ADHD

Negative outcomes associated with ADHD

-Poor academic functioning -difficulty with relationships -diffuclty in employment settings -more car accidents -lose things -difficulty managing money

prevalence of ADHD

2008 to 2012 there have been skyrocketing rates of ADHD increased by 53%, nearly doubled in young Americanan adults. Inattention, distractibility, and hyperactivity can be caused by other conditions and experiences

prevalence rates of ADHD

5-10%, (low income white and black adolescent boys are the highest)

what number of dollars in sales of stimulant medication in one year

9 billion years

Global Assessment of Functioning (GAF) Scale or Children's Global Assessment Scale (CGAS) Selected Sample Descriptions Below (not complete)

91 -100 = superior functioning in a wide range of activities; no symptoms71 - 80 = slight impairment; transient symptoms51 - 60 = moderate symptoms; moderate difficulty in functioning31 - 40 = some impairment in reality testing; major impairment in several areas 1 - 10 = persistent danger of harm to self or others

How does Ritalin work?

= methylphenidate. it blocks the reuptake of dopamine so more dopamine is available in the synapse. (The dopamine transporter (DAT) removes dopamine from the synapse and reabspobs it into the presynaptic neuron)

ADHD is highly heritable (70-80%)

Adaptive values of DRD4-7, repeat 7 allele 40,000 years old, may be associated with migration patters

two arguments against ADHD Diagnosis

Benign explanations: American or Western "social construction" resulting from busy, fast-paced, urban lives • Or American parents are too permissive and raise misbehaving children Nefarious expiration: ADHD is a "fraud" perpetrated by pharmaceutical companies for profit

The four Ds

Diviance, distress, dysfunction, and danger. The four elements do not need to all be present if one ormore is severe enough to warrant a diagnosis of a psychological disorder.

what is the evidence that ADHD is a "real" disorder?

History of the diagnosis. prevalence rates, gene studies, psychological studies

treatment types of ADHD

Medication and psychosocial

world wide meta analysis

North American rate does NOT exceed those is most other regions North American rate is higher than Europe's, which uses the ICD-10, a more stringent system World wide Prevalence Rates Indicate that it's NOT just an American Problem

psychosocial treatment for ADHD (see chapter 5)

Psychoeducation, Individual therapy, Compensatory behavioral and self-management training, Coaching, Technology-based programs, School/work accommodations

medication to treat ADHD

Stimulants (eg ritalin) and antidepressants. Many with ADHD are treated with methylphenidate (Ritalin), or other stimulant drugs It is estimated that 2.2 million children in the US, 3% of all school children, take Ritalin or other stimulant drugs for ADHD

synaptic transmission

The neuron where the signal is initiated is called the presynaptic neuron, while the neuron that receives the signal is called the postsynaptic neuron. In the presynaptic neuron, there are chemical signals called neurotransmitters that are packaged into small sacs called vesicles. When the presynaptic neuron is excited by an electrical signal called an action potential it causes these vesicles to fuse with the presynaptic membrane and release their contents into the synaptic cleft. Once they are in the synaptic cleft, neurotransmitters interact with receptors on the postsynaptic membrane. They bind to these receptors and can cause an action to occur in the postsynaptic cell as a result. (This action may involve increasing the likelihood that the postsynaptic cell will become activated and itself fire an action potential, or decreasing it (inhibition).) Eventually, the neurotransmitter molecules must be cleared from the synaptic cleft. Some of them will simply drift away in a process called diffusion. In some cases, the neurotransmitter is taken back up into the presynaptic neuron in a process called reuptake. Once back inside the presynaptic neuron, the neurotransmitter can be recycled and reused. In other cases, enzymes break down the neurotransmitter within the synapse. Then the component parts can be sent back into the presynaptic neuron to make more neurotransmitter.

Distress

Unpleasant and upsetting to the person

diagnosis bias

a systematic error in diagnosis (example an African American patient is more likely to be diagnosed with schizophrenia rather than a mood disorder.)

multiaxial diagnositc stustem

axis I: clinical disorders axis II: Personality Disorders/mental Retardation axis III: general medical conditions axis IV: Psychosocial/Environmental Problems axis V: Global Assessment of Functioning (GAF)

DSM-V Attention-Deficit Hyperactivity Disorder

classified as a neurodevelopment disorder, group of disorders that typically onset in the developmental period, usually early in life, Duration: Symptoms present for at least 6 months, maladaptive & inconsistent with developmental level Some symptoms present before age 12 Some symptoms present in at least 2 settings (e.g., school, home, work, etc; with friends or relatives) Clear evidence that symptoms interfere with social, academic, or occupational functioning

why not diagnose?

diagnosis bias and stigmatization

deviance

different, extreme, unusual, perhaps even bizarre.

dots task

hearts and flowers

DRD4 gene

heavily expressed in the prefrontal cortex, Ch. 11, Exon III, 48bp VNTR Polymorphism. 7-repreat allele (frequency: 15-20%) reduces gene expression and is less efficient receptors, associated to novelty seeking, alcohol and drug use, ADHD associated. relates to dopamine system and executive functions in the frontal cortex

ADHD is a problem m of

inhibitory control (Barkley, 1997)

games like Simon says, red light, green light use/can

inhibitory cortrol and can improve ADHD symptoms in preschoolers per a 2013 study in 90 min session for 5-8 weeks and included other games and parent education treatment benefits lasted 3 months later

three sub types of ADHD

instructive, hyperactive, and impulsive

dysfunction

interfering with the person's ability to conduct daily activities in a constructive way.

prefrontal cortex

part of frontal lobe responsible for thinking, planning, and language

danger

posing risk of harm

executive functions

problem with executive functions and Capacity to control thoughts and behavior (Shallice, 1982). 'Umbrella' term which includes working memory, decisions making, response inhibition, selective attention, underpin our ability to direct our attention, hold a plan in mind, and inhibit non-desired impulses, pre frontal region of the brain

What are the pros & cons of medication for ADHD?

pros: • Effective for most people who take them (9 out of 10) • Works quickly • Less time consuming than behavioral treatments cons: Side effects (e.g., insomnia, weight loss, anxiety) • Possible risk of dependence • No evidence of long-term improvement • Can be costly $$$

Why diagnose?

provide appropriate treatment, improve communication — common agreed upon language, make research findings more reliable and valid, qualify for insurance coverage, access services.

phonological working memory test

read numbers and letters mixed up has to put numbers in order from least to greatest and whatever the earliest letter in the alphabet read is

DSM-V Criteria for ADHD hyperactivity-Impulsivity

the presents of 6 or more of these symptoms: Hyperactivity: Fidgets or squirms Often leaves seat Runs or climbs excessively Can't play quietly In constant motion Talks excessively Impulsivity: Blurts out answers Difficulty awaiting turn Often interrupts or intrudes

DSM-V Criteria for ADHD inattention

the presents of 6 or more of these symptoms: Poor attention to details Poor sustained attention Often does not listen Fails to carry out instructions Disorganized Dislikes tasks that require sustained attention Often loses things Easily distracted Often forgetful

history of ADHD timeline

was around before the drugs

good self control predicts important life outcomes regardless of ADHD status (present or not)

Ø Physical health Ø Substance dependence Ø Income & social class Ø Financial planning & struggles Ø Single parenting Ø Adult criminal conviction Ø Every increase in self-control predicts an increase in positive outcomes