Abnormal Child Psychology International Edition 5th Edition By Eric J. Mash – Test Bank

 

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• Attention-Deficit/Hyperactivity Disorder (ADHD)

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Chapter Summary:

Attention-deficit/hyperactivity disorder (ADHD) is marked by age-inappropriate symptoms of inattention, hyperactivity, and impulsivity.  There are three subtypes of ADHD in the DSM-IV-TR:  predominately inattentive type (ADHD-PI), predominately hyperactive-impulsive type (ADHD-HI), and combined type (ADHD-C).  Other diagnostic criteria include the presence of ADHD behaviors before age 7, and impairment in academic or social performance in at least two settings. Associated characteristics of ADHD include: cognitive deficits (e.g., executive functions), intellectual deficits, impaired academic functioning, learning disorders, distorted self-perceptions, speech and language impairments, medical and physical concerns, family problems, and social/peer problems.  Comorbid psychological disorders may include oppositional defiant disorder (ODD), conduct disorder (CD), anxiety disorders, and mood disorders.  ADHD affects children all over the world at all levels of socioeconomic status.  Approximately 5-7% of school-aged children are estimated to have ADHD.  Boys are more likely to be diagnosed than girls, which may be due to gender differences in symptom presentation and referral biases.  ADHD is likely present at birth, but becomes more obvious during the preschool and early elementary years when the child must meet the demands of the classroom setting.  Many children do not outgrow ADHD and it may continue on into adulthood. Numerous causes for ADHD have been proposed, and current research suggests that neurobiological factors likely play a primary role (e.g., abnormalities in the frontalstriatal circuitry of the brain).  A number of neurotransmitters may be involved as well (e.g., dopamine, norepinephrine).  In addition, genetic factors are implicated as ADHD runs in families.  Main treatments include stimulant medication, parent management training, and educational intervention.  Medications currently appear to be the most effective and commonly used treatment for the management of ADHD symptoms.

Chapter Outline:

I.                   Description and History

1. Description of Attention-Deficit/Hyperactivity Disorder

1.                   Symptoms: age-inappropriate inattention, hyperactivity, and impulsivity

2. No distinct physical signs, can only be identified by characteristic patterns of behavior that may differ among children
3. “ADHD” has become a blanket term; there are many different behavior patterns of children with ADHD, which vary in severity and etiology
4. Associated with problems in social, cognitive, academic, familial, and emotional domains of development and adjustment
5. High societal costs associated with ADHD; estimated $32 billion a year in the S. (about $11,000 per child)

B.                 History

1. In the early 1900s, symptoms of over-activity were considered to be due to poor “inhibitory volition” and “defective moral control”
2. Increased interest arose from the encephalitis epidemic of 1917-18, which gave rise to the concept of the brain-injured child syndrome (associated with mental retardation); however, there was no evidence of brain damage or retardation, and therefore the concept evolved to minimal brain damage and minimal brain dysfunction in the 1940s-50s
3. In late 1950s, referred to as hyperkinesis and attributed to poor filtering of stimuli entering the brain; motor over-activity seen as the primary feature
4. By 1970s, deficits in attention and impulse control, in addition to hyperactivity, seen as the major symptoms
5. Most recently, focus on child’s poor self-regulation and the child’s difficulty in inhibiting behavior as key impairments

II.                Core Characteristics

1. Inattention (IA)
2. Behaviors indicative of inattention may include:
3. Problems with concentration, easily distracted
4. Appearing as if the child is not listening
5. Disorganization and forgetfulness
6. Failure to finish assignments, frequent change in activities
7. Difficulty persevering on a task even when child tries
8. Insufficient to say a child has an attention deficit, could include deficits in one or more of: attentional capacity, selective attention (distractibility), and sustained attention
9. Primary deficit in ADHD is sustained attention, particularly for repetitive, structured, and uninteresting tasks
10. Hyperactivity-Impulsivity (HI)
11. Given that hyperactivity and impulsivity almost always go together, some have argued it is best to think of them as a single dimension, some have also suggested they are both part of a more fundamental deficit in behavioral regulation
12. Hyperactive-impulsive behavior is activity that is excessively energetic, intense, inappropriate, and not goal directed
13. Children with ADHD show more motor activity than other children, particularly when asked to sit still and complete a classroom task
14. Children who are impulsive may show difficulties with cognitive impulsivity, behavioral impulsivity, or both
15. Behaviors indicative of hyperactivity include:
16. Fidgeting, difficulty staying seated when required
17. Moving, running, climbing about
18. Excessive talking
19. Appearing as if “driven by a motor”
20. Behaviors indicative of impulsivity include:
21. Difficulty stopping on-going behavior
22. Difficulty awaiting turn
23. Inability to resist immediate gratification
24. Interrupting others’ conversations
25. Subtypes

1.         Predominantly Inattentive Type (ADHD-PI) (“pure” attention deficit)

a.                   Less common

1. Frequently described as drowsy, confused, “in a fog”

c.         May be co-morbid with learning disorders, slow processing speed, difficulties with information retrieval, anxiety, and mood disorders

1. Attention problems may be in alerting and preparing for the task from the outset, as well as, the ability to sustain attention

e.         Some debate as to whether this should be thought of as a separate disorder altogether

2. Predominantly Hyperactive-Impulsive Type (ADHD-HI) and Combined Type (ADHD-C)
3. Both are associated with aggressiveness, defiance, peer rejection, school suspension, and placement in special education classes
4. It is not yet known if these are actually two distinct subtypes or the same type at different ages
5. Most research studies have studied mixed groups of children with ADHD, creating inconsistencies in the literature
6. Additional DSM Criteria
7. Excessive, long-term, and persistent behaviors (at least 6 months)
8. Behaviors appear prior to age 7
9. Age-inappropriate
10. Behaviors occur in several settings
11. Behaviors cause significant impairments in at least two environments
12. Behaviors not due to another psychological disorder, medical condition, or serious life stressor
13. What DSM Criteria Don’t Tell Us
14. Developmentally insensitive (most problematic limitation)
15. Categorical view of ADHD
16. Requirement of an onset before age 7 is arbitrary and overly restrictive

