Problem 1
ATTENTION DEFICIT DISORDER (ADHD)
Inattention and/or hyperactivity greater than normal for a child’s developmental age
DSM-5 = Before age of 12 for at least 6 months found in 2+ contexts
o Children diagnosed keep symptoms in adulthood
o Adult ADHD require 5 rather than 6 symptoms for the diagnosis
o Found across cultures but more common in males -> More likely to be referred for a treatment
o Girls tend to have less disruptive behavior -> Maladaptive
o The IQ is normal average but because of inattention people may score lower
1. ADHD inattentive
Six (or more) inattention symptoms & less than six hyperactivity/impulsivity symptoms
2. ADHD hyperactive/impulsive
Six (or more) hyperactivity/impulsivity symptoms & less than six inattention symptoms
3. ADHD Combined = Inattentive & hyperactive
Six (or more) inattention symptoms & six (or more) hyperactivity/impulsivity symptoms
SYMPTOMS
INATTENTION HYPERACTIVITY/IMPULSIVITY
Lack of attention to details or careless mistakes Talk excessively
Not listening when spoken to directly Run or climb in inappropriate situations
Difficulty maintaining attention & easily distractable Not sitting still or leaving seat when unexpected
Forgetful in daily activities Unable to participate in games quietly
Instruction ignored Interrupting others frequently
Difficulty organizing Trouble waiting a turn and shouting an answer
Tasks shift without completing them before the question has fully asked
Losing things needed for a task
COMORBIDITY & ETIOLOGY
Comorbid disorder of ADHD = Oppositional defiant disorder - ODD (or conduct disorder)
Often diagnosed after school begins -> Learning affected, below intellectual capabilities & poorer academic
performance
o Violation of social norms and basic rights of others
o Aggressive and disruptive behavior which affects social relationships
Highly heritable disorder at 76% -> Twin study proof
Maternal smoking & drinking or environmental toxins -> Increase hyperactivity and affects development
ADHD = Reduced brain volume in areas as frontal cortex, cerebellum and basal ganglia and reduced gray matter –
Reduced frontal lobe volume (involved in problem solving and planning)
Catecholamine neurotransmitters abnormality (dopamine, serotonin & norepinephrine) located on chromosome 16
TREATMENTS
Psychostimulants -> Ritalin – Dexedrine – Cylert & Adderall -> Increase alertness and arousal
o Psychostimulants are medication that increase the central nervous system activity
o Act immediately and lasts around 3-4 hours
o Side effect = Reduced appetite, trouble sleeping, increasing motor tics
In short terms hyperactivity/impulsivity improve but inattention problems might persist
Paradoxical effect = In normal people Ritalin increase concentration, energy and focus -> In people with ADHD has a
calming effect
, ARTICLE
Non-medical interventions discussed for ADHD
Preschool children
o Parent training improves child-parent relationship
o It teaches how to identify and monitor problematic situations through rewarding and prosocial behavior
o It decrease unwanted behaviors through planned ignoring and time-out
Middle school/adolescent children
o Group training = Parent training + Classroom interventions + Stimulant medications for ADHD
Adults
o Stimulant medications
AUTISM SPECTRUM DISORDER (ASD)
Impairment in several developmental areas
It can occur before 2 years old and it is diagnosed within the age of 20
SYMPTOMS
1. Social and emotional disturbances
o Non-verbal behavior impaired and inability to regulate social interactions
o Failure in understanding other’s emotions, desires and beliefs (Theory of mind – sally/anne false belief)
o Decreased prefrontal cortex and amygdala activation
2. Language and communication
o More than half children with autism display echolalia -> Immediate imitation of what has been just heard
3. Development of stereotyped or self-injured behavior pattern
o Distress when routine is disrupted
o Attachment to inanimate objects
o Stereotyped body movements -> Hand clapping, finger snapping, rocking, swaying
4. Intellectual disabilities
o Lower IQ score less than 70
o Above average IQ on a specific task -> Savant syndrome
ETIOLOGY
Found across cultures but more common in males -> Bias and increased attention to diagnosis
Highly heritable disorder
Perinatal factors (e.g., maternal infection, intrauterine exposure to drugs, maternal bleeding), genetic and
environment have an influence on autism development
TREATMENTS
Antipsychotics -> Haloperidol (adults) & risperidone (children)
o Antipsychotics reduce stereotyped behavior, social withdrawal and aggression/challenging behaviors
Modelling -> Demonstrating a required behavior then imitated (e.g., teaching sign language)
