Attention deficit hyperactivity disorder
Dr. C Sims
Children developing
Attention-deficit
Hyperactivity Disorder
Dr. Ceri Sims
Psy2014, Psy4022
seminar
AHDH - Outline
1. What is ADHD?
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Evidence of ADHD as a valid medical diagnosis
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Emotional and behavioural problems; co-morbidities
2. Theories – Cognitive, Biological, Environmental
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Attention deficit hyperactivity disorder
Dr. C Sims
Fidgety Phil
He won’t sit still
He wriggles
And giggles
The naughty restless child
Growing still more rude and wild
(Heinrich Hoffman, 1845)
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Attention-deficit Hyperactivity
Disorder (ADHD)
 Neurodevelopmental disorder and one of the most common
childhood behavioural disorders
 Disruptive behaviour marked by over activity, excessive
difficulty sustaining attention, distractibility and impulsiveness
  1845 - Dr. Heinrich Hoffman “The story of fidgety Philip”.
 1902 - Sir G. Still - lectures to Royal College of physicians,
England - described group of impulsive children with significant
behavioural problems
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Attention deficit hyperactivity disorder
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3 main symptoms are
Inattention, Impulse control difficulties
and Hyperactivity
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An ‘externalising’ disorder: behaviour a result of internal difficulties
Approx. 85 % manifest all of these symptoms
Few manifest predominantly attention difficulties (ADD) – more in
community surveys/harder to detect (R. Barclay argued underresearched - ADD children tend to be underactive and dreamy)
Most believe difficulties in directing and sustaining attention represent
the fundamental problem
some become calmer and less active as develop, but disorder persists
throughout adolescence (70-80%) and adulthood (50-65%)
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Attention deficit hyperactivity disorder
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Who identifies the
problem?
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Often detected first by parent - many teachers
diagnose the problem because they are familiar
with norms of behaviour such as normal
friendships and expected levels of achievement.
Questionniares used by parents or teachers to
assist diagnosis: Conners teacher and parent
rating scale, Achenbach child-br checklists,
Edelbrock child attention problems rating scale,
Barley and DuPaul ADHD rating scale.
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Attention deficit hyperactivity disorder
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Example questions from Child
Behaviour Checklist (Achenbach.
1991, 1992)
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DIAGNOSIS OF ADHD continued
Formal diagnosis by specialist - Paediatrician and or
Educational psychologist:
compare child’s behaviour against medical criteria (DSMIV-R) - at least 6 inattention and 6 Hyperactive/
Impulsive
Is the problem continuous and situation general and
excessive compared with peers of the same age?
Wide range of situational observations as child may sit
still in a clinicians consulting room
Need to rule out other problems or disabilities that are
not classified as ADHD
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Attention deficit hyperactivity disorder
Dr. C Sims
Expression of core symptoms
INATTENTION
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Does not pay attention when being spoken to
Difficulty directing and sustaining attention in tasks and activities
Easily distracted by extraneous stimuli and activities
Failure to initiate or complete assignments/school work and homework
Careless mistakes, forgetful in daily activities, often loses things
Daydreaming, wandering off and generally having trouble focusing on
present situation
General difficulty organising tasks and activities
(One criticism of the current behavioural criteria for
inattention is that they are inappropriate for assessing
problems for very young pre-school children)
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Expression of core symptoms
IMPULSIVENESS
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Rushes into an activity without thinking
Blurts out answers before questions completed
Difficulty awaiting his/her turn
Interrupts others’ conversations
Intrudes on others’ activities and sabotages games
Moves from one unfinished task to another
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Attention deficit hyperactivity disorder
Dr. C Sims
Expression of core symptoms
HYPERACTIVITY
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Fidgety and restless
Difficulty remaining seated for manual activities and lessons
Talks excessively
Excessive physical activity in inappropriate environments:
climbing, running, tumbling
Displacement behaviours when seated: finger drumming, feet
tapping, fiddling with objects
Accident prone
(Motor difficulties – some ADHD also have these problems:
handwriting, coordination, movement planning, accident prone –
often appear clumsy/dyspraxic)
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Attention deficit hyperactivity disorder
Dr. C Sims
Specialists need to use various sources
of information to rule out the
following:
Sudden change in child’s life (family crisis or bereavement)
Chaotic family life and home environment
Undetected seizures (petit mal, temporal lobe)
Ear problems (glue ear, hearing problems, infections)
Medical disorders
Conduct disorders without ADHD
Other learning disabilities or psychiatric problems (Reading
disorders; Dyspraxia, Autism; Obsessive-compulsive disorder;
Tourettes)
• Anxiety or Depression
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Conduct Disorders with
ADHD
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ADHD often found to show oppositional defiant behavioursmost common category referred to mental health practitioners.