III.             Associated Characteristics

1. Cognitive Deficits
2. Executive Functions
3. Executive functions are higher-order mental processes that underlie the child’s capacity for self-regulation
4. Executive functions include cognitive processes (e.g., working memory, planning, organization), language processes (e.g., verbal fluency, use of self-directed speech), motor processes (e.g., motor coordination, response inhibition), and emotional processes (e.g., self-regulation of emotional arousal)
5. Intellectual Deficits
6. Most children with ADHD are of at least normal overall intelligence
7. Their difficulty is in applying their intelligence to everyday life
8. May show lower IQ scores due to deficits in working memory and sustained attention
9. Impaired Academic Functioning
10. Most children with ADHD experience severe difficulties in school
11. ADHD associated with lower academic productivity, lower grades, failure to advance in grade level, more frequent placements in special education classes, and failure to complete high school
12. Learning Disorders
13. Often have specific learning disorders, particularly relating to reading, spelling, and math
14. Different pathways may underlie the relationship between ADHD and learning disorders
15. Distorted Self-Perceptions
16. Many children with ADHD report a higher self-esteem than would

be expected, given their behavior; this exaggeration of competence is called the positive illusory bias

1. Those with ADHD-HI and conduct problems are more likely to demonstrate a positive illusory bias than those with ADHD-PI and symptoms of anxiety/depression
2. Speech and Language Impairments
3. Occurring in about 30-60% of children with ADHD
4. Often difficulty in using language in daily situations (e.g., excessive and loud talking, frequent shifts in conversation, interrupting others, use of unclear links in conversation)
5. Developmental Coordination and Tic Disorders
6. As many as 30-50% of children with ADHD display motor coordination

difficulties

2. About 20% of children with ADHD have tic disorders
3. Medical and Physical Concerns
4. Some researchers have argued that there is an association between ADHD and sleep disturbances, slight growth deficits in height through mid-adolescents, and motor coordination difficulties, but the findings are inconsistent
5. Many children with ADHD have tic disorders, but ADHD does not seem to increase the risk of a childhood diagnosis of a tic disorder
6. Associated with accident-proneness and risky behaviors
7. Social Problems
8. Family problems include interactions characterized by child negativity, child noncompliance, high parental control, maternal depression and health problems, paternal antisocial behavior, marital conflict
9. Problems with peers, which are attributed to annoying, socially insensitive, loud, inappropriate, and socially aggressive behaviors; display little of the give-and-take that characterize other children

IV.             Accompanying Psychological Disorders and Symptoms

1. Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)
2. About 50% (mostly boys) also meet criteria for ODD
3. About 30%-50% eventually develop conduct disorder (CD)
4. Some researchers have suggested an “aggressive subtype” of ADHD, however this issue remains in question
5. Anxiety Disorders
6. About 25% experience excessive anxiety
7. Children with co-occurring ADHD and anxiety often display social and academic impairments and greater long term impairment and health problems than those with either condition alone
8. Co-morbidity of ADHD and anxiety reduced or eliminated in adolescence
9. Mood Disorders
10. About 20%-30% also experience depression
11. Likelihood of developing a mood disorder increases by early adulthood
12. Link to mood disorders may be genetic or familial
13. Bipolar mood disorder (BP) seems to increase a child’s risk for ADHD, but ADHD does not seem to increase a child’s risk for BP

V.                Prevalence and Course

A.                Gender

1.      2% to 4% of all school aged girls and 6% to 9% for all school aged boys

2. Diagnosed more frequently in boys (2.5X more likely in general population, and 6X more likely in clinic-referred), which may be due, in part, to sampling, referral, and definition biases
3. Girls with ADHD and symptoms of ODD are referred at a younger age than boys, suggesting different expectations and more concern for these behaviors in girls
4. DSM criteria developed and tested with mostly boys, and the specific diagnostic criteria may be more appropriate and valid for boys than girls
5. ADHD girls in community samples tend to be less impaired than boys with ADHD, and less likely to receive stimulant medication
6. ADHD girls in clinic samples tend to be quite similar to boys in terms of symptom expression and severity, treatment response, brain abnormalities, and level of impairment
7. Girls with ADHD have severe problems in adolescence including peer rejection, conduct problems, large deficits in academics, attentional skills, executive functions, and language abilities, high service utilization
8. Girls with ADHD impulsive-hyperactive behaviors are more likely to develop an eating disorder than girls with ADHD inattention and non-ADHD girls

B.                 Socioeconomic Status and Culture

1. Slightly more prevalent among lower SES groups, which is best accounted for by the presence of co-occurring conduct problems (associated with factors such as stress)
2. Inconsistent findings regarding relationship between ADHD and race and ethnicity; higher rates of teacher-rated ADHD in African American versus Caucasian children and lower rates for Hispanic, Asian, American Indian, and Pacific Islander
3. Access to treatment knowledge about ADHD appears greater among Caucasian, non-Hispanic, and higher educated families
4. Found in all countries and cultures, although rates vary depending on factors such as ages and gender of children studied, cultural norms and tolerance, and definition of ADHD

