The video below is the section for ADHD (Psychological Assessment Domain) from Part 5 of TSM’s lecture series on DSM-5 and the EPPP, followed by a transcript. This lecture series aims to equip those preparing for the EPPP with everything you need to know about the impact DSM-5 will be having on the EPPP. To watch all of Part 5, click HERE. To watch earlier lectures in this series, or register for our webinar series on DSM-5 and the EPPP, click HERE.
Transcript of DSM-5 EPPP Lecture Video: ADHD (Psychological Assessment Domain)
NARRATIVE DEFINITION:
Attention-Deficit Hyperactivity Disorder (ADHD) is a neurological disorder usually diagnosed in elementary school-age children. It is characterized by inability to focus one’s attention, excessive motor activity and highly impulsive behavior. A child with ADHD is likely to have social difficulties with peers and caregivers, develop low self-esteem, exhibit reduced academic performance and attainment, be more prone to accidents and injury, and may experience social rejection. As an adult, poor occupational performance, attainment and attendance, a high probability of unemployment, and elevated interpersonal conflict.
The causes for this disorder have yet to be identified. Although the genetic contribution has been found to be strong, the environmental influence on the development of the disorder appears to be as crucial. Research indicates that there are brain differences between children with the diagnosis and children who do not have the diagnosis, but specific areas affected remain elusive. What is known is that the ADHD brain matures slowly, and has less grey matter (consequently, less overall activity) in brain areas responsible for attention and emotion, with decreased activity in dopaminergic and noradrenergic systems.
The diagnosis of ADHD is clinical, based on history and clinical picture. Several checklists, symptom lists, and behavioral questionnaires help parents, teachers, doctors, counselors, and other caregiving adults identify symptoms and narrow down the diagnosis. At this time, there are no blood tests or biological markers, neuroimaging techniques, or neuropsychological tests that can prove the presence of ADHD. However, it is possible to document high probability of ADHD, and the educational system can use the discrepancy between intellectual ability with lower than expected academic achievement, with suggestive irregular patterns of learning and knowledge.
Diagnosis for ADHD begins with a broad-band assessment in order to differentiate it from other disorders. The Behavioral Assessment for Children (BASC) and Child Behavior Checklist (CBC) are two popular tests used for this purpose. If a WAIS-IV or WISC-IV has been administered, look for sub-test variability, or a “SCAD” profile, which is the most useful in evaluating for ADHD or learning disorders. However, the WISC-IV SCAD profiles have not been extensively researched as of yet, so SCAD information should be used cautiously for this purpose. Continue assessment with a narrow-band scale to obtain detailed information on symptoms for treatment.
The ADHD rating scale includes lists of symptoms that parallel those presented in the DSM-5 for ADHD. Other instruments, like the Stroop Color-Word Association Test, can help assess behavioral inhibition.
FLASHCARD:
About
1. Childhood behavior disorder
2. Excessive motor activity and inability to focus attention
Characterized by
1. Inattention
2. Impulsivity
3. Hyperactivity
4. Typically diagnosed in elementary grades
Brain regions
1. Frontal cortex
2. Basal ganglia
Three subtypes
1. Predominantly inattentive type
2. Predominantly hyperactive-impulsive type
3. Combination type (high levels of both inattention and hyperactivity-impulsivity)
Assessment
1. Broad-band assessment: differentiates ADHD from other disorders
2. Behavioral Assessment for Children (BASC) & Child Behavior Checklist (CBC)
3. WAIS-IV & WISC-IV: look for sub-test variability, “SCAD” profile; this profile also used for LDs
4. Narrow-band assessment: obtains detailed information on symptoms for treatment
5. ADHD Rating Scales: List of DSM-IV symptoms for ADHD
6. Stroop Color-Word Association Test (to assess behavioral inhibition)
QUESTION:
Which one of these is not a characteristic of ADHD?
ANSWERS:
A. Impulsivity
B. Inattention
C. Hyperactivity
D. Oppositional behavior
RATIONALE: D is the correct answer as this type of behavior is not usually associated with ADHD. A, B, and C are hallmarks of the disorder.