Class Notes 1/29/18: ADHD

I. Diagnostic Criteria
A. Inattention
1. Misses details, careless mistakes
2. Poor sustained attention
3. Poor listening
4. Poor follow through
5. Avoids sustained mental effort
6. Loses important things
7. Distractible
8. Forgetful
9. ** usually worse in boring or repetitive situations
B. Hyperactivity
1. Fidgets or squirms
2. Leaves seat inappropriately
3. runs/climbs inappropriately
4. Difficulty playing quietly
5. Often “on the go”
6. Talks incessantly
7. **appear worse in structured situations
C. Impulsivity
1. Blurts out answers before questions completed
2. Difficulty awaiting turn
3. interrupts/intrudes on others
4. **difficulty delaying gratification
II. Subtypes
A. Predominantly Inattentive (PI)
1. Meet criteria for inattention symptoms
2. Can have hyperactive symptoms or may not
B. Predominantly Hyperactive-impulsive (HI)
C. Combined type
D. Depends on number of criteria met for each of the 3 clusters
III. Other Criteria:
A. Symptoms by age 12 (used to be age 6)
B. Symptoms and impairment in 2 or more settings
C. Social, academic, or occupational impairment
IV. Process of Diagnosis
A. Based on the history of the disorder
B. Methods used: (pediatrician)
1. Rating scales (parent and teacher)
2. Interviews (what is developmentally appropriate)
C. No medical test or lab measure to diagnose ADHD
V. Prevalence
 A. 5% of children and 2.5% of adults
B. Much more common in boys than in girls
1. 4:1 - 2:1 (sometimes higher)
2. Many more boys than girls
C. Boys more likely to have aggression and defiance
D. Girls more likely to be inattentive
VI. Etiology
A. Of children with ADHD, ⅓ of them have a biological relative with ADHD
B. Rates 3x higher in biological parents vs. adoptive parents
C. Twin studies support genetic transmission
1. About 75% variance
2. Identical twin concordance about 65%
3. Among most heritable of child problems
D. Vulnerability can interact with the environment
VII. Prognosis
A. ⅓ → tolerable outcomes
1. Have only mild problems, but still must work hard
B. ⅓ → moderately poor outcome
1. Will continue to have moderate - serious problems such as school or work
problems, underachievement, interpersonal problems
C. ⅓ → bad outcome
1. Severe psychopathology, criminal activity and incarceration,
alcoholism/substance abuse
D. Based on how severe their problems are initially
1. Children who can participate relatively well with some symptom treatment
and have a good environment can end up doing pretty well
2. Bad outcome → more severe problems at the beginning,
learning difficulties, difficulties with getting in trouble,
graduating etc.
VIII. Associated Features:
A. Learning problems
1. 25% of children with ADHD have a significant delay in one or more areas
relative to IQ (have a learning disorder)
B. Peer problems
1. Impaired peer relations
2. Association with deviant peers
C. Aggression/noncompliance
1. Up to 50% of children with ADHD have significant conduct problems