C.                Course and Outcome

1. Probable that ADHD is present at birth, but difficult to identify in infancy
2. Hyperactivity-impulsivity usually appears first
3. Onset often in preschool years, and usually by school age
4. Deficits in attention increase as school demands increase
5. In early school years oppositional and socially aggressive behaviors often develop
6. Most children still have ADHD as teens, although hyperactive-impulsive behaviors decrease
7. Problems often continue into adulthood; those adults with ADHD may experience a great deal of boredom, work difficulties, impaired social relations, depression, low self-concept, and substance abuse
8. Better outcomes are more likely for youngsters who have less severe symptoms, good care, supervision, support, and access to economic and community resources

VI.             Theories and Causes

1. Genetic Influences
2. ADHD runs in families; about 1/3 of family members of children with ADHD also have the disorder
3. Adoption and twin studies indicate a strong hereditary basis for ADHD
4. The dopamine transporter gene (DAT) and the dopamine receptor gene (DRD4) appear to be implicated in ADHD
5. Pregnancy, Birth, and Early Development
6. Although no pre- or perinatal factors have been shown to be specific to ADHD, pregnancy and birth complications, low birth weight, malnutrition, early neurological insult or trauma, and diseases of infancy may be related to later symptoms of ADHD
7. Consistent support for an association between maternal cigarette smoking during pregnancy and ADHD, especially for children who carry specific genetic risk
8. Maternal substance use is associated with higher than normal rates of ADHD, although this could be accounted for by a generally negative family environment
9. Neurobiological Factors
10. There is strong evidence that ADHD is largely a neurobiological disorder
11. Consistent support for the implication of the frontostriatal circuitry (prefrontal cortex and basal ganglia, which are the areas of the brain associated with attention, executive functions, delayed responding, and response organization)
12. MRI findings suggest smaller cerebral volumes and a smaller cerebellum, which cannot be accounted for by medication therapy
13. Delay in brain maturation, especially in prefrontal regions
14. Neurotransmitters involved include dopamine, norepinephrine, epinephrine, and serotonin
15. Diet, Allergy, and Lead
16. Although diet (particularly sugar and food additives), allergy, and

exposure to lead have received considerable attention as possible causes of ADHD, their role as primary causal factors has not received empirical support

1. Family Influences
2. No clear causal relationship between family life and ADHD, although in some circumstances ADHD symptoms may be associated with insensitive and interfering early care-giving
3. Family conflict may increase the severity of hyperactive-impulsive symptoms
4. Family problems may result from interacting with a child who is impulsive and difficult to manage
5. Family problems likely relate to the later emergence of associated oppositional and conduct problems

VII.          Treatment

1. Medication
2. Stimulant medications are the most effective treatment for the management of ADHD symptoms and associated impairments (e.g., social interactions, physical coordination, aggressive behaviors, academic productivity)
3. Most common stimulant medications used are dextroamphetamine and methylphenidate; they are considered quite safe when used under proper supervision
4. These medications alter activity in the frontostriatal brain region by affecting neurotransmitters important to this region
5. Short-term benefits are well documented, long-term benefits are limited
6. Recent non-stimulant drug, atomoxetine, is potentially effective and can be administered by wearing a patch
7. Parent Management Training (PMT) – provides parents with a variety of skills to help them manage their child’s oppositional and non-compliant behaviors, reduce parent-child conflict, and cope with the difficulties of raising a child with ADHD
8. Educational Intervention – focus on managing inattentive and hyperactive-impulsive behaviors that interfere with learning, providing a classroom environment that capitalizes on the child’s strengths and improves academic performance, and teaching pro-social and task-oriented classroom behavior
9. Intensive Interventions – combines stimulant medication trials, PMT, educational interventions, and additional treatments in an all-out treatment effort
10. MTA study suggests children with uncomplicated ADHD, adequate social

functioning and good academic performance do well with medication; children with ADHD, oppositional symptoms, poor social functioning, and ineffective parenting do best with medication and behavioral treatment

 

1. Additional Interventions – include family counseling, support groups, and individual counseling for the child
2. A Comment on Controversial Treatments – there are many “fad” treatments available that may be expensive, provide false hope for an easy solution, and delay treatments that have scientific support
3. Keeping Things in Perspective – every child is unique and has numerous strengths and resources that should be recognized and supported

 

Learning Objectives:

 

1. To discuss the history of the etiologies proposed and symptoms described in children with ADHD, providing a context for the current term as it is used today

 

1. To describe the core characteristics of ADHD, including the major difficulties and deficits seen within the areas of inattention (IA) and hyperactivity-impulsivity (HI)

 

1. To describe the DSM-IV-TR diagnostic criteria for ADHD, including an discussion of the three subtypes

 

1. To identify some of the key limitations of the current DSM-IV-TR criteria

 

1. To discuss other problems commonly associated with ADHD

 

1. To identify common comorbid psychological disorders

 

1. To consider gender and cultural differences in ADHD and reflect on the reasons that may be behind these differences

 

1. To describe the prevalence and developmental course of ADHD

 

1. To identify many of the controversial explanations for ADHD, including those lacking scientific support

 

1. To describe the current empirical findings with regard to etiology (e.g., genetic influences, neurobiological factors, and family influences)

 

1. To discuss the most recognized and empirically supported treatments for ADHD

 

 

Warning Signs of Attention-Deficit /Hyperactivity Disorder (ADHD):

 

• Difficulty sustaining attention

 

• Easily distractible

 

• Poor attention to detail

 

• Problems with organization

 

• Forgetful, careless

 

• Fidgety, restless when asked to sit

 

• Overly sensitive to sensory stimulation

 

• Extremely active, always “on the move”

 

• Interrupts others, blurts out answers in class

 

• Difficulty waiting for turn

 

• Loses everyday items (e.g., pencils, coat)

 

• Appears to ignore you

 

• Runs or climbs on things when improper to do so

 

• Fails to follow through with instructions

 

