PSY 183 ADHD Lecture Notes 2024 PDF

Introduction to Psychopathology Alan J. Fridlund, Ph.D. NOTICE: These Lecture Notes © Copyright 2014, 2020, 2023, by Alan J. Fridlund, Ph.D. All Rights Reserved. They May Be Downloaded for Private Use Only by Students Currently Registered in UCSB Psych...

Introduction to Psychopathology Alan J. Fridlund, Ph.D. NOTICE: These Lecture Notes © Copyright 2014, 2020, 2023, by Alan J. Fridlund, Ph.D. All Rights Reserved. They May Be Downloaded for Private Use Only by Students Currently Registered in UCSB Psych 183. For-Profit Reproduction in Whole or In Part Without Written Permission of the Instructor Is a Violation of U.C. Regulations and the DMCA and Is Expressly Prohibited.  Notice All Course materials (class lectures and discussions, handouts, examinations, Web materials) and the intellectual content of the Course itself are protected by United States Federal Copyright Law, and the California Civil Code. UC Policy 102.23 expressly prohibits students (and all other persons) from recording lectures or discussions and from distributing or selling lectures notes and all other course materials without the prior written permission of the Instructor (See http://policy.ucop.edu/doc/2710530/PACAOS-100). Students are permitted to make notes solely for their own private educational use. Exceptions to accommodate students with disabilities may be granted with appropriate documentation. To be clear, in this class students are forbidden from completing study guides and selling them to any person or organization. The text has been approved by UC General Counsel. You are granted permission in Psych 183 to download and retain personal copies of these slides solely for your own use. Attention Deficit Hyperactivity Disorder (ADHD)  Historical Diagnoses: Attention-Deficit Disorder (ADD) + “Childhood Hyperactivity” DSM-5-TR Attention Deficit / Hyperactivity Disorder (ADHD) Predominantly Predominantly Hyperactive- Inattentive Impulsive Presentation Presentation (“Fidgeters”) (“Dreamers”) “Combined Presentation” NOTE: DSM-5-TR Considers ADHD a “Neurodevelopmental Disorder” (along with ASD). ADHD cannot be diagnosed unless significant signs/symptoms were present before age 12.  Attention Deficit Hyperactivity Disorder (ADHD) People with the Predominantly Hyperactive-Impulsive Presentation (“Fidgeters”; need 6 or more for at least 6 months) tend to: ⚫ show frequent fidgeting and squirming. ⚫ leave seat often when seating is expected. ⚫ have difficulty sitting for normal lengths of time. ⚫ run around or climb where inappropriate (in adolescence, have persistent feelings of restlessness). ⚫ have difficulty with quiet play. ⚫ are always “on the go,” as if “driven by a motor.” ⚫ talk excessively. ⚫ blurt out answers before Q is finished. ⚫ have difficulty waiting their turn. ⚫ interrupt frequently and butt in others’ activities. ADHD – Hyperactive-Impulsive Type  Attention Deficit Hyperactivity Disorder (ADHD) People with ADHD Predominantly Inattentive Presentation (“Dreamers”; need 6 or more over at least 6 months) tend to: ⚫ show poor attention to detail, and/or make careless mistakes in schoolwork etc. ⚫ have difficulty sustaining attention to normal range of tasks and/or play activities. ⚫ fail to listen when spoken to directly. ⚫ lack follow-through on instructions, and fail to finish assignments or work duties [a lifetime of procrastination and unfinished projects]. ⚫ have difficulty organizing tasks and activities [and are easily overwhelmed by a series of tasks]. ⚫ Avoid and dislike tasks requiring sustained mental effort. ⚫ lose things necessary for tasks or activities (e.g., tools, school materials, eyeglasses). ⚫ be easily distracted. ⚫ be very forgetful in daily activities (e.g., paying bills, doing chores, keeping appointments). Note: For all ADHD, need to rule out vision and hearing impairments. Also, most ADHD Hyperactive-Impulsive people also have some attention problems like those with Inattentive ADHD.  