1. Chapter 9 Attention-Deficit/Hyperactivity Disorder

2. Defining Attention-Deficit/Hyperactivity Disorder (DSM-IV-TR) Criterion A: persistent pattern of inattention and/or hyperactivity-impulsivity Criterion B: Some interactive-impulsive or inattentive symptoms that cause impairment present before 7 years Criterion C: Some impairment from symptoms present in at least two settings Criterion D: Clear evidence of interference with developmentally appropriate function gin Criterion E: Disturbance does not occur exclusively during course of pervasive developmental disorder

3. Three major characteristics Inattention – central characteristic Impulsivity – poor self-control, excitability, inability to delay gratification Overactivity – interpretation of activity levels difficult due to lack of norms –Differentiates from children with ADD (attention deficit disorder)

4. Possible Causes Organic Brain Damage – long associated with overactivity and poor impulse control Many with ADHD show abnormalities in: –Frontal lobes –Basal ganglia –cerebellum

5. Neurotransmitter imbalance –Defective inhibitory system. Use of stimulant medication aimed at restoring balance between inhibitory and excitatory systems –More research needed in this area

6. Genetic Factors Genetic studies (Studying parents, studying twins) indicate that heredity does play a role –Exact role is difficult to determine

7. Environmental Factors Increasing exposure to harmful stresses in environment (pollution, toxins, additives in foods) implicated in higher rates of ADHD –Prenatal exposure to alcohol, nicotine is a heavy predictor –Exposure to toxins in childhood (lead paint) –Food additives have received attention in past but empirical evidence doesn’t reveal a link

8. Multiple Causes Increasing evidence that biological and genetic causes are key Environmental causes interrupt important neurological processes

9. Treatment: Medical Approaches Stimulant Medication –Most controversial current treatment –Results in behavioral improvement in 80% of cases –Stimulant arouses frontal lobe of brain (regulatory influences) and improves impulse control

10. –Medication reduces activity, but does not automatically increase academic performance in long-term –Issues of side effects from from resolved Insomnia Rebound irritability Decreased appetite Headaches

11. Behavior Management Targeted behavior techniques seem effective but don’t guarantee academic improvement Techniques include 1)Positive reinforcement for on-task behavior 2)Response cost for inappropriate behavior 3)Cognitive-behavioral modification emphasizing self-control and self- reinforcement

12. Parents key in any behavior management –Most effective when parents receive specific management training Multimodal (behavior management and and medication) intervention tend to be more effective