• Plays or performs activities loudly

 

• Appears to “tune out” at times

 

• Extremely chatty

 

• Avoids long homework tasks

 

• Touches or opens everything in sight

 

• Does not think before acting

 

• Clumsy, accident-prone

 

• Moves quickly from activity to activity

 

Key Terms and Concepts:

 

alerting

attentional capacity

attention-deficit/hyperactivity disorder (ADHD)

combined type (ADHD-C)

developmental coordination disorder (DCD)

distractibility

executive functions

frontostriatal circuitry of the brain

goodness of fit

hyperactive

impulsive

inattentive

methylphenidate

parent management training (PMT)

predominantly hyperactive-impulsive type (ADHD-HI)

predominantly inattentive type (ADHD-PI)

quality of life

response-cost procedures

selective attention

stimulant medications

subtype

sustained attention

tic disorders

 

 

 

Test Items:

 

1. To diagnose ADHD in a child, a psychologist is likely to look for:

1. characteristic patterns of behavior
2. metabolites in the blood
3. an abnormality in the frontal lobe of the brain
4. abusive behavior in the parents

ANS: A           REF: p. 123     DIF: Easy        COG: Factual

 

2. Children with ADHD generally:
3. get pleasure from feeling out of control
4. want to do well but have difficulty due to limited self control
5. can behave appropriately when they try hard enough
6. do better with strict rules

ANS: B           REF: p.123      DIF: Moderate COG: Factual

 

3. The brain damage theory of ADHD, which arose in the 1940s and 1950s, was discarded because:

1. no evidence of brain damage could be found using x-ray
2. the psychological cause of ADHD was “found” in 1958
3. it could explain only a very small number of cases of ADHD
4. brain damage was thought to cause mental retardation, not ADHD

ANS: C           REF: p.124      DIF: Moderate COG: Factual

 

 

4. Which of the following statements about ADHD is false?

1. No single cause for the behavior patterns of children with ADHD has been identified.
2. ADHD is an umbrella term used to describe several different patterns of behavior that differ slightly.
3. Hyperactivity and inattention together are essential features of ADHD.
4. There are no distinct signs of ADHD that can be seen with an x-ray or a lab test.

ANS: C           REF: p.124      DIF: Easy          COG: Factual

 

5. Virginia Douglas (1972) made the argument that:

1. hyperactivity is the primary component of ADHD
2. in addition to hyperactivity, inattention and deficits in impulse control are the primary symptoms
3. ADHD is due to minimal brain damage
4. ADHD is psychological rather than biological in origin

ANS: B           REF: p.124      DIF: Moderate COG: Factual

 

6. Recently, the symptoms that have been emphasized as the central impairments of ADHD are:

1. inattention and difficulty regulating motor behavior
2. difficulty inhibiting behavior and poor self-regulation
3. inattention and poor moral control
4. hyperactivity and cognitive problems

ANS: B           REF: p.124      DIF: Easy                    COG: Factual

 

7. Jeremy cannot remember a phone number without jotting it down. He demonstrates a deficit in:

1. impulsivity
2. sustained attention
3. selective attention
4. attentional capacity

ANS: D           REF: p.126      DIF: Moderate COG: Applied

 

8. When Jessica sits down to do her homework and study she is easily distracted by the television in another room. Jessica demonstrates a deficit in:

1. attentional control
2. sustained attention
3. selective attention
4. attentional capacity

ANS: C           REF: p.126      DIF: Moderate COG: Applied

 

9. Bradley has particular difficulty paying attention when he is tired or uninterested in the task at hand. Bradley demonstrates a deficit in:

1. sustained attention
2. distractibility
3. selective attention
4. attentional capacity

ANS: A           REF: p.126      DIF: Moderate COG: Applied

 

10. Which of the following is another term for a deficit in selective attention?

1. distractibility
2. impulsivity
3. dual attention
4. disorganization

ANS: A           REF: p.126      DIF: Moderate COG: Factual

 

11. The core attentional deficit in ADHD is believed by many to be:

1. selective attention
2. attentional capacity
3. sustained attention/vigilance
4. distractibility

ANS: C           REF: p.126      DIF: Moderate COG: Factual

 

12. What might be the most difficult task for a child with ADHD?

1. learning a new video game
2. paying attention to the teacher when someone else in the class is talking
3. remembering a friend’s phone number
4. working for 45 minutes on a sheet of simple math problems

ANS: D           REF: p.126      DIF: Moderate COG: Applied

 

13. When is a child with ADHD likely to display more motor activity than other children?

1. when asked to sit still at his desk
2. in his sleep
3. while playing on the playground
4. all of these

ANS: A           REF: p. 126     DIF: Easy                    COG: Factual

 

14. What is an example of cognitive impulsivity?
15. blurting out an answer in class
16. touching a hot stove
17. rushed thinking
18. interrupting a parent on the telephone

ANS: C           REF: p.127      DIF: Moderate COG: Factual

 

15. Children with ADHD who are at increased risk for conduct or oppositional problems are those who exhibit:

1. behavioral impulsivity
2. cognitive impulsivity
3. selective inattention
4. diminished attentional capacity

ANS: A           REF: p. 127     DIF: Easy                    COG: Factual

 

 

16. Children who are at increased risk for problems in academic achievement are those who exhibit:

1. behavioral impulsivity
2. cognitive impulsivity
3. selective inattention
4. behavioral impulsivity and cognitive impulsivity

ANS: D          REF: p.127      DIF: Moderate COG: Factual

 

17. Which of the following is an additional criterion for a diagnosis of ADHD?

1. Symptoms must appear prior to age 12
2. Symptoms must be present for at least one year
3. Symptoms must occur in at least one setting
4. Symptoms must produce significant impairments in the child’s social or academic performance

