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  • Cengage Learning 2016 Eric J. Mash David A. Wolfe Attention-Deficit/Hyperactivity Disorder (ADHD) 8
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  • Cengage Learning 2016 Attention-deficit/hyperactivity disorder (ADHD) is exhibited as persistent age- inappropriate symptoms of inattention, hyperactivity, and impulsivity that are sufficient to cause impairment in major life activities Characteristic behaviors vary considerably from child to child Different behavior patterns may have different causes Description
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  • Cengage Learning 2016 Early 1900s Children who lacked self-control and showed symptoms of overactivity/inattention in school were said to have poor inhibitory volition and defective moral control Following the worldwide influenza epidemic from 1917-1926 Brain-injured child syndrome 1940s-1950s: minimal brain damage and minimal brain dysfunction History
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  • Cengage Learning 2016 Historical Example
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  • Cengage Learning 2016 Late 1950s ADHD was called hyperkinesis Led to definition of hyperactive child syndrome, in By the 1970s Deficits in attention and impulse control, in addition to hyperactivity, were seen as the primary symptoms 1980s saw increased interest in ADHD Rise in stimulant use generated controversy History (contd.)
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  • Cengage Learning 2016 Key symptoms fall under two well- documented categories Inattention Hyperactivity-impulsivity Using these dimensions to define ADHD oversimplifies the disorder Attention and impulse control are closely connected developmentally Core Characteristics
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  • Cengage Learning 2016 DSM-V Diagnostic Criteria for ADHD
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  • Cengage Learning 2016 DSM-V Diagnostic Criteria for ADHD (contd.)
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  • Cengage Learning 2016 DSM-V Diagnostic Criteria for ADHD (contd.)
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  • Cengage Learning 2016 Inability to sustain attention, particularly for repetitive, structured, and less enjoyable tasks Deficits may be seen in one or more types of attention Attentional capacity Selective attention Distractibility Sustained attention/vigilance (a core feature) Inattention
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  • Cengage Learning 2016 Inability to voluntarily inhibit dominant or ongoing behavior Hyperactive behaviors include Fidgeting and difficulty staying seated Moving, running, touching everything in sight, excessive talking, and pencil tapping Excessively energetic, intense, inappropriate, and not goal-directed Hyperactivity-Impulsivity
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  • Cengage Learning 2016 Impulsivity Inability to control immediate reactions or to think before acting Cognitive impulsivity includes disorganization, hurried thinking, and need for supervision Behavioral impulsivity includes difficulty inhibiting responses when situations require it Emotional impulsivity includes impatience, low frustration tolerance, hot temper, quickness to anger, and irritability Hyperactivity-Impulsivity (contd.)
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  • Cengage Learning 2016 Predominantly inattentive presentation (ADHD-PI) Predominantly hyperactiveimpulsive presentation (ADHD-HI) Combined presentation (ADHD-C) ADHD Presentation Types
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  • Cengage Learning 2016 Inattentive, drowsy, daydreamy, spacey, in a fog, and easily confused May have learning disability, process information slowly, have trouble remembering things, and display low academic achievement Often anxious, apprehensive, socially withdrawn, and may display mood disorders Predominantly Inattentive Type (ADHD-PI)
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  • Cengage Learning 2016 Primarily symptoms of hyperactivity- impulsivity (rarest group) Primarily includes preschoolers and may have limited validity for older children May be a distinct subtype of ADHD-C Predominantly Hyperactive-Impulsive Type (ADHD-HI)
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  • Cengage Learning 2016 Children who have symptoms of both inattention and hyperactivity-impulsivity Most often referred for treatment Combined Type (ADHD-C)
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  • Cengage Learning 2016 Appears prior to age 12 Persists more than 6 months Occurs more often and with greater severity than in: Other children of the same age and sex Occur across two or more settings Interferes with social or academic performance Not explained by another disorder Additional DSM Criteria
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  • Cengage Learning 2016 Limitations of DSM criteria for ADHD Developmentally insensitive Categorical view of ADHD DSM criteria shape our understanding of ADHD DSM criteria are also shaped by, and in some instances lag behind, new research findings What DSM Criteria Dont Tell Us
