temperament
*Harshly defiant, argumentative |
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Term
Antisocial Behaviors and:
*School Age
*Preadolescence |
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Definition
*Fighting, lying, petty theft
*Assault, Sexual Precocity |
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Term
Antisocial behaviors and:
*Adolescence
*Adulthood |
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Definition
*Robbery, SA
*Repetitive criminal acts, callous relationships,
spousal/child abuse |
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Term
Prevalence and ODD
*Generally
*Gender
-Why |
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Definition
*Fairly common, 2-16%
*M>F
-Males are more confrontational |
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Term
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Definition
Precursor to CD
1/2 people have dx 3 yrs later
1/2 of this 1/2 go onto to develop CD |
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Term
| General description of ODD |
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Definition
| Pattern of negativistic, hostile, and defiant behavior for at least 6 mo. |
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Term
| Four or more of the following are needed for ODD dx. |
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Definition
1. Often loses temper
2. Argues w/adults
3. Actively refuses to comply w/adult rules
4. Deliberately annoys people
5. Blames others for own mistakes/misbehaviors
6. Touchy/Easily annoyed
7. Angry/resentful
8. Spiteful/Vindictive |
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Term
| 4 other DSM criteria for ODD |
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Definition
1. Occurs more frequently than norms
2. Affects function in school, home, community
3. Not co-current w/Mood/Psychotic d/o
4. CD trumps ODD |
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Term
| General description of CD |
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Definition
Persistent pattern of behaviors that violate basic
rights of others and/or major age appropriate
norms |
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Term
CD and Prevalence:
Very common in what population
Gender differences
SES differences |
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Definition
*Inpatient clinics
*6-16% boys
*2-9% girls
*Very common in poor, inner city environments |
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Term
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Definition
1. Bullying
2. Starting fights
3. Using a dangerous weapon
4. Cruelty to people/animals
5. Forced sexual activity
6. Arson
7. Destruction of property
8. Breaking into another's house/car
9. Stealing w/ or w/o confronting victim
10. Conning
11. Breaking curfew often
12. Running away
13. Truancy
14. Overt/Covert antisocial actions
15. Lack of remorse/interpersonal callousness
are hard to id in children |
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Term
CD Prevalence:
*Gender differences
-Why |
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Definition
boys 4x girl
-Boys: Direct physical aggression
-Girls: Indirect aggression (mental)
*Group affiliation |
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Term
CD:
*Genetic and Environmental Etiology |
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Definition
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Term
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Definition
*Preschool age
*Interpersonal aggression
*Decreased Verbal IQ (Low achievement)
*Low Prevalence (Boys>Girls)
*Comorbid w/ADHD
*Poor Prognosis |
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Term
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Definition
*Late Adolescence
*Covert Aggression
*Social Mimicry
*Higher Prevalence (B=G)
*No IQ deficits
*No comorbidity
*Good prognosis |
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Term
Etiology (Moffitt):
*Childhood Onset
*Adolescent Onset |
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Definition
*Combo of early neurodevelopmental deficits,
inadequate parenting, and adverse social
influences
*Peer influences during transition to adulthood |
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Term
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Definition
*Most common subtypes.
*Passage of urine only during nighttime
sleep.
*Usually occurs during the first 1/3 of the
night. |
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Term
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Definition
*Passage of urine only during waking hours
*Occurs during the early afternoon on school
days.