Only between 10-20% of ADHD children reach adulthood free of
any psychiatric diagnosis.
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Restlessness at age 3 predicts conduct disorders at age 8
(Stevenson and Graham, 1975).
Hyperactivity and Impulsivity among the most important
factors that predict later delinquency and juvenile
convictions; Cambridge study of Delinquent development
(Farrington, 1991, 1995).
Other attributes of ADHD related to delinquency: poor
concentration, sensation seeking and risk taking.
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Social and Emotional
consequences of ADHD
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Academic difficulties, Health and Life-style implications:
Studies also show that these problems can persist into
adolescence and adulthood (Hallowell and Ratey 1994;
Wender 1995).
injuries,
anti-social behaviour,
alcohol and substance abuse (Molina and Pelham, 2003),
personality and emotional disturbances,
risky driving/traffic accidents,
marital disruptions
more job changes
legal infractions
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Attention deficit hyperactivity disorder
Dr. C Sims
Is ADHD a social adaptational
problem?
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Jensen et al 1997 - ADHD diagnoses increasing as
ADHD is an ‘adaptational problem’ - changing
expectations of behaviour in Western societies
Popular press and TV have debunked the existence
of ADHD - no laboratory test for ADHD
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Blaming children for educational shortcomings - e.g.
not enough physical activity in school
Doctors pushing medication
However:
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Increasing evidence of Biological causes and understanding
of ADHD as universal across societies – recent research
showing high prevalence in China and South Africa.
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ENVIRONMENTAL FACTORS
ASSOCIATED WITH ADHD:
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Perinatal Environment:
Evidence that prenatal exposure to alcohol (Oesterheld and
Wilson, 1987); cigarettes (Thapar et al, 2003) or other drugs
can lead to attention problems.
Maternal smoking – 3 times the risk, no direct causative link
but effects remain when SES factors controlled for
(Sadowski and Parish, 2005)
Pregnant mothers with Rubella (German measles) at increased
risk of having child with attention disorder.
Prenatal exposure to high levels of lead, or oxygen
deprivation in the womb are risk factors
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RESEARCH ON ATTENTION
DEFICIT OF ADHD:
Hypothesis: ‘distractibility’ - cannot be selective when confronted
with numerous stimuli that compete for their attention
Landou, Larch and Milich (1992): 6-12 year old ADHD boys compared
with same aged non-ADHD boys
watch TV programme under two conditions:
a) Toys present in room
b) No toys
Test memory of details of TV programme
When toys present, ADHD sample remembered significantly
less (half as much) about the programme compared with the nonADHD group of boys
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Working Memory (Badderley, 1981, 1986)
Central
Executive
Phonological
loop
controls the processing
of information in working
Memory:
ability to focus attention
on appropriate
information and to divide
attention between tasks
Long-term
memory
Visuo-spatial
scratchpad
Implicated in cognitive deficit theories of ADHD (Barkley et al. 2001)
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Attention deficit hyperactivity disorder
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RESEARCH IN ADHD AND
‘IMPULSE CONTROL’:
HYPOTHESIS: ADHD are able to inhibit motor responses under
highly motivating conditions
Jennings et al. (1997): ADHD and non-ADHD boys
- participated in a computer game that required them to move an
arrow to different parts of the screen
- When a horn was heard the task was simply to stop moving as
quickly as possible
- Rewards and penalties given for success
The ADHD group took significantly longer to respond but they
were able to do this task successfully especially the older
ADHD children (over 10 years)
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Research on ADHD and working
memory
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Working memory deficits in ADHD: The contribution of
age, learning/language difficulties and task parameters –
Sowerby et al. 2011, Journal of Attention disorders
What is this study about?
Rationale for the research?
Aims and hypotheses?
Choice of methodology?
Who are the participants? How recruited?
What measures are used?
Do results support the hypotheses?
Were appropriate controls used?
How could future research build on this study?
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Attention deficit hyperactivity disorder
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Additional references
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Lopez-Williams et al. (2005) Athletic performance and
social behaviour as predictors or ppr acceptance in
children diagnosed with ADHD. Journal of Emotional
and Behavioural Disorders, 13,3
Loe et al. (2008) Early histories of school-aged children
with ADHD. Child Development 79(6) 1853-1868
Bailey, U.L et al (2009) Developmental changes in
Attention and Comprehension among children with
ADHD. Child Development, 80(6) 1842-1855
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