lecture 5 *DPP*

those in which the symptoms are manifested but outward behaviour such as agression defiance or hyperactivity

adhd ( attention deficit/hyperactivity disorder

oppositinal defiant disorder (ODD)

conduct disorder (CD)

not part of the DSM however psychologist use the therminology

predictive of substance use disorders (SUD) and anti social perosnality disorder (ASPD) later in life

first incapacity of attending with a neccery degreee of contracy to any one object

seconds a total suppresion of its effects in the brain

arises form unatural or morbid sensibility of the nerves

born with a person or due to diesses

when born with a person evident at a very early period of life

minimal brain damage ( MBD)

DSM II : they hyperkinetic reaction of childhood

DSM III : ADD / H & ADD/WO

DSM IV : ADHD C, ADHD I, ADHD HI

DSM 5 : current symptom presentation

**symptoms** crierion : 6 or more sympotms present

**age** criterion : < 12

**cotnext** criterion : 2 or more

**limitations** crieterion : hindrance

**other disorders** crieterion : symptoms cannot be explained by other disorders

innatention

hyperactivity

impulsivity

innatetion : breifly paly (<3min) , not finishing activities, not listening

hyperactivity : wirlwind

impulsivity : not listening , ni sense of fanger

innatention : short activities (<10 min ) , prematurly changing activities, chaotic

hyperactivity : restrell at innapopriate times

impulsivity : not able to wait, disrupts other childre, breaks rules

innattention : less persevrence (<30 min ) , no attention , bad planning

hyperactivity : restless and fidgety

impulsicity : weak self control and reckless risk taking

children 5 to 6.5 %

adults 2.5 to 3%

children : hyperactive and impulsive

adults innantetion and persisitent

children 80% male

adults 50% male

children ODD/CD

adults SUD

1. diagnostic interviewer ( alweys )

1. questionnaires ( mostly )
2. observations ( regularly )
3. neuropsychological assesment
4. physical examination ( sometimes )

intelligence (regularly)

continous performance task ( sometimes )

physcial cause

contra indications pharmacological treatment

lose job , geh hospitalised ,have conflicts with the ones around you, develope adictions, depression or anxiety

Multidisciplinary guideline ADHD for children adn adolescence

( two pillers )

medication and behavioural psychological tretment

patient training in behaviour management and classorm management

medication when behavioural interventions are not effective

medication in combination with parenting training in behavioural management and behavioural intervention class

aim to bring about change through the manipulation of social or pyschological factors

1. behavioural parenting trainaing ( BPT)
2. bhevaioural clasroom management (BCM )
3. behavioural peer intervention (BPI)
4. combination of BPT BCM and BPI

setting rules, giving , instructions, reinforcing desired behavior, ignoring undesirable behavior

stongest evidence for preschool age , less strong evidence for adolesence

effects do not genralise to other environemnts

Ritalin metylphenidate

name after his wife Rita

first use for patients with low blood pressure

Rita used Ritalin

later used for depression and hyperkinetic behaviour in children

work on two different neurotransmitters : blocks reuptake in synaptic cleft

dopamine and neirandal

usally in prefronal lobe and basal ganglia ( attantion , self contorl , working memeory )

large effects

proven effecttive

effects ADHD , ODD/CD up to two years

reatively chep

30% usatisfatory reaction

limited improvements in educational outcomes

long term effects are unknown

side effects

resistance parents

poor medication adherence

Anti Ritalin movement in 60s

multimodal treatemnt of attention ADHD

579 children , 7 /10 years old

RCT : medication , behavioural therapy , combination , comunity care ( 14 months )

flow up measuremnts : naaturalistic , uncontrolled

primary outcomes ADHD/ODD symptoms

anxiety symptoms , academic performace, parent child relationahips and social skills and lower medication doses compared to medication only groups

1. genetic
2. envronemntal
3. endophenotype
4. neurobiological

twin studies : 76% gentic

many genes with small effects

dopamine system

setotonien stsyem

environemntal factors and gene environemnt interactions seem more important in complex disorders

parental risk factors

birth complications

premature birth

exposure to led

extreme neglect

alcohol use , smoking , stress

it should be heritable , co segregate with a psychic ilness yet be present even wehn the dieses is not , and be found in non affecetd family members at a higher rate then in the population

endophynoty are mesuarbel constructs that can be found in between phenotype and diesese genes

closer to genese

have to be heritbale as well

1. inhibition
2. working memort
3. response to variability
4. delay aversion
5. timing

ability to surpess prepontent responses

ability to manipulate information in stm

variability in reaction times

preference fot an immediate small award over lage delay reward

ability to estimate units of time

maturational delay

*delayed development compared to healthy control

*still developed fully but in more time

white matter is deviant in ADHD patients

both executive and reward circuits have a role in ADHD symptoms

1. we cannot diagnese ADHD with an fMRI and will nwvwe bw possible form a objective pov

1. ADHD seen as brain diesese when it is not
2. not only due to bad parenting ( influences but not 100% true )