ANS: D           REF: p. 128     DIF: Moderate COG: Factual

 

18. Which of the following is NOT an additional criterion for a diagnosis of ADHD?

1. Symptoms must appear prior to age 12
2. Symptoms must be present for at least 6 months
3. Symptoms must occur in more than one setting
4. Symptoms must produce significant impairments in the child’s social or academic performance

ANS: A           REF: p.128      DIF: Moderate COG: Factual

 

19. In comparison to children with ADHD-HI, children with the subtype ADHD-PI are at greater risk of:

1. antisocial behavior
2. rejection by peers
3. anxiety/mood disorders
4. placement in a special education class

ANS: C           REF: p.128      DIF: Moderate COG: Factual

 

20. Which of the following is NOT true about ADHD-HI?

1. Children with ADHD-HI are often older than those with ADHD-C
2. The ADHD-HI subtype is the rarest subtype of ADHD
3. Children with ADHD-HI are more likely to display behavioral problems than those with ADHD-PI
4. Children with ADHD-HI are more likely to be suspended from school than those with ADHD-PI

ANS: A           REF: p.128      DIF: Moderate COG: Factual

 

 

 

 

 

 

21. Which of the following is NOT true about ADHD-PI?

1. Children with ADHD-PI are often described as daydreamy and drowsy.
2. Children with ADHD-PI have difficulties with speed of information processing.
3. Children with ADHD-PI are often described as aggressive and rude.
4. Research evidence suggests that children diagnosed with ADHD-PI may actually have a completely different disorder than children with ADHD-HI and ADHD-C.

ANS: C           REF: p.128      DIF: Moderate COG: Factual

 

22. Which of the following is NOT a criticism of the DSM-IV-TR criteria for ADHD?

1. The number of required symptoms is not adjusted for age or level of maturity.
2. The requirement of persistence for 6 months may be too long for young children.
3. The DSM takes a categorical view of ADHD.
4. The required age of onset of age 7 may be too young.

ANS: B           REF: p.129      DIF: Moderate COG: Factual

 

23. The mental processes underlying children’s capacity for self-regulation are called:

1. executive functions
2. metacognition
3. self-perceptions
4. thought tracking

ANS: A           REF: p.130      DIF: Easy                    COG: Factual

 

24. Which of the following statements best describes the intelligence of a child with ADHD?

1. Over 50% of children with ADHD are below average in intelligence.
2. Over 50% of children with ADHD are above average in intelligence.
3. Brighter children tend to show more symptoms of impulsivity and hyperactivity.
4. Most children with ADHD are of average intelligence.

ANS: D           REF: p.130      DIF: Easy        COG: Factual

 

25. Which child would be more likely to display a positive illusory bias?

1. A child with ADHD-HI and conduct problems
2. A child with ADHD-HI and depression
3. A child with ADHD-PI and anxiety
4. A child with ADHD-PI and conduct problems

ANS: A           REF: p.131      DIF: Easy                    COG: Factual

 

26. Which is NOT a characteristic of the speech/language of a child with ADHD?

1. quiet, mumbling speech that is difficult to hear
2. frequent shifts in conversation
3. use of fewer pronouns and conjunctions
4. unclear links in conversation

ANS: A           REF: p.132      DIF: Moderate COG: Factual

 

 

 

 

27. Which of the following is false about the health of children with ADHD?

1. Children with ADHD often experience sleep disturbances.
2. Children with ADHD may display slight growth deficits, which are likely due to medication use.
3. Children with ADHD display higher rates of tic disorders than other children.
4. Children with ADHD are more accident-prone than other children.

ANS: B           REF: p.132      DIF: Easy                    COG: Factual

 

28. Mothers of children with ADHD are also more likely to have:

1. substance abuse problems
2. schizophrenia
3. depression
4. antisocial personality disorder

ANS: C           REF: p.133-134          DIF: Moderate COG: Factual

 

29. Which of the following is TRUE of children with ADHD?

1. They are deficient in social reasoning
2. They have the same social agenda as their peers
3. They report receiving high social support from peers
4. They are consistently rejected by peers

ANS: D           REF: p.134      DIF: Easy                    COG: Factual

 

30. Children with ADHD display:
31. a decreased desire for peer relationships
32. a poor understanding of social reasoning
33. a strong ability to correctly recognize emotions in others
34. little give-and-take in relationships with peers

ANS: D           REF: p.134      DIF: Moderate COG: Factual

 

31. The most common co-morbid psychological disorder(s) in children with ADHD is/are:

1. anxiety & depression
2. oppositional defiant disorder & depression
3. tic disorder
4. conduct disorder & oppositional defiant disorder

ANS: D           REF: p.135      DIF: Easy                    COG: Factual

 

32. One reason that ADHD is so challenging is that as many as ____ percent of children with ADHD have a co-occurring psychological disorder.

1. 60
2. 70
3. 80
4. 90

ANS: C           REF: p.135      DIF: Moderate COG: Factual

 

 

 

33. The relationship between ADHD and depression appears to be a function of:

1. the teasing and demoralization that the child experiences as a result of their symptoms
2. family risk for one disorder increasing the risk for the other
3. general family stress
4. all of these

ANS: B           REF: p.136      DIF: Moderate COG: Factual

 

34. The best prevalence estimate for ADHD in school-age children in North America is:

1. 1%-2%
2. 6%-7%
3. 9%-10%
4. 15%-20%

ANS: B           REF: p.137      DIF: Easy        COG: Factual

 

35. The higher incidence of ADHD in boys versus girls is most likely due to:
    1. sampling and referral biases
    2. societal expectations and acceptance
    3. more aggression in boys
    4. all of these

