I need someone to take my weekly short online quiz
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ADHD PART 2
Correlates and Causes
Executive Functions: higher-order mental processes that underlie a child’s capacity to regulate thought, emotion, and behavior
Cognitive: working memory, planning, organization
Motor: response inhibition, response speed
Emotion: self-regulation of emotional arousal
Executive Function Deficits
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Examples of Impaired Executive Functions in ADHD
Intellectual and Academic Deficits
Most children with ADHD have at least normal intelligence Score 5-9 points lower on IQ tests
Difficulty lies in applying intelligence to tests and to everyday life situations
Impaired academic functioning
Children with ADHD frequently have lower productivity, grades, and scores on achievement tests
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Learning disorders are common for children with ADHD Problem areas: reading, spelling,
and math
Distorted self-perceptions Self-esteem in children with ADHD
may vary with the subtype of ADHD ADHD-I: Low self-esteem
ADHD-HI: Positive bias (exaggeration of one’s competence)
Cognitive Deficits: Learning Disorders and Self-Perceptions
30-60% have speech or language problems
Impairments in pragmatic language skills Difficulty understanding others’
speech
Excessive and loud talking
Frequent shifts and interruptions in conversation
Tangential stories
Speech and Language Impairments
Teacher: “How old was the boy?” Child: “Grade one…seven and…so she..um.. we went on it and he was… he got pushed a little bit on the swing you know and then…pow…down he falls and then we called his brother over…he was really really rough and…he was really light too and um he went on the swing and…and my friend you know she put it in again and we said come on and I don’t know I …forget the boy’s name…but we…told him to come over and sit on the swing and…so he came over and sat on the swing…”
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30-50% of children with ADHD display motor coordination difficulties Clumsiness, poor performance in sports,
or poor handwriting
Tic disorders occur in 20% of children with ADHD
Sudden, repetitive, non-rhythmic motor movements or sounds such as eye blinking, facial grimacing, throat clearing, and grunting
Developmental Coordination and Tic Disorders
Physical health problems Asthma, bedwetting, dental issues,
obesity, eating problems
Sleep problems High-rates of disordered sleep
Sleep apnea and sleep reduction kids mimics ADHD
Stimulants can interfere with sleep
Reduced life expectancy/higher medical costs Accident prone
Cigarette smoking, substance use disorders, traffic accidents, risky sexual behaviors
Health Issues
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Family problems include: Negativity (parent and child)
Sibling conflict
Maternal depression
Paternal antisocial behavior
Marital conflict
Transactional influence
Many family problems may be driven by co-occurring conduct problems
Social Problems: Family
Social Problems: Peers
Often unable to apply their social understanding in social situations Can be bothersome, stubborn, socially awkward, and socially
insensitive; can have trouble following rules while playing games
Often disliked and rejected by peers or have few friends
Maintaining friends difficult
Type Differences ADHD-PI: experience peer neglect
ADD-HI: experience peer rejection
Positive friendships may buffer negative outcomes
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Up to 80% have a co-occurring psychological disorder
Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)
About 50% (mostly boys) also meet criteria for ODD
About 30% eventually develop conduct disorder (CD)
Hyperactivity increases the odds of developing ODD/CD 10-fold
Anxiety (about 25% of children with ADHD)
Social and academic impairment
Depression
20-30% of children with ADHD experience depression
Being diagnosed with ADHD between ages 4 to 6 is a risk factor for future depression and suicidal behavior
Comorbid Psychopathology
What Causes ADHD?
We know what doesn't cause ADHD Sugar, food additives
Allergies
Exposure to lead
Bad parenting
What does cause ADHD? …. Different causal factors might exist for different ADHD
presentations
Different causal factors might interact with each other
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ADHD runs in families across generations
Adoption studies: ADHD rates 3 times higher in biological than adoptive parents of kids with ADHD
Twin studies: 75% heritability estimates for hyperactive-impulsive and inattentive behaviors
65% concordance rates for identical twins (vs. < 34% for fraternal twins)
Specific genes implicated
Dopamine transporter gene (DAT1)
Dopamine receptor gene (DRD4) But only in the case of environmental risk
(i.e. maternal smoking)
Genetic Influences on ADHD
Factors that compromise development of the nervous system before/after birth related to later development of ADHD Pregnancy and birth complications
Low birth weight
Malnutrition
Early neurological insult or trauma
Maternal substance use
Maternal smoking (especially in combination with genetic risk)
Pregnancy, Birth, and Early Development
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Many children with ADHD show Executive Functioning (EF) deficits Particularly in processes involved in regulating
one’s attention, behavior and emotions
Could be related to alterations in PFC Children with ADHD have smaller total and right
cerebral cortex volumes (by 3-4%)
But not everyone with ADHD has EF deficits
Promising Theory 1: Executive Functioning Deficits
Promising Theory 2: Reward/Motivation Deficits
Perform similarly to other children when continuous reward
Difficulty motivating themselves and performing well when rewards are unavailable or delayed
Related to abnormalities in the frontostriatal circuitry of the brain
Includes prefrontal cortex and basal ganglia
Areas rich in dopamine receptors
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EEG shows under-activation of PFC in cognitive tasks
fMRI studies of reward: Increased striatal response
Decreased activation of prefrontal regions and pathways connecting them to striatum in reward tasks
How could this translate to behavioral need for higher reward?
Frontostriatal Circuitry and ADHD: Functional Abnormalities
green= cortex more active
Promising Theory 3: Arousal Level Deficits
Diminished arousal on psychophysiology tests Lower galvanic skin response
Decreased heart-rate
But not reliable enough for diagnosis
Hyperactivity–impulsivity may reflect an effort to maintain an optimal level of arousal by excessive self-stimulation
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Importance of family influences
Family influences may exacerbate ADHD symptoms or lead to a greater severity of symptoms
Parents may have ADHD themselves
Family conflict is likely related to the presence, persistence, or later emergence of associated oppositional and conduct disorder
Family Influences
Where do we go from here?