Parent-implemented early intervention -> Improve communication & interaction with autistic child and increase
understanding about the disease
Problem 2
EATING DISORDERS
, Anorexia = Highest rate mortality - Binge-eating = Most common
Recovery is possible and patient with bulimia and binge-eating have high rates of clinical remission
Eating disorders are more common in women & gay and bisexual men -> Possible reason underdiagnosis in
men because of gender biases
1. ANOREXIA NERVOSA
Intense feeling of gaining weight or becoming fat
Age onset around 15-19 y/o
Anorexia is not a culture-bound syndrome
SYMPTOMS
A. Significantly low weight, less than expected C. Disturbance experienced at the level of self-
because of restriction of energy intake evaluation, or lack of recognition of the
B. Intense fear of gaining weight or to becoming seriousness of the current low body weight
fat, or persistent behavior that interferes with
weight gain Note: Amenorrhea (cessation of menstruation) is no
longer a diagnosis criteria
SUBTYPES
RESTRICTING TYPE = Deliberate effort to limit food quantity & avoidance in eating in front of others
BINGE-EATING / PURGING TYPE = Patient either binge (greater than normal food consumption), purge (self-
induced vomiting, use of laxatives etc.) or both
TREATMENTS
FAMILY THERAPY = Best treatment based on Maudsley model:
o Parents support and therapist help the patient
o Family issues and problems addressed
o Development of healthy relationship between parent and patient
INDIVIDUAL THERAPY = Provides benefits but less effective than family therapy
COGNITIVE-BEHAVIORAL THERAPY = Change of behaviors and maladaptive thinking styles
o Lasts around 2 years
MEDICATIONS
o Antidepressant = No efficiency proven
o Antipsychotic = It could be beneficial
2. BULIMIA NERVOSA
Uncontrollable binge-eating followed by use of inappropriate compensatory behaviors (e.g., self-induced
vomiting or excessive exercise) to prevent gaining weight
Age onset around 20-24y/o
Bulimia is a culture-bound syndrome
Difference with anorexia binge-eating/purging type
o In anorexia binge-eating/purging type = Underweight but unaware of seriousness
o In bulimia = Normal weight / or overweight and aware of it – preoccupied with shame, guilt or
self-deprecation
SYMPTOMS
A. Recurrent episodes of binge Eating an amount of food discrete period of time
eating larger than normal in a (within 2 hours)
ATTENTION DEFICIT DISORDER (ADHD)
Inattention and/or hyperactivity greater than normal for a child’s developmental age
DSM-5 = Before age of 12 for at least 6 months found in 2+ contexts
o Children diagnosed keep symptoms in adulthood
o Adult ADHD require 5 rather than 6 symptoms for the diagnosis
o Found across cultures but more common in males -> More likely to be referred for a treatment
o Girls tend to have less disruptive behavior -> Maladaptive
o The IQ is normal average but because of inattention people may score lower
1. ADHD inattentive
Six (or more) inattention symptoms & less than six hyperactivity/impulsivity symptoms
2. ADHD hyperactive/impulsive
Six (or more) hyperactivity/impulsivity symptoms & less than six inattention symptoms
3. ADHD Combined = Inattentive & hyperactive
Six (or more) inattention symptoms & six (or more) hyperactivity/impulsivity symptoms
SYMPTOMS
INATTENTION HYPERACTIVITY/IMPULSIVITY
Lack of attention to details or careless mistakes Talk excessively
Not listening when spoken to directly Run or climb in inappropriate situations
Difficulty maintaining attention & easily distractable Not sitting still or leaving seat when unexpected
Forgetful in daily activities Unable to participate in games quietly
Instruction ignored Interrupting others frequently
Difficulty organizing Trouble waiting a turn and shouting an answer
Tasks shift without completing them before the question has fully asked
Losing things needed for a task
COMORBIDITY & ETIOLOGY
Comorbid disorder of ADHD = Oppositional defiant disorder - ODD (or conduct disorder)
Often diagnosed after school begins -> Learning affected, below intellectual capabilities & poorer academic
performance
o Violation of social norms and basic rights of others
o Aggressive and disruptive behavior which affects social relationships
Highly heritable disorder at 76% -> Twin study proof
Maternal smoking & drinking or environmental toxins -> Increase hyperactivity and affects development
ADHD = Reduced brain volume in areas as frontal cortex, cerebellum and basal ganglia and reduced gray matter –
Reduced frontal lobe volume (involved in problem solving and planning)
Catecholamine neurotransmitters abnormality (dopamine, serotonin & norepinephrine) located on chromosome 16
TREATMENTS
Psychostimulants -> Ritalin – Dexedrine – Cylert & Adderall -> Increase alertness and arousal
