• Sustained: focus on something for a period of time
• Selective: focus on what you want to focus on
• Adaptive: realize when it is best to use one strategy over another adaptively

·         Increases sharply between 2 and 3.5 years, may be due to a variety of changes at this age: 

•  Frontal lobe growth: more inhibition
•   More complex play goals:kids learn during play
•   Adult scaffolding

•  Diagnostic criteria for ADHD now is age 7 or earlier that you want to see symptoms
• New age for DSM-V might be 12

·         Ability to control distracting stimuli

o   Internal: thoughts (e.g. anxiety)

o   External: distractions (e.g. ADHD)

·         Improves from infancy on

o   Gains on complex tasks from childhood to adolescents

• Production deficiency
• Control deficiency
• utilizationd eficiency: performance problem
• Effective strategy usse

Barkley's explanation

• inhibition
• nonverbal WM: sense of time
• verbal WM
• emotional & motivational regulation
• planning & problem solving

-cyclical pattern, wait long enough and old becomes new

-started as minimal brain dysfunction suggesting an organic cause

-know termed ADHD which again suggests an organic cause

• 6 or more inattentive symptoms OR hyperactivity-impulsiviy symptoms
• persistent for 6 months
• maladaptive & inconsistent w/ developmen
• Symptoms present before age 7
• impairment from symptoms in 2 or more settings
• clinically significant impairment in social, academic, or occupational functioning
• Symptoms don't occur exclusively during and arent better accounted for by other disorders 

1. no close attention to details, makes careless mistakes
2. difficulty sustaining attention in tasks or play
3. doesn't seem to listen when spoken to directly
4. doesn't follow through on instructions or finish schoolwork/chores/work duties (not due to opposition or failure to understand)
5. difficulty organizing tasks & activities
6. avoids, dislikes, or is reluctant to engage in tasks requiring sustained mental effort (schoolwork)
7. loses things necessary for tasks
8. easily distracted by extraneous stimuli
9. forgetful in daily activities

1. fidges w/ hands or feet or squirms in seat
2. leaves seat in class or places remaining seated is expected
3. runs aorund or climbs excessivily in inappropriate situations
4. difficulty playing or doing in leasure activities quietly
5. often "on the go" as if "driven by a motor"
6. talks excessively 

1. blurts out answers before question is complete
2. difficulty waiting turn
3. interrupts or intrudes on others

• Combined type: 6 symptoms are met for inattentive AND 6 are met for hyperactivity-impulsivity
• Predominantly Inattentive type: 6 met for inattentive, 6 not met for hyperactivity-impulsivity
• Predominantly hyperactive-impulsive type: 6 met for hyperactivity-impulsivity, 6 not met for inattentive

1. Cognitive impairments (7-10pts lower)
2. Language (35% delayed onset)
3. Adaptive functioning (10-30pts lower)
4. motor development (52% delayed coordination)
5. emotion (poor self-regulation)
6. school performance (30% repeat a grade)
7. task performance (e.g. poor persistance)
8. medical/health risks (57% greater proneness to accidents)

• combined is most common 
• 90% of hyperactive go on to have combined type
• 25% comorbid w/ anxiety
• 25% comorbid w/ mood disroder
• 87% have at least 1 comorbid disorder, 67% may have at least 2

Barkley says one of the tope 3 heritable disorders

-ADHD (2/3 genetic cause)

-autism

-bipolar

May be something different from other ADHD types

-sluggist cognitive tempo (foggy, slow)

-multiple low-grade non-diagnosable learning disorders

-slow inattentive impairment across the board

Problems with inhibition around the 3-4 years

Problems with inattention around 5-7 years

Suggested treatment for ADHD

-5% were helped by diet, these 5% had a food allergy

-telling a parent their child has been given sugar (when actually given a placebo) makes child behavior ratings worse: larger effect then comparing actually given sugar to placebo 

• Parent report
• Teacher report
• Child report
• Diagnostic interview
• Lab based tests of attention (not good w/ kids, differentiates from controls but not other disorders)

• ADHD is an empidemic
• Truth: only 3-7% of school age kids
• It's just bad parenting
• Truth: parent training helps but symptoms can't be due to only bad parenting
• If child responds to medication he has ADHD
• Truth: everybody responds to ADHD meds

• growth: loss of 1cm/yr, younger can be 1.4cm/yr
• nervousness
• insomnia
• Blood pressure/pulse change
• loss of appetite
• more aggression and irritability

• Performance is worse:
• later in the day
• with greater task complexity
• when restraint is demanded
• under low levels of stimulation
• under variable schedules of immediate consequences
• under long delays to reinfrocement
• in absence of adult supervision

• PMT: parent management training
• CBT (better for comorbid internalizing disorder)
• Social Skills Training
• Meds (better for comorbid externalizing disorder)

• minimal brain dysfunction
• hyperkinetic impulse disorder/hyperactive child syndrome
• hyperkinetic reaction of childhood
• Attention deficit disorder (DSM-III, 1980)
• Attention-deficit hyperactivity disorder (DSM-III-R, 1987)
• Attention-deficity/hyperactivity disorder (DSM-IV, 1994)

New way to diagnose based on the base rates in the general population and your specific clinic

-must have good assessment/instruments

-provides incremental validity for each new piece of information

likelihood ratios are used for assessing the value of performing a diagnostic test. They use the sensitivity and specificity of the test to determine whether a test result usefully changes the probability that a condition (such as a disease state) exists. (wikipedia)