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  • Cengage Learning 2016 Children with ADHD often display other problems in addition to their primary difficulties Cognitive deficits Speech and language impairments Developmental coordination and tic disorders Medical and physical concerns Social problems Associated Characteristics
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  • Cengage Learning 2016 Cognitive processes Language processes Motor processes Emotional processes Cognitive Deficits: Executive Functions
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  • Cengage Learning 2016 Examples of Impaired Executive Functions
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  • Cengage Learning 2016 Intellectual deficits Most children with ADHD have at least normal intelligence - the difficulty lies in applying intelligence to everyday life situations Impaired academic functioning Children with ADHD frequently have lower productivity, grades, and scores on achievement tests Cognitive Deficits: Intellectual and Academic
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  • Cengage Learning 2016 Learning disorders are common for children with ADHD Problem areas: reading, spelling, and math Distorted self-perceptions Positive bias: exaggeration of ones competence Self-esteem in children with ADHD may vary with the subtype of ADHD Distortions in perceptions of quality of life Cognitive Deficits: Learning Disorders and Self-Perceptions
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  • Cengage Learning 2016 Formal speech and language disorders Difficulty understanding others speech Excessive and loud talking Frequent shifts and interruptions in conversation Inability to listen Inappropriate conversations Speech production errors Speech and Language Impairments
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  • Cengage Learning 2016 As many as 30-50% of children with ADHD display motor coordination difficulties Clumsiness, poor performance in sports, or poor handwriting Overlap exists between ADHD and developmental coordination disorder (DCD) Marked motor incoordination and delays in achieving motor milestones Developmental Coordination and Tic Disorders
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  • Cengage Learning 2016 Tic disorders occur in 20% of children with ADHD Sudden, repetitive, nonrhythmic motor movements or sounds such as eye blinking, facial grimacing, throat clearing, and grunting Developmental Coordination and Tic Disorders (contd.)
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  • Cengage Learning 2016 Health-related problems Higher rates of asthma and bedwetting Studies findings are inconsistent Sleep disturbances may be related to use of stimulant medications and/or co-occurring conduct or anxiety disorders Medical and Physical Concerns
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  • Cengage Learning 2016 Accident-proneness and risk taking Over 50% are described as being accident- prone At higher risk for traffic accidents At risk for early initiation of cigarette smoking, substance use disorders, and risky sexual behaviors Reduced life expectancy Higher medical costs Medical and Physical Concerns (contd.)
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  • Cengage Learning 2016 Family problems include: Negativity, child noncompliance, excessive parental control, sibling conflict, maternal depression, paternal antisocial behavior, and marital conflict Family difficulties may be due to co- occurring conduct problems Social Problems
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  • Cengage Learning 2016 Peer problems ADHD children can be bothersome, stubborn, socially awkward, and socially insensitive They are often disliked and uniformly rejected by peers, have few friends They are unable to apply their social understanding in social situations Positive friendships may buffer negative outcomes Social Problems (contd.)
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  • Cengage Learning 2016 Up to 80% of children with ADHD have a co-occurring psychological disorder Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) Role of COMT gene A common genetic contribution for ADHD, ODD, and CD Family connections there is evidence for a contribution from a shared environment Accompanying Psychological Disorders and Symptoms
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  • Cengage Learning 2016 Anxiety disorders About 25% of children with ADHD experience excessive anxiety Co-occurring anxiety worsens symptoms or severity of ADHD Findings are inconsistent Children with co-occurring ADHD and anxiety: Display social and academic difficulties Experience greater long-term impairment and mental health problems Accompanying Psychological Disorders and Symptoms Anxiety Disorders
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  • Cengage Learning 2016 Mood disorders ADHD at 4-6 years is a risk factor for future depression and suicidal behavior 20-30% of children with ADHD experience depression Family risk for one disorder may increase the risk for the other C


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