ADHD – Prevalence + Risk Factors Facts about ADHD: ⚫ ADHD is found in every culture and socioeconomic level. ⚫ Worldwide, about 7 percent of preadolescents have ADHD (range from 1- 20%); average age of diagnosis is 7 years old. ⚫ CDC reports that ~6-11% of American children are diagnosed with ADHD, of whom ~60 % are taking meds and ~47% getting behavioral treatment. ⚫ 3:1 to 9:1 M > F ratio for Predominantly Hyperactive-Impulsive Presentation, but for Predominantly Inattentive Presentation, F > M. ⚫ Possible genetic link: concordances of 0.5 for MZ and 0.4 for DZ twins; 40- 50% of people with ADHD have at least one 1st-degree relative with ADHD. ⚫ Rates are higher in children: – who, as infants, had prenatal complications, premature births, and/or low birth weights. – whose mothers drank and/or smoked tobacco during pregnancy. – whose mothers had high levels of anxiety during weeks 12-22 of their pregnancies. – with high blood levels of lead. – who had frequent changes of residence, whose parents divorced, or had irresponsible/ antisocial fathers (cause or effect?). – who have had a Traumatic Brain Injury (TBI).  Consequences of ADHD ⚫ Poor school grades and conduct. ⚫ Comorbidities: – ~20% of students w/ADHD have a concurrent learning disability. – 10-30% of children w/ ADHD have a mood disorder, mainly Major Depression, and 25% have an Anxiety Disorder. – ~25-40% of children with ADHD, Hyperactive-Impulsive Presentation, develop Conduct Disorder, delinquency and/or drug abuse. ⚫ Teenagers with ADHD, Predominantly Hyperactive-Impulsive Presentation, are much likelier to have traffic or other accidents, lose their jobs, get pregnant, develop an STD, commit arson, or run away from home. ⚫ ~50 % of imprisoned felons and ~50% of adolescents in juvenile detention facilities have untreated ADHD. ⚫ Up to 80% of ADHD children retain symptoms through adolescence and beyond. ⚫ Only about 5% of college students w/ untreated ADHD graduate.  What Differs in the Brains of ADHD People? ⚫ People with ADHD show 3-5 year delays in the growth of neurons, both gray matter (cells) and white matter (myelinated connections), especially in the frontal lobes of the brain. ⚫ These areas are involved in attention, impulse control, and initiation and perception of movement. What Differs in the Brains of ADHD People? Major theories: ⚫ Under-activation of prefrontal areas of brain ⚫ Abnormally low dopamine activity with deformations in areas of the basal ganglia ⚫ Possible “sensory screen” which leads to less motivation by external events and less “capture” of attention ⚫ Differences in sensing passage of time: in ADHD, not noticing time passing until looking at the clock 50-90% of ADHD Individuals also have at least one of the following: ⚫ Bipolar disorder ⚫ Conduct Disorder -> Antisocial PD ⚫ Major Depression ⚫ Obsessive-Compulsive Disorder ⚫ Oppositional-Defiant Disorder ⚫ Specific Learning Disorders ⚫ Tourette’s Syndrome  ADHD Treatment: Medication ⚫ Psychostimulants: ~70-80% of ADHD children are helped by stimulant drugs (may unmask tic disorder/Tourette’s) (Note: stimulants quiet everyone); not addictive when dosed for ADHD. Insomnia, headache, nausea are frequent initial side-effects. These are all controlled drugs: – Ritalin, Concerta (methylphenidate) – Ritalin most common ADHD med – named for inventor Leandro Panizzon’s wife Rita. – Adderall (mixed amphetamine, d-amphetamine), Dexadrine (d- amphetamine). – Vyvanse (lis-d-amphetamine); Abuse-Deterrent Formulation (ADF) - metabolized only in GI tract to reduce street commerce and snorting/injecting. ⚫ Sustained use of stimulant drugs leaves children shorter at high doses (premature closure of bone growth plates), but this is alleviated with summer and other “drug holidays.” ⚫ Use of prescribed stimulants lowers the rate of substance abuse in ADHD. ⚫ Non-stimulant alternative medications e.g., Wellbutrin, Straterra, Provigil are generally less effective. ⚫ Sometimes, anxiety and hypomania can mimic ADHD. For these conditions, SSRI’s for the anxiety, and mood stabilizers for the hypomania, can be quite helpful. Psychostimulants in the Classroom and Home ADHD Management  ADHD Treatments: Non-Medication Management ⚫ Structuring school and home environments: – Consistent daily scheduling – Breaking tasks into small chunks – Clear immediate rewards and punishments for target behavior – Best punishment is time out or withdrawal of privileges; spanking is ineffective and disruptive – Minimizing of distractions ⚫ For older people with ADHD, relaxation strategies: mindfulness, yoga, muscle relaxation exercises, etc.  