ANS: D           REF: pp.137    DIF: Easy                    COG: Factual

 

36. In comparison to boys, girls with ADHD are more likely to display:
    1. higher levels of hyperactivity
    2. greater impairment in executive functions
    3. higher levels of aggression
    4. inattentive/disorganized symptoms

ANS: D           REF: p.137      DIF: Moderate COG: Factual

 

37. Girls with ADHD are more likely than girls without ADHD to:
    1. have conduct, mood, and anxiety disorders
    2. have lower rates of verbal aggression
    3. have higher IQ and school achievement scores
    4. none of the above

ANS: A           REF: p.138      DIF: Moderate COG: Factual

 

38. The higher rates of ADHD in lower SES groups are best accounted for by:
    1. the presence of co-occurring depression
    2. the presence of co-occurring parental psychopathology
    3. the presence of co-occurring conduct problems
    4. the presence of co-occurring learning problems

ANS: C           REF: p.138      DIF: Moderate COG: Factual

 

 

 

 

 

39. Which is NOT true regarding ADHD and culture?
    1. ADHD has been found to occur more in higher SES groups than lower ones
    2. ADHD has been identified in every country around the world in which it has been studied
    3. Differences in the prevalence of ADHD across cultures may reflect cultural norms
    4. Differences in the prevalence of ADHD across cultures may reflect variations in definition

ANS: A           REF: p.138-139          DIF: Moderate COG: Factual

 

40. Children from which racial/ethnic group are teachers most likely to rate as ADHD?
41. Caucasian
42. African American
43. Asian
44. Hispanic

ANS: B           REF: p.138      DIF: Easy                    COG: Factual

 

41. Mothers of children with ADHD often describe their children as being __________ as infants.
    1. difficult
    2. easy
    3. indistinguishable from their siblings
    4. overly anxious and depressed

ANS: A           REF: p.139      DIF: Easy                    COG: Factual

 

42. With regard to the onset of symptoms of ADHD:
    1. symptoms of hyperactivity-impulsivity and inattention tend to emerge at about the same time, usually in the preschool years
    2. symptoms of hyperactivity-impulsivity and inattention tend to emerge at about the same time, usually in the early primary school years
    3. symptoms of inattention usually emerge before symptoms of hyperactivity-impulsivity
    4. symptoms of hyperactivity-impulsivity usually emerge before symptoms of inattention

ANS: D           REF: p.139      DIF: Easy                    COG: Factual

 

43. Which is true of the course of ADHD?
    1. ADHD does not develop until school age.
    2. The majority of children with ADHD outgrow their problems before adolescence.
    3. Many adults have ADHD but were never been diagnosed in childhood.
    4. All of these.

ANS: C           REF: p.141      DIF: Moderate COG: Factual

 

44. Adults with ADHD are likely to have better outcomes in their life if:
45. their symptoms are less severe
46. they have family support
47. have access to resources
48. all of the above

ANS: D           REF: p.141      DIF: Easy                    COG: Factual

 

45. Which of the following is most likely to cause ADHD?
    1. too much sugar
    2. fluorescent lighting
    3. poor school environment
    4. none of these

ANS: D           REF: p.141-142          DIF: Easy                    COG: Factual

 

46. Children with ADHD display:
    1. deficits in motivation
    2. deficits in arousal level
    3. deficits in self-regulation
    4. all of these

ANS: D           REF: p.142 (Interrelated Theories of ADHD)     DIF: Moderate       COG: Factual

 

47. Research into causal factors provides strong evidence for ADHD as a disorder with __________ determinants.
    1. biological
    2. neurobiological
    3. socio-environmental
    4. familial

ANS: B           REF: p.144      DIF: Easy        COG: Factual

 

48. Twin studies suggest that __________ factors play the largest role in accounting for ADHD.
    1. shared environmental
    2. nonshared environmental
    3. heritable
    4. all factors play a similar role

ANS: C           REF: p.143      DIF: Moderate COG: Factual

 

49. DRD4, the dopamine receptor gene, has been linked to:
    1. thrill-seeking
    2. excitable behavior
    3. impulsivity
    4. all of these

ANS: D           REF: p.143      DIF: Moderate COG: Factual

 

50. Minor physical anomalies and other risk factors before, during, and after birth are specific risk factors for:
    1. ADHD, but not other forms of psychopathology
    2. many forms of psychopathology
    3. ADHD and conduct disorder alone
    4. anxiety and depression alone

ANS: B           REF: p.143-144          DIF: Moderate COG: Factual

 

 

51. Neurobiological research on the causes of ADHD has shown consistent support for the implication of the:
    1. limbic system
    2. hippocampus
    3. reticular activating system
    4. frontostriatal circuitry

ANS: D           REF: p.144      DIF: Easy                    COG: Factual

 

52. In Hoover & Milich’s study (1994), mothers who (erroneously) believed that their children had ingested sugar:
    1. described them as “sweeter” than did mothers of children in the control condition
    2. rated them as happier and calmer than did mothers of children in the control condition
    3. were more critical of their children and rated them as more hyperactive than did mothers of children in the control condition
    4. did not notice any change in their children’s behavior

ANS: C           REF: p.146      DIF: Easy        COG: Factual

 

53. Research into the negative influence of family on ADHD symptomatology indicates that:
    1. Familial factors account for a significant degree of variance in ADHD symptoms.
    2. Familial factors account for only a small degree of variance in ADHD symptoms.
    3. Familial factors may increase the severity of certain ADHD symptoms.
    4. Familial factors account for only a small degree of variance in ADHD symptoms, although they may increase the severity of certain symptoms.