*Sometimes due to a reluctance to use the
toilet b/c of social anxiety/preoccupation/
or play activity |
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Term
| What gender is more prone to Diurnal Enuresis |
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Definition
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Term
| Diurnal/Nocturnal Combined Type |
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Definition
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Term
| Why do we care about enuresis? |
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Definition
| *1st sign of greater psychopathology |
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Term
Prevalence of enuresis:
*At age 5
*At age 10
*At age 18 |
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Definition
*7% M and 3% F
*3% M and 2% F
*1% M and <1% F |
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Term
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Definition
| *Term used when the child has NEVER established urinary continence. |
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Term
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Definition
*D/O develops AFTER a period of urinary
continence
*Pretty concerning |
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Term
| Family Pattern and Enuresis |
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Definition
*3/4 of all children w/enuresis have a 1
degree bio. relative w/the d/o
*Evidence w/twin studies |
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Term
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Definition
*D/O develops AFTER a period of urinary
continence
*Pretty concerning |
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Term
| Family Pattern and Enuresis |
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Definition
*3/4 of all children w/enuresis have a 1
degree bio. relative w/the d/o
*Evidence w/twin studies |
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Term
| Encopresis w/Constipation and Overflow Incontinence: |
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Definition
*Usually involuntary
*Child becomes constipated-->has frequent accidents manifested as leakage throughout the day and night |
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Term
| Encopresis w/o Constipation and Overflow Incontinence |
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Definition
*Voluntary
*Feces often deposited in a prominent
location
*No evidence of constipation
*Usually for secondary gain |
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Term
| Prevalence and Encopresis |
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Definition
*1% of 5 y.o. have encopresis
*M>F
*6-10% of all clinic referrals for encopresis
-Due to social stigma, parental anxiety/
annoyance |
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Term
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Definition
| *Child has never established control of feces |
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Term
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Definition
*Child was once in control of feces
*VERY Concerning |
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Term
| What does encopresis mean? |
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Definition
*Early warning sign of psychopathology
*If early tx is possible you could take child
off of a poor trajectory |
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Term
| 3 Possible Explanations for Enuresis |
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Definition
1. Medical causes: Leading to inability
to recognize need to urinate
2. Deep sleep
3. Family factors for Diurnal Type |
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Term
| 1 explanation for encopresis you need to examine |
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Definition
| Neuropathology (eg. Hirschprung's Disease) |
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Term
| 2 Additional explanations for Encopresis constipation subtype |
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Definition
1. Poor Nutrition
2. Child has learned to avoid BM. May result from the child attempting to gain control, parent-child interaction problems, or possible fear of the toilet.
**NEEDS psych intervention |
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Term
| 2 Possible explanations for Encopresis non-constipation subtype |
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Definition
1. IBS. Incontinence is the result of excessive stress +/- anxiety or intolerance to certain foods
2. In order to manipulate parents, achieve some goal. (eg Punish parents)
****VERY CONCERNING |
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Term
| 7 Possible tx for enuresis |
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Definition
1. Dissac. bedwetting from laziness
2. Train kids to attend to feeling of needing to urinate
3. "Bell and Pad"
4. Overcorrection: engage child in cleanliness ritual.
EG. excessive clean up
5. Train children in bladder retention by giving large amts of liquid and reinforcing increased periods of retention
6. Reinforce dry nights
7. Do NOT restrict fluids before bedtime.
*For daytime enuresis follow encopresis plan |
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Term
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Definition
1. Enemas
2. Lifestyle change: change diet
*Goal: Child to use bathroom often and w/o
doubt
3. Reinforce trips to toilet as a routine
4. Reinforce child initiated toilet trips
5. Reinforce accident free days
6. Neg. consequences for accidents occurring
due to not following the routine
7. Desensitize child to bathroom usage |
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Term
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Definition
1. Inattention
2. Hyperactivity/Impulsivity |
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Term
| 6+ to get the Inattentive subtype of ADHD |
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Definition
1. Lack of attn to detail, careless, mistakes
2. Difficulty sustaining attn
3. Doesn't seem to listen
4. Doesn't finish things or follow through
5. Difficulty organizing tasks/activities
6. Avoids tasks w/sustained mental effort
7. Loses things
8. Easily distracted
9. Forgetful |
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Term
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Definition
1. Fidgets/Squirms
2. Leaves seat
3. Runs, climbs in inappropriate situations
4. Difficulty playing quietly
5. On the go; driven by a motor
6. Talks a lot
7. Blurts out answers
8. Difficulty awaiting turn
9. Interrupts/Intrudes on others |
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