PSYCHOPATHOLOGY OF CHILDREN AND FAMILY

PSYCHOPATHOLOGY OF CHILDREN AND FAMILY WEEK 13 ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

Seven-year-old john’s mother is desperate for help. “he walked at 10 months and has kept me running ever since. As a child he was always bouncing around the house and crashing into things. He is inconstant motion, impulsive and never listens. When I ask him to put his shirt in the hamper, I find him playing with the shirt still on the floor. John has no routines and seldom sleeps. Discipline doesn’t work, nor do the techniques that work for my other boys. He’s obviously to his behavior. He could have a forbidden piece of cake in his hand and deny ever taking. He never finishes anything, and except for sitting down to play a video game, rarely watches television except on the run.”

John’s teacher says his main problems in school are staying on task and keeping track of what’s happening. “He blurts things out in class and is constantly fidgeting or out of his chair,” she says. Although John can complete his assignments, he forget to brings to bring home the book he needs to do his homework. When he does complete his homework, he forgets to put in his backpack or to hand it in. John has great difficulty waiting his turn or following rules with other children. Other kids think he’s “weird” and don’t want to play with him.

Introduction • Attention deficit hyperactivity disorder (ADHD) describes children who display persistent age-inappropriate symptoms of inattention and hyperativity-impulsivity. • ADHD can only be identified by characteristic patterns of behavior, which vary quite a bit from child to child. • The behavior of children with ADHD is a constant sources of stress and frustration for the child and parents, siblings, teachers and classmates.

Diagnostic Criteria for ADHD A. Either 1 or 2 1) Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Inattention a) Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities b) Often has difficulty sustaining attention in tasks or play activities c) Often does not seem to listen when spoken to directly d) Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) e) Often has difficulty organizing tasks and activities f) Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) g) Often loses things necessary for tasks or activities (eg, toys, school assignments, pencils, books, or tools) h) Is often easily distracted by extraneous stimuli i) Is often forgetful in daily activities

2) Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Hyperactivity a) Often fidgets with hands or feet or squirms in seat b) Often leaves seat in classroom or in other situations in which remaining seated is expected c) Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) d) Often has difficulty playing or engaging in leisure activities quietly e) Is often "on the go" or often acts as if "driven by a motor" f) Often talks excessively Impulsivity g) Often blurts out answers before questions have been completed h) Often has difficulty awaiting turn i) Often interrupts or intrudes on others (eg, butts into conversations or games)

Different types of inattention • Attentional capacity - is the amount of information we can remember and attend for a short time • Selective Attention - is the ability to concentrate on relevant stimuli and not to be distracted by “noise” in the environment. • Sustained Attention - is the ability to maintain a persistent focus over time or when fatigued.

Different forms impulsivity • Cognitive impulsivity - disorganization, hurried thinking and the need for supervision • Behavioral Impulsivity - calling out in class or acting without considering the consequences.

Additional Criteria • Not every child who displays inattentive, hyperactive or impulsive behavior has ADHD. In order to diagnose ADHD, these additional questions must be asked: - Do the behaviors appear before age 7? - Do they occur more often and with greater severity than in other children of the same age and gender? - Are they a persistent problem (for at least 6 month)? - Do they occur across several settings and not only in one location? - Do they produce significant impairments in the child’s social or academic performance?

Subtypes of ADHD • Predominantly Inattentive Type (ADHD-PI) • Predominantly Hyperactive-Impulsive Type (ADHD)-HI) • Combined type (ADHD-C)

Attention-Deficit/Hyperactivity Disorder, Combined Type: if both criteria A1 and A2 are met for the past 6 months • Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type: if criterion A1 is met but criterion A2 is not met for the past 6 months • Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive, Impulsive Type: if criterion A2 is met but criterion A1 is not met for the past 6 months

Associated Characteristics • Besides their primary difficulties, children with ADHD display other problems such as cognitive deficits, speech and language impairments, interpersonal difficulties and task and situational factors. • Children with ADHD display deficits in executive functions, the higher order mental processes that underlie, the child’s capacity for self regulation. • Most children with ADHD are of normal intelligence. Their difficulty is in applying their intelligence to certain everyday life situation.

Children with ADHD experience school performance difficulties including lower grade, and more frequent placement in special education class. • Many children with ADHD have a specific learning disorder, typically in reading or math. • They often have language and speech impairment, and also have difficulty using language in everyday situations. • They may experience health related problems, especially sleep disturbances, and are accident-prone. • They experience numerous interpersonal problems with family members, teachers and peers

Causes • Genetic influences • Pregnancy, Birth and Early development • Neurobiological Factors • Diet, Allergy, and Lead • Family Influences

Treatment for ADHD • Stimulant Medication • Parent Management Training • Educational Intervention • Family Counseling • Support Groups • Social Skill Training • Cognitive Behavioral Self Control Training • Individual Counseling

PSYCHOPATHOLOGY OF CHILDREN AND FAMILY