ANS: D           REF: p.147      DIF: Moderate COG: Factual

 

54. The best treatment for ADHD is:
    1. stimulant medication
    2. parent management training
    3. educational intervention
    4. all of these, in combination

ANS: D           REF: p.148      DIF: Easy                    COG: Factual

 

55. Stimulant medications work by:
    1. paradoxically slowing kids down
    2. altering neurotransmitter activity in the frontostriatal region of the brain (stimulating areas that are underaroused)
    3. enhancing mood, which in turn enhances self-esteem and behavioral control
    4. “convincing” parents and teachers that the medications are working, even when they’re not (placebo effect)

ANS: B           REF: p.149      DIF: Easy          COG: Factual

 

 

 

 

 

 

56. An educational intervention for ADHD may include:
    1. response-cost procedures in the classroom
    2. use of visual aids in the classroom
    3. giving written and oral instructions in the classroom
    4. all of these

ANS: D           REF: p.152      DIF: Easy        COG: Factual

 

57. Results of the Multimodal Treatment Study of Children with ADHD (MTA Study) were that:
    1. in general, behavioral treatment was superior to medication management
    2. adding behavioral treatments to medication resulted in benefits over and above medications in terms of alleviating core symptoms
    3. three years after the conclusion of the treatment, only the medication management group continued to benefit from treatment
    4. none of these

ANS: C           REF: p.153      DIF: Moderate COG: Factual

 

58. When utilizing educational interventions, disruptive or off-task classroom behaviors may be punished with ________________ that involve the loss of privileges, activities, points, or tokens following inappropriate behavior.
    1. partial-response procedures
    2. all-or-nothing procedures
    3. response-cost procedures
    4. delayed-cost procedures

ANS: C           REF: p.152      DIF: Moderate COG: Factual

 

59. To date, ___________ has focused mainly on teaching parents to manage the overt disruptive behaviors that accompany their child’s ADHD, rather than on changing the deficits underlying the child’s ADHD.
    1. adult sponsor training
    2. response-cost training
    3. parent management training
    4. family management training

ANS: C           REF: p.152      DIF: Moderate COG: Factual

 

60. Why is it important not to lose sight of the fact that each child is unique and has assets and resources that need to be recognized and supported?
    1. Because these assets can serve as a means in reducing the child’s medication needs
    2. Because these assets can serve as a buffer in increasing the child’s behavior problems and referral concerns
    3. Because these assets can serve as a buffer in reducing the child’s behavior problems and referral concerns
    4. Because these assets will do little to help the child in school

ANS: C           REF: p.147      DIF: Moderate COG: Factual

 

 

 

Short Answer/Essay Questions:

 

1. Describe three types of attention deficits seen in children with ADHD, and provide an example of each.
2. What are some of the limitations of the DSM-IV-TR as a means of diagnosing ADHD? What changes have been suggested to address these limitations?
3. Executive functions include cognitive, language, motor, and emotional processes. Give an example of each, and explain how executive functions relate to ADHD.
4. What are the possible explanations for the link between maternal depression and ADHD?
5. The co-occurrence of ADHD and conduct disorder has led some researchers to suggest an “aggressive subtype” of ADHD. What support is there for such a subtype?
6. How do the symptoms of inattention and hyperactivity-impulsivity change over the lifespan?
7. Distinguish between the different subtypes of ADHD. What is the current consensus in the literature regarding the existence of these subtypes?
8. Discuss the differences in self esteem of children with ADHD who display inattentive and depressive/anxious symptoms versus children with ADHD and hyperactivity-impulsivity and conduct problems. What are the explanations for these differences?
9. Describe the difficulties children experience that have co-occurring ADHD and anxiety.
10. Describe the behaviors that ADHD children often display which can create negative reactions in both the children and adults who spend time with them.
11. Discuss the behavioral differences in boys and girls with ADHD that have been found in clinical samples.
12. Discuss three problems that girls with ADHD experience in adolescence.
13. What is the role of the family in etiology and development of ADHD symptoms?
14. Discuss the relationship between ADHD and race and ethnicity. What racial/ethnic groups are teachers most and least likely to rate as ADHD.
15. Discuss the factors that can influence more positive outcomes for adults with ADHD.

 

Questions and Issues for Discussion:

 

1. Should ADHD-PI be considered a separate disorder from ADHD-HI and ADHD-C? Have students research some of the studies that have demonstrated or suggested that ADHD-PI is a completely separate psychological disorder.  Ask students to decide whether the research has swayed them in either direction, and why.
2. Some commonly followed treatments for ADHD have not been scientifically substantiated, including restricted or modified diets, treatments for allergies, treatment for inner ear problems, treatments for yeast infections, megavitamins, chiropractic adjustment and bone alignment, eye training, special colored glasses, and biofeedback. Have students research some of these unsupported treatments, as well as the literature that questions their empirical use.
3. Can a diagnosis of ADHD be used as a defense when an individual has committed a crime? It appears to be used more and more, but does it work?  Have students research this topic and provide case examples in which ADHD has been used to argue mental illness (see “Admitted robber gets 17 years in jail for diner stickup”, Staten Island Advance, September 25, 2003).

What are the implications of a successful defense for the field of mental health and society in general?

