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ADHD

- Psychosocial consequences;
o Teenage pregnancy
o Car accidents
o Suffer depression and personality disorders
- Works on a continuum

ADHD Medication
- Over 200 studies showed the effectiveness of stimulant medication in alleviating symptoms of
ADHD
o Works effectively in 70-80% with ADHD
- The effects of medication on ADHD confirm the role of dopamine and noradrenaline in executive
function tasks and other reward processing


Main pathways of Dopamine (DA) and Norepinephrine (NE)
- DA main neurotransmitter associated with ADHD- reward processing
o Problem with DA= problem understanding reward
o Drugs that contain dopamine or address signalling issues reduce ADHD symptoms
- Ventral tegmental area and substantia nigra only place in brain that produces DA
o These fire to the executive functions in the PFC
§ Signalling problems lead to lack of DA in these vital areas
- Under arousal is a consequence of problem with signalling
o NE produced in the Locus Coeruleus and fires to key areas in EF


ADHD as a Motivational Deficit Disorder
- Drive of source is instinct and motivation
- Lack willpower- the ability to engage in a self-disciplined course to their goals
o Need self-motivation for future directed behaviour

Effects of different drugs
- Methylphenidate; increases both DA and NE in the PFC and basal ganglia
- Atomoxetine; increases both DA and NE in PFC, Anterior cingulate cortex but not the basal ganglia
- ADHD; Motivation, reward and goal-orientated behaviour deficits
o Goal won’t be achieved as there is a goal that is associated with these neurotransmitters
that is responsible for behaviour
§ Smith, 2013; normalising effect of drugs
• Drugs been shown to reduce the differences between groups of ADHD and
control subjects
o Reduction in symptoms and neuropsych differences between control

Diagnosis and symptoms of ADHD
- Inattention and Hyperactivity
o Subtypes/presentations:

Combined
Predominantly Inattentive
Inattentive
Predominantly Hyperactive/Impulsive
Cannot be ADHD without inattention but can he hyper and impulsivity and not have ADHD
o If you don’t have symptom associated with inattention, you don’t have ADHD
Inattention:
o Not pay close attention to details or make careless mistakes
o Difficulty sustaining attention
Hyperactivity/Impulsivity
o Often fidgets with hands or feet
o Runs about or climbs in situations where it is inappropriate
Can’t always see inattention as visibly as hyperactivity

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Facts of diagnosis
- 3-5% of children have ADHD
- More commonly in boys (but could be due to expression of symptoms)
- Research predominantly conducted on boys with ADHD so less known about girls

ADHD in adults
- Still prevalent in adults
- Disorder transmogrifies into different symptoms

ADHD as an attention deficit
- Precludes you from organising across time
- Frontal lobes- puts knowledge into play (back of brain is knowledge
o ADHD separates these; don’t have knowledge deficit but how to use it
o Performance disorder in using what you know
o Have to restructure the environment
§ No point teaching skills as they are knowledge
- Problems with goal direction reflects inattention
o All research on combined type but could be two disorders
§ Need to look more closesly at inattention

Comorbidity (Taylor, 2006)
- 60% oppositional defiant disorder
- 20% conduct disorder
- 25% mood disorders
- 25% anxiety disorders
- 30% learning disorders e
...
dyslexia
o Adulthood; mood and anxiety disorders (Bierderman ,2005)
o Drug and alcohol abuse (Tannock , 1998)

Underlying causes of ADHD
- Impulsivity and hyperactivity reflect a problem with behavioural inhibition and executive function
o Not modular- they’re higher level supervisory systems
- Signalling problems with DP and NE


Neuropsychological theories of ADHD
1
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Problem with State Regulation
o Poor state regulation- problems with regulation of effort, arousal and affect
§ Underpins poor EF (Sergeant, 2005)
3
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5 of ADHD children

o Neither EF deficit or delay aversion is sufficient to account for ADHD



The Cognitive Energetic Model of ADHD (Sergeant, 2005)
- Single deficit models of ADHD are not sufficient
- Efficiency of information processing is determined by:
o Computational resources (processing and storage- WM)
o State regulation (arousal, activation and effort)
o Management of resources (EF)
- Poor start regulation gives rise to slower and variable reaction times in EF tasks

Problems with CEM
- Not well specified
- Complicated
- Testing it will depend on identifying satisfactory measures of arousal, activation and effort



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