Introduction to Psychopathology: ADHD

Introduction to Psychopathology

• Text copyright 2014, 2020, 2023 by Alan J. Fridlund, Ph.D.
• All rights reserved
• Content may be downloaded for personal use by UCSB Psych 183 students.
• Commercial reproduction prohibited without permission.
• Violates U.C. regulations and DMCA.

Notice (Page 2)

• All course materials (lectures, discussions, handouts, exams, web materials) are protected by U.S. federal copyright law and California civil code.
• Recording lectures or distributing/selling course materials without permission is prohibited.
• Students may take notes for personal educational use.
• Exceptions for accommodations for disabilities may be granted with appropriate documentation.
• Completing and selling study guides is forbidden.
• Text approved by UC General Counsel.
• Personal copies of slides are permitted for personal use in Psych 183.

Attention Deficit Hyperactivity Disorder (ADHD)

• Historical diagnoses included attention-deficit disorder (ADD) and childhood hyperactivity.
• DSM-5-TR classifies ADHD as a neurodevelopmental disorder.
• ADHD diagnosis requires symptoms present before age 12.
• Predominantly Hyperactive-Impulsive Presentation (Fidgeters)
• Predominantly Inattentive Presentation (Dreamers)
• Combined Presentation

ADHD - Predominantly Hyperactive-Impulsive Presentation

• Frequent fidgeting and squirming
• Leaving seats inappropriately
• Difficulty sitting still
• Running or climbing excessively
• Difficulty with quiet activities
• Constant "on the go" feeling
• Excessive talking
• Blurt out answers before questions are complete
• Difficulty waiting turns
• Interrupting others

ADHD - Prevalence + Risk Factors

• ADHD found across all cultures and socioeconomic backgrounds
• Worldwide prevalence of ADHD is approximately 7% in preadolescents (range 1–20%)
• Average age of diagnosis is 7 years old.
• CDC reports ~6-11% of American children are diagnosed.
• Diagnosis ratio of Male:Female is 3:1 to 9:1 predominantly hyperactive-impulsive presentation and for predominantly inattentive presentation it is F > M
• Possible genetic link (0.5 MZ and 0.4 DZ twins)
• Higher rates in children with:
  • prenatal complications, premature birth, low birth weight
  • Mothers who drank and/or smoked during pregnancy
  • High anxiety during pregnancy weeks 12-22
  • High blood lead levels
  • Frequent residential changes, divorced or irresponsible parents
  • Traumatic Brain Injury (TBI)

Consequences of ADHD

• Poor school grades and conduct
• Comorbidities (co-occurring conditions):

  • Learning disabilities in ~20% of students with ADHD

  • Mood disorders (e.g., major depression) in 10-30% of children with ADHD.

  • Anxiety disorders in 25% of children with ADHD.

  • Conduct disorder, delinquency, and/or drug abuse in 25–40% of children with ADHD (predominantly hyperactive-impulsive presentation).

  • Teenagers with ADHD (hyperactive-impulsive presentation) are more likely to have accidents, lose jobs, become pregnant, develop STDs, commit arson, or run away from home (~50% of imprisoned felons have untreated ADHD).

  • Up to 80% of ADHD children retain symptoms into adulthood

  • Only about 5% of college students with untreated ADHD graduate.

What Differs in the Brains of ADHD People

• People with ADHD show 3-5 year delays in brain growth, particularly in the frontal lobes.
• These areas are involved in attention, impulse control, and movement initiation/perception.

Major Theories About ADHD Brain Differences

• Under-activation of prefrontal areas of the brain.
• Abnormally low dopamine activity with deformations in basal ganglia areas.
• Possible "sensory screen."
• Differences in sensing the passage of time.

Bipolar Disorder, Conduct Disorder and other Comorbid Conditions with ADHD

• 50-90% of adults with ADHD also have at least one other mental health condition.

• Conditions like conduct or oppositional-defiant disorders.

• Mood disorders or depressive conditions

• Obsessive-compulsive disorder.

• Specific learning disorders

• Tourette’s syndrome.

ADHD Treatment: Medication

• Psychostimulants (e.g., Ritalin, Concerta, Adderall, Vyvanse) for 70-80% effectiveness.
• Stimulants may unmask tic disorders (e.g., Tourette's syndrome). Initial side effects: insomnia, headaches and Nausea
• Sustained use of stimulants can result in shorter stature at high doses but alleviated with drug breaks.
• Stimulant use can lower the rate of substance abuse in ADHD.
• Non-stimulant alternatives (e.g., Wellbutrin, Strattera, Provigil) typically less effective. Medication used cautiously in patients with risks of anxiety or hypomania.

Psychostimulants in the Classroom and Home ADHD Management

• School and home environment structure and routines.
• Consistent daily schedules
• Tasks broken into smaller chunks
• Clear rewards, punishments such as time-outs, and withdrawal of privileges.
• Reduction of distractions.
• Relaxation strategies including mindfulness, yoga, and muscle relaxation.

Is ADHD Overdiagnosed

• Ritalin sales have increased 700% since 1991
• Some manufacturers have contributed millions to ADHD support groups.
• More than one out of every 30 Americans aged 5–19 have a psychostimulant prescription.
• Prevalence differs significantly between states.
• Evidence suggests ADHD is not over-diagnosed.

Is There a Psychostimulant Epidemic

• Graph shows a significant increase in US amphetamine and methylphenidate use over time.

Are Psychostimulants Dangerous

• Non-prescribed Ritalin use is common among high school and college students.
• May be shared among students at high costs.
• BUT, experiments have mixed results regarding whether psychostimulants improve memory and learning.
• Can heighten psychosis and paranoia with long-term, high doses.
• Some use stimulants to consume more alcohol, a risky practice.
• Potential for abuse or dependence ranges from 10–15%.
• Intranasal snorting or intravenous injection is potentially lethal.
• Prescribed use in good health is generally safe and effective.

Unproven ADHD Treatments

• EEG biofeedback
• Elimination diets (sugar, food dyes)
• Nutritional supplements

Adult ADHD

• Prevalence is about 4% of the U.S. adult population.
• Up to 70% of children with ADHD retain some symptoms into adulthood (~20% retain full disorder).
• Adult ADHD ratio approaches 1:1 (male to female). This likely due to maturation of hyperactive-impulsive ADHD in males.
• Increasing diagnosis in females.

Frequent Manifestations of Adult ADHD

• Preference for highly stimulating environments

• Frequent changes in television/radio stations.

• Difficulty in lines and waiting periods.

• Tendency to tune out in conversations or intimate moments.

• Difficulty with controlling remarks ("blurt" out).

• Frequent display of "intuitive" and "novel" problem-solving approaches.

Is ADHD a Gift? Probable ADHD'ers

• List of famous individuals associated with ADHD characteristics

• A proposition that ADHD can lead individuals to be unconventional thinkers and creators due to their traits.

Explore the psychological concepts surrounding Attention Deficit Hyperactivity Disorder (ADHD) in this introductory quiz based on the coursework of Psych 183. Understand historical diagnoses and crucial aspects of psychopathology related to ADHD. Perfect for students diving into the complexities of mental health.