4. How much influence should schools have in deciding whether a child should be placed on stimulant medication? There are several recent cases in which parents have been charged with educational neglect for choosing not to give their children Ritalin. For an example see “Parents lose fight to take 8-year-old off Ritalin: Child’s hyperactivity disrupted classes, school officials say” The Sunday Gazette Mail, October 22, 2000, Charleston, West Virginia (http://www.wvgazette.com).  Have students search the internet for related legal or ethical cases.
5. In 2000, lawsuits were filed against the manufacturers of Ritalin and the American Psychiatric Association in California, New Jersey, and Texas. The lawsuits alleged that the drug manufacturers and the psychiatric association conspired to “create” a disease/disorder and hype the benefits of Ritalin as the mode of treatment. For a news article on the suits see “Maker of Ritalin, psychiatric group sued”, The Wall Street Journal, Thursday, September 14, 2000.  Can a disorder be “created”?  Is it possible that there may be political, economic, or other “hidden” agendas involved in the diagnosis and treatment of ADHD and other problems of childhood?  If so, what may some of these be?
6. There are numerous myths and concerns regarding stimulant use for the treatment of ADHD in children. Have students research some of these misconceptions or other common myths and concerns regarding stimulant use for the treatment of ADHD (see National Institute of Mental Health (1994). Attention Deficit Hyperactivity Disorder: Decade of the Brain. NIH Publication No. 94-3572, for a discussion of some of the more common misconceptions).
7. As indicated in the text, it is estimated that about 1.3 million children in North America take Ritalin on a regular basis. Children as young as 2 years of age are currently receiving prescriptions for methylphenidate, even though the drug has only been tested and approved from children 6 years of age and older.  Is it ethical to subject preschoolers to clinical trials of Ritalin?  Have students research and identify some of the ethical issues in conducting these kinds of studies on young children (see “Scandal! They haven’t tested Ritalin on the children it’s prescribed for! Scandal! They’re going to test Ritalin on the children!,” The Washington Post, January 2, 2001).
8. A great deal of hype is now surrounding the new ADHD medication Strattera™. Have students research this medication and why physicians, pediatricians, teachers, and parents are so interested in it as the new “wonder drug”.  Compare and contrast it with other common ADHD medications (see “New drug for attention deficit, hyperactivity, gains, as school starts”, Miami Herald, September 6, 2003).
9. Many different computer tests have been created to “simulate” ADHD-like difficulties with attention and impulsivity (e.g., CPT). How do these tests compare to paper-and-pencil tests?  Have students research some of the widely used tests of attention and compare and contrast them in terms of usefulness.
10. We hear in the media about the problem of teens selling prescription medications on the street, including those used to treat ADHD. How serious is this concern and what can society do?  Have students research the extent of this problem and identify some possible solutions to the issue (see “Figures showing problem widespread”, The Tennessean, September 22, 2003).

 

Website Suggestions:

 

http://www.add.org   Homepage for the National Attention Deficit Disorder Association.  An award-winning site with all the information a student could want for a research paper, including links to many other resources.

 

http://www.chadd.org/   Website for C.H.A.D.D., Children and Adults with Attention-Deficit Hyperactivity Disorder, the largest national ADD organization, with on-line fact sheets and information about adults with the disorder.

 

http://www.help4ADHD.org  Is a program of C.H.A.D.D. and covers all aspects of ADHD.

 

http://www.cdc.gov/ncbddd/adhd/  Provides clinical information, prevalence rates, and resources.

 

http://kidshealth.org/teen/school_jobs/school/adhd.html Provides teens with doctor approved jargon-free information.

 

http://borntoexplore.org/   “Born to Explore! The Other Side of ADD”, is a site devoted to exploring positive and alternative views of ADD/ADHD.

 

http://www.oneaddplace.com/ One A.D.D. Place.  Includes research, FAQs, famous people with ADD, and an adult symptom checklist.

 

http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml Website for the National Institute of Mental Health.  Comprehensive website link on ADHD, including sources of information and support (books, support groups).

 

http://www.aacap.org/  Website for the American Academy of Child and Adolescent Psychiatry.

 

Video Suggestions:

 

A New Look at ADHD: Inhibition, Time, and Self-Control (2000).  Guilford Publications Inc.  (30 minutes; $95 purchase price)

This video provides an introduction to Russell A. Barkley’s prominent theory of the nature and causes of ADHD.  Dr. Barkley shares his thoughts about the underlying causes of ADHD symptoms and points to how this new understanding of the disorder may lead to more effective interventions.

 

Coping with Attention Deficit Disorder in Children (1995).  Films for the Humanities and Sciences. (24 minutes; $149 purchase price, $75 rental price)

Reviews what ADD and ADHD are, including symptoms, causes, assessment and diagnosis, and approaches to intervention.  The emotional impact these disorders have on children and their families is also discussed.

 

Living with Attention-Deficit/Hyperactivity Disorder (2000).   Films for the Humanities and Sciences. (53 minutes; $149 purchase price)

Therapists, teachers, parents, and clients comment on living with ADHD.  Treatment approaches using psychological techniques and stimulant medications are discussed.  Etiologies in terms of brain development and biochemistry are considered.

 

Understanding Attention Deficit Hyperactivity Disorder (1996).  Meridian Productions, available through Films for the Humanities and Sciences.  (20 minutes; $74 purchase price)

This video reviews both sides of the physiological vs. psychological debate regarding the etiology of ADHD.  It also addresses the question of whether medication or behavior modification with increased structure and discipline should be the preferred mode of treatment.

 

Ritalin: Drug Treatment for Attention Deficit Disorder (1995).  Films for the Humanities and Sciences.  (20 minutes; $129 purchase price, $75 rental price)

“This program takes a close look at Ritalin, the drug which has gained wide acceptance as a treatment for Attention Deficit Disorder (ADD). The program examines whether Ritalin, which appears to provide quick and effective treatment, is being over prescribed as a quick cure to a complicated problem and looks at the dangers of misusing the drug. The program also visits a school where children with behavioral problems are taught skills that help them focus their attention without drugs.”

 

Attention? A Team Approach to ADHD (1997).  Aquarius Productions Inc.  (41 minutes; purchase price unavailable)

Discusses the importance of a team approach to the assessment and treatment of ADHD and addresses the roles that educators, medical professional, and parents might take in this process.  Includes interviews with medical and education professionals.