1.6 Problem 6 Summary

1.6 Problem 6
Young, Fast and Wild
Attention Deficit Hyperactivity Disorder
ADHD- Persistent pattern of inattention and/or hyperactivity-impulsivity that’s at a
significantly higher rate than would be expect for the child at that developmental stage
 Manifest behaviourally in many ways
 Child sufferers typically have strong dislike for tasks requiring self-application and
mental effort, and easily distracted by irrelevant stimuli
Hyperactivity- high than normal level of activity
 Manifest with excessive fidgetiness, running/climbing when inappropriate,
excessive talking
 Appear constantly “on the go”
Impulsivity- act of reacting to a situation without considering the consequences
 Manifest as impatience, difficultly appropriately delaying responses, constantly
interrupting others
 Sometimes desire for immediate rewards
 May result in accidents and indulging in dangerous activities

ADHD Diagnosis
- Must ensure hyperactivity/inattention significantly greater, and that it’s
generalised/persistent predisposition not confined to single context
DSM-5 for ADHD
 Ongoing pattern of inattention and/or hyperactivity and impulsivity that interferes with normal
functioning or development, with the following
o Inattention: min. 6 of following, for min. 6 months
 Paying little attention to details/making careless mistakes
 Difficulty maintaining attention in activities
 Doesn’t listen when spoken to directly
 Ignores instructions
 Difficulty organising
 Dislikes/avoids tasks requiring sustained mental effort
 Loses things needed for tasks
 Easily distractible
 Forgetful in daily activities
o Hyperactivity and impulsivity: min 6 of following, for min. 6 months
 high level of fidgeting
 not sitting still/leaving seat when expected to sit
 runs/climbs in situations where inappropriate
 unable to engage in activities quietly
 excessive talking
 blurts out answer before question finished
 difficulty awaiting turn
 interrupts/intrudes on others frequently
 Symptoms present before age 12
 Symptoms present in at least 2 setting
 Symptoms reduce quality of educational, social, or occupational ability
 Symptoms don’t occur during schizophrenia or other psychotic disorder and are not better explained
by another mental disorder
 most individuals present both inattention and hyperactivity, but one often more
dominant
 3 subtypes to be used if 6+ of dominant symptoms present with less than 6 of
less dominant symptoms present
1. Attention deficit hyperactivity disorder, predominantly inattentive
presentation
2. Attention deficit hyperactivity disorder, predominantly
hyperactive/impulsive presentation
3. Combined presentation
 Approx. 50% also diagnosed with oppositional defiant

,  If diagnosed with both, will exhibit worst of both disorders

Can define children with ADHD but not oppositional defiant disorder as:
1. More aggressive
2. Live in families with lower socioeconomic status
3. Parents exhibiting antisocial behaviour

 Some ADHD leads to earlier onset of conduct disorder
 ¼ of children with combined presentation diagnosed with conduct disorder
o Perhaps as become involved in symptom escalation: behaviour causes
aggressive reactions, evoking aggressive/antisocial reactions in sufferer

Recognition/Symptom Display
 Usually parents when child’s a toddler, just as school begins
 Learning/adjustment at school very affected by disorder
 Not all hyperactive toddlers go on to develop ADHD
 Development into adolescence, symptoms lessen
 Approx. 50% of cases develop into adulthood- affects intellectual functioning and
IQ

Comorbidity
 Anxiety and depressive disorders with ADHD

Prevalence
 Approx. 5% of school-age children internationally
 2.5% of adults internationally
 More common in boys than girls in childhood, not in adulthood
o Perhaps likelier to be referred for treatment
o Identification of girls been hampered by teacher/parent bias

Consequences
- Prone to temper outburst, frustration, bossiness, stubbornness, changeable
moods, poor self-esteem
o Academic achievement impaired causing conflict with teachers/family
- Family members frequently view outburst as intentional/irresponsible because of
the disruption caused
o Resentment within family
- Predominant inattentive symptoms= most academic achievement impairment
- Predominant hyperactivity/impulsivity= more peer rejection/accidental injury
- Aggressive/disruptive behaviour, struggle understanding peers’
intentions/responding correctly
o Difficulty making friends/integrating into social groups
- Adulthood
o Less success/safety at work
o Poorer interpersonal relationships
o Poorer academic outcomes
o Poorer general life satisfaction

Aetiology
Biological
 Genetic factors
o One of most heritable psychiatric disorders
 Proven in twin studies- 76% heritability
 Proven in adoption studies
o Perhaps linked to chromosome 16?
 May cause abnormalities in dopamine, norepinephrine and
serotonin symptoms
X- individual gene variant for ADHD must have small individual
effect