o Psychostimulants are medication that increase the central nervous system activity
o Act immediately and lasts around 3-4 hours
o Side effect = Reduced appetite, trouble sleeping, increasing motor tics
In short terms hyperactivity/impulsivity improve but inattention problems might persist
Paradoxical effect = In normal people Ritalin increase concentration, energy and focus -> In people with ADHD has a
calming effect
, ARTICLE
Non-medical interventions discussed for ADHD
Preschool children
o Parent training improves child-parent relationship
o It teaches how to identify and monitor problematic situations through rewarding and prosocial behavior
o It decrease unwanted behaviors through planned ignoring and time-out
Middle school/adolescent children
o Group training = Parent training + Classroom interventions + Stimulant medications for ADHD
Adults
o Stimulant medications
AUTISM SPECTRUM DISORDER (ASD)
Impairment in several developmental areas
It can occur before 2 years old and it is diagnosed within the age of 20
SYMPTOMS
1. Social and emotional disturbances
o Non-verbal behavior impaired and inability to regulate social interactions
o Failure in understanding other’s emotions, desires and beliefs (Theory of mind – sally/anne false belief)
o Decreased prefrontal cortex and amygdala activation
2. Language and communication
o More than half children with autism display echolalia -> Immediate imitation of what has been just heard
3. Development of stereotyped or self-injured behavior pattern
o Distress when routine is disrupted
o Attachment to inanimate objects
o Stereotyped body movements -> Hand clapping, finger snapping, rocking, swaying
4. Intellectual disabilities
o Lower IQ score less than 70
o Above average IQ on a specific task -> Savant syndrome
ETIOLOGY
Found across cultures but more common in males -> Bias and increased attention to diagnosis
Highly heritable disorder
Perinatal factors (e.g., maternal infection, intrauterine exposure to drugs, maternal bleeding), genetic and
environment have an influence on autism development
TREATMENTS
Antipsychotics -> Haloperidol (adults) & risperidone (children)
o Antipsychotics reduce stereotyped behavior, social withdrawal and aggression/challenging behaviors
Modelling -> Demonstrating a required behavior then imitated (e.g., teaching sign language)
Parent-implemented early intervention -> Improve communication & interaction with autistic child and increase
understanding about the disease
Problem 2
EATING DISORDERS
, Anorexia = Highest rate mortality - Binge-eating = Most common
Recovery is possible and patient with bulimia and binge-eating have high rates of clinical remission
Eating disorders are more common in women & gay and bisexual men -> Possible reason underdiagnosis in
men because of gender biases
1. ANOREXIA NERVOSA
Intense feeling of gaining weight or becoming fat
Age onset around 15-19 y/o
Anorexia is not a culture-bound syndrome
SYMPTOMS
A. Significantly low weight, less than expected C. Disturbance experienced at the level of self-
because of restriction of energy intake evaluation, or lack of recognition of the
B. Intense fear of gaining weight or to becoming seriousness of the current low body weight
fat, or persistent behavior that interferes with
weight gain Note: Amenorrhea (cessation of menstruation) is no
longer a diagnosis criteria
SUBTYPES
RESTRICTING TYPE = Deliberate effort to limit food quantity & avoidance in eating in front of others
BINGE-EATING / PURGING TYPE = Patient either binge (greater than normal food consumption), purge (self-
induced vomiting, use of laxatives etc.) or both
TREATMENTS
FAMILY THERAPY = Best treatment based on Maudsley model:
o Parents support and therapist help the patient
o Family issues and problems addressed
o Development of healthy relationship between parent and patient
INDIVIDUAL THERAPY = Provides benefits but less effective than family therapy
COGNITIVE-BEHAVIORAL THERAPY = Change of behaviors and maladaptive thinking styles
o Lasts around 2 years
MEDICATIONS
o Antidepressant = No efficiency proven
o Antipsychotic = It could be beneficial
2. BULIMIA NERVOSA
Uncontrollable binge-eating followed by use of inappropriate compensatory behaviors (e.g., self-induced
vomiting or excessive exercise) to prevent gaining weight
Age onset around 20-24y/o
Bulimia is a culture-bound syndrome
Difference with anorexia binge-eating/purging type
o In anorexia binge-eating/purging type = Underweight but unaware of seriousness
o In bulimia = Normal weight / or overweight and aware of it – preoccupied with shame, guilt or
self-deprecation
SYMPTOMS
A. Recurrent episodes of binge Eating an amount of food discrete period of time
eating larger than normal in a (within 2 hours)
