Module 7 Outline. Module 7 Outline. Module 7, Segment 1. Module 7. Attention-Deficit/Hyperactivity Disorder. (Slides 6-14)

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1 This material is copyright under US and applicable international laws. It is a violation of copyright to copy, duplicate, edit, or broadcast this material for any reason or by any means without prior written consent from Denise Krause. Module 7 Attention-Deficit/ Hyperactivity Disorder Module 7 Outline Module 7 Outline Segment 1 (Slides 6-14) History Core Characteristics Segment 2 (Slides 15-25) Subtypes Associated Characteristics Prevalence Developmental Course Segment 3 (Slides 26-39) Theories Causes Treatment Case Assessment Module Assessment Module 7, Segment 1 (Slides 6-14) History Attention-Deficit/Hyperactivity Disorder Considered a severe disorder with biological underpinnings Symptoms: age-inappropriate inattention, hyperactivity, and impulsivity Associated with problems in social, cognitive, academic, familial, and emotional domains of development and adjustment

2 History of Early 1900 s- considered to be due to poor inhibitory volition and defective moral control Great encephalitis epidemic of gave rise to the concept of a brain-injured child syndrome, which was often associated with mental retardation History of In 1950 s- referred to as hyperkinetic impulse disorder, motor overactivity seen as primary feature By 1970 s, deficits in attention and impulse control, in addition to hyperactivity, seen as the primary symptoms Most recently, more focus on child s impulsivity Inattention inability to sustain attention, particularly for repetitive, structured, and less enjoyable tasks Inattention inattentive behaviors may include: problems with concentration, easily distracted often seems as if child not listening disorganization, forgetfulness failure to finish assignments, frequent change in activities difficulty persisting even when child wants to Hyperactivity-Impulsivity hyperactivity and impulsivity may be thought of as a single dimension and/or as part of a more fundamental deficit in behavioral inhibition hyperactive-impulsive behavior is excessively energetic, intense, inappropriate, and not goal-directed hyperactivity-impulsivity is a specific marker for (inattention is not) Hyperactivity-Impulsivity impulsive behaviors include: difficulty stopping on-going behavior inability to resist immediate gratification responding too quickly interrupting others

3 Hyperactivity-Impulsivity hyperactive behaviors include: fidgeting, difficulty staying seated when required moving, running, climbing about excessive talking appearing as if driven by a motor Additional Diagnostic Criteria Excessive, long-term, and persistent behaviors (at least 6 months) Behaviors appear prior to age 7 Age-inappropriate Behaviors occur in several settings Behaviors cause impairments in at least 2 areas Behaviors not due to another disorder Module 7, Segment 2 (Slides 15-25) Subtypes Associated Characteristics Prevalence Developmental Course DSM-IV Subtypes Predominantly Inattentive Type (-PI) less common, frequently co-morbid with learning disorders, slow processing speed, difficulties with info retrieval, and symptoms of anxiety DSM-IV Subtypes Predominantly Hyperactive-Impulsive Type (-HI) and Combined Type (-C) associated with aggressiveness, defiance, opposition, peer rejection, and placement in special education classes Limitations of DSM Criteria Developmentally Insensitive Categorical view of Requirement of an onset before age 7 uncertain Requirement of persistence for 6 months may be too brief for young children

4 Associated Characteristics Cognitive Deficits deficits in executive functions difficulties in applying intelligence (although usually have normal intelligence) academic delays learning disorders, especially in reading and math Associated Characteristics Speech and Language Impairments Medical and Physical Characteristics sleep disturbances common associated with accident-proneness and risky behaviors Associated Characteristics Interpersonal Difficulties family problems, including negative interactions, child noncompliance, high parental control, maternal depression, paternal antisocial behavior, marital conflict problems with peers Accompanying Disorders and Symptoms Oppositional Defiant Disorder Conduct Disorder Anxiety Disorders Depression Prevalence 3% - 5% of all school age children Diagnosed more frequently in boys (3 times more likely) More prevalent among lower SES groups Found in all cultures, although rates may vary Developmental Course Hyperactivity-impulsivity appears first Onset often in preschool years, and usually by school age Deficits in attention increase as school demands increase In early school years oppositional and socially aggressive behaviors develop in 40%-70% of children

5 Developmental Course Most children still have as teens, although hyperactive-impulsive behaviors decrease Most problems continue into adulthood Prognosis poorer for children with comorbid behavioral problems Module 7, Segment 3 (Slides 26-39) Theories Causes Treatment 4 Main Theories of Motivation Deficits diminished sensitivity to rewards and punishment, resulting in deterioration of performance when rewards infrequent Deficits in Arousal Level low arousal, resulting in excessive selfstimulation (hyperactivity) in order to maintain an optimal level of arousal Theories of Deficits in Self-regulation inability to use thought and language to direct behavior, resulting in impulsivity, poor maintenance of effort, deficient modulation of arousal level, and attraction to immediate rewards Deficits in Behavioral Inhibition inability to control behavior, which is the basis for the many cognitive, language, and motor difficulties associated with Theories of Figure 5.2 A possible developmental pathway for Genetics: runs in families adoption studies suggest genetic influence accounts for nearly half of the variance in attention problem scores; twin studies suggest heritability estimates of.80 or higher the dopamine transporter gene (DAT) and the dopamine receptor gene (DRD4) appear to be implicated

6 Pregnancy, Birth, and Early Development none have been shown to be specific to - however, pregnancy and birth complications, low birth weight, malnutrition, early neurological trauma, and diseases of infancy may be related to later symptoms of maternal substance abuse associated with Neurobiological Factors believed to be largely a neurological disorder consistent support for the implication of the frontostriatal circuitry (prefrontal cortex and basal ganglia) neurotransmitters involved include dopamine, norepinephrine, epinephrine, and serotonin Diet, Allergy, and Lead (particularly sugar and food additives) no empirical support as causes of Family Influences no clear causal relationship some types of behaviors may be associated with insensitive and interfering early caregiving family conflict may shape the severity of the child s initial biological vulnerability Family Influences family problems may result from interactions with a child who is impulsive and difficult to manage family problems may be associated with the later emergence of conduct problems Treatment Medication stimulant medications most effective treatment most common ones used are dextroamphetamine and methylphenidate these medication alter activity in the frontostriatal brain region by affecting important neurotransmitters

7 Treatment Parent Management Training (PMT) provides parents with skills to help manage child s behavior, reduce parent-child conflict, and cope with difficulties of raising a child with Treatment Educational Intervention focus on managing behaviors that interfere with learning, providing classroom environment that capitalizes on child s strengths and improves academic performance Intensive Interventions combines medications, PMT, educational interventions, and additional treatments Treatment Additional Interventions family counseling, support groups, individual counseling Case Assessment Case of Timmy Complete the case assessment in the Module 7 Learning Unit. The case assessment is in the Module 7 folder. Module Assessment Complete Module 7 assessment in the course assessment section of the website. Module 7 assessment is in the Module 7 folder. Module 7 assessment must be successfully completed before moving onto Module 8.