Is ADHD Overdiagnosed? ⚫ Sales of Ritalin (used in 80-90% of ADHD cases) have increased 700% since 1991. ⚫ Ritalin’s manufacturer has contributed nearly $1 million to ADHD support groups since 1991. ⚫ Americans consume 90% of all the psychostimulants in the world; more than 1 out of every 30 Americans between 5 and 19 years old has a prescription for a psychostimulant. ⚫ On average, 6% of U.S. students are on psychostimulants, and in some states (Kentucky, Louisiana, Arkansas, Indiana) rates are 9- 10%; Alaska, California and Hawaii are lowest at ~3.5%. ⚫ Yet several studies suggest that ADHD is not over-diagnosed. Is There a Psychostimulant Epidemic? U.S. Amphetamine Use By Year (Most recent compilation)  Are Psychostimulants Dangerous? ⚫ Nonprescribed Ritalin used illicitly at least once by 8% of high-schoolers, and regularly by >5% of college students, who typically share their prescribed meds with others at $10-15 per pill. Students say it helps them concentrate and stay up late studying. ⚫ BUT … experiments testing whether psychostimulants aid learning and memory have yielded mixed results. Most likely, underperformers are helped, but good performers are not helped and may even be impaired. ⚫ Surveys suggest that psychostimulants are 2nd-most used “illicit” substance in college, next to marijuana. ⚫ Long-term higher-than-normal dosing can create psychosis and paranoia. ⚫ Some students use psychostimulants so they can consume more alcohol, or mix them with drugs to prolong partying; this is also potentially lethal. ⚫ Prevalences of abuse and dependence are difficult to determine, but may approach 10-15% of users, and are most frequently associated with recreational use of ground-up pills to get “high” or “buzzed” via intranasal snorting or intravenous injection. This is potentially lethal, and potential harm is reduced by use of Vyvanse (an Abuse-Deterrent Formulation) in high-risk patients. ⚫ BUT: Under prescribed regular dosing, for individuals in good health, psychostimulants for ADHD appear overwhelmingly safe and effective.  Unproven ADHD Treatments ⚫ EEG Biofeedback ⚫ Elimination diets (sugar, food dyes and additives) ⚫ Nutritional supplements  Adult ADHD ⚫ Prevalence is about 4 % of the U.S. adult population. ⚫ Up to 70% of ADHD children retain some symptoms through adulthood, and ~20% retain the full disorder. ⚫ By adulthood, the Male : Female ratio in ADHD approaches 1:1, possible due to a combination of: – Maturation of the Hyperactive-Impulsive ADHD males into a Predominantly Inattentive or Combined Presentation. – Increasing diagnosis of Predominantly Inattentive ADHD females.  Frequent Manifestations of Adult ADHD Adults with ADHD tend to: ⚫ prefer highly stimulating situations; seek noisy, busy places in order to get work done. ⚫ frequently change TV/radio stations, or listen to only parts of songs. ⚫ have difficulty waiting in lines. ⚫ tune out in conversation and at intimate moments. ⚫ blurt and find it difficult to withhold unwelcome remarks. ⚫ often show: – special Intuitiveness – novel “out-of-the-box” approaches to problems  IS ADHD a Gift? Probable ADHD’ers Include: ⚫ Ansel Adams ⚫ Ryan Gosling ⚫ Ludwig van Beethoven ⚫ Will Smith ⚫ Winston Churchill ⚫ Jim Carrey ⚫ Albert Einstein ⚫ Simone Biles ⚫ Benjamin Franklin ⚫ Michael Jordan ⚫ John F. Kennedy ⚫ John Lennon ⚫ Michelle Rodriguez ⚫ Jules Verne ⚫ Adam Levine ⚫ Walt Disney ⚫ Emma Watson ⚫ Mozart ⚫ Justin Timberlake ⚫ Thomas Edison ⚫ Richard Branson ⚫ Leonardo da Vinci Perhaps ADHD leads some people to be “out-of-the-box,” unconventional thinkers and creators. End