ADHD Developmental Stages

Development of ADHD Symptoms

• In preschool age, activities are brief (10 minutes) and hyperactive symptoms are present.
• In school-age years, persistence in tasks is less than 20-30 minutes, and details are often forgotten.
• In college years, forgetting appointments and assignments, and having less patience for long-term projects are common.

Hyperactivity

• In preschool age, children cannot be settled.
• In school years, restlessness is prominent.
• In adolescence, fidgeting and squirming are common.
• In college years, feelings of restlessness are reported.

Impulsivity

• In preschool age, children show no sense of danger and do not listen to warnings.
• In school years, blurring out answers, interrupting others, and having accidents are common.
• In adolescence, speaking before thinking, and having no planning ahead are typical.
• In college years, acting before thinking, making quick decisions, and reckless driving are common.

Sluggish Cognitive Tempo

• Characterized by few or no symptoms of hyperactivity-impulsivity, but predominantly inattentive.
• In school years, children may appear drowsy, confused, spacey, and disoriented, and have problems making friends.
• They may take a long time to respond and have trouble engaging in classroom activities.
• Traditional ADHD medications may be less effective for this type.
• Also referred to as "Concentration Deficit Disorder" to avoid negative terminology.

Sleep Problems

• Dysomnias: refusing to fall asleep, problems falling asleep, and waking up in the morning.
• Movement disorders: sleep talking, grinding teeth, and excessive tossing and turning.
• Parasomnia: night wakings, recurrent nightmares, or terrors.
• Reduced sleep can increase problems with attention, hyperactivity, and impulsivity.
• The earlier sleep symptoms are addressed, the better the prognosis.

Prevalence

• Hyperactive symptoms are present at 3-4 years old.
• Inattention increases at 5-8 years old, leading to a diagnosis of combined presentation.
• Inattention is prominent at 9-12 years old, with a disproportionate number of girls being diagnosed later as predominantly inattentive.
• Attention and concentration problems in adolescence are linked to substance use and car accidents.
• ⅔ of adults continue to have inattention and restlessness.

Gender Ratio

• Clinically, the ratio is 10:1 (boys:girls), but in community samples, it's 3:1.
• The large gap is likely due to referral bias, as boys are more likely to have conduct and externalizing symptoms.

Academic Problems

• Lower achievement scores, more school problems, memory problems, and cognitive processing problems.
• Cognitive problems can cause children to miss information presented to them.
• Problems with working memory interfere with the ability to perform multi-step academic tasks.

Parent-Child Interactions

• Parents of children with ADHD are more hostile, less sensitive, and less responsive.
• Children with ADHD are more negative and more defiant.
• Negative interactions can lead to ODD and conduct disorder later.

Peer Rejection or Neglect

• Peer rejection can lead to negative reputations, which can worsen ADHD symptoms.
• Kids with ADHD often develop negative relationships, which can affect their social and emotional wellbeing.

Executive Function

• Focuses on controlling behavior rather than having behavior controlled by stimuli.
• Four basic functions: working memory, internalized speech, emotional regulation, and creative problem-solving.

Conduct Disorder, Intermittent Explosive Disorder, and ODD

• ODD: angry, irritable mood, argumentative or defiant behavior, and vindictiveness toward others.
• Conduct Disorder: a developmental pathway where kids show conduct problems before age 10, leading to a risk of ASPD in adulthood.

Social Information Processing Model

• An approach to perceiving, interpreting, and solving social dilemmas or disputes.
• Six steps: encoding cues, interpreting cues, clarifying goals, and responding.

Coercive Family Process

• Parents negatively reinforce noncompliance when children throw tantrums, while children reinforce parents backing down.

Hostile Parenting Behavior

• Harsh disciplinary techniques, verbal and physical abuse, and low parental monitoring.

Treatment for Conduct Problems

• Parent-Management Training (PMT): a behavioral intervention focusing on reducing coercive parent-child interactions and promoting positive reinforcement.