THE MANY FACES OF ADHDTHE MANY FACES OF ADHDFrancis M. Crinella, Ph.D.Francis M. Crinella, Ph.D.

Clinical Professor of Pediatrics, Psychiatry & Human Behavior, Clinical Professor of Pediatrics, Psychiatry & Human Behavior, and Physical Medicine & Rehabilitationand Physical Medicine & RehabilitationDirector, Neuropsychology LaboratoryDirector, Neuropsychology Laboratory

Child Development CenterChild Development CenterUniversity of California, IrvineUniversity of California, Irvine

25 JAN 1025 JAN 10

WHAT IS ATTENTION?WHAT IS ATTENTION?A special [mental] function was instituted which had periodically to search the outer world in order that its data might be already familiar if an urgent inner need should arise: This function was attention. Its activity meets the sense impressions half way, instead of awaiting their appearance. At the same time, there was probably introduced a system of notation, whose task was to deposit the result of this periodic activity of consciousness—a part of which we call memory.

Sigmund Freud [Formulations regarding the two principles of mental functioning, 1911]

WHAT IS ATTENTION?WHAT IS ATTENTION?

Everyone knows what attention is. It is the taking possession in the mind, in clear and vivid form, of one out of what seem several simultaneous object or trains of thought.

William James [The Principles of Psychology, 1890]

CONSIDER YOUR LIFE CONSIDER YOUR LIFE WITHOUT ATTENTION--WITHOUT ATTENTION--

SOME IMPORTANT SOME IMPORTANT FEATURES OF FEATURES OF ATTENTIONATTENTION

ATTENTION HELPS US TO MANAGE ATTENTION HELPS US TO MANAGE CONFLICTING PERCEPTUAL INPUTSCONFLICTING PERCEPTUAL INPUTS

ATTENTION ALLOWS US TO ATTENTION ALLOWS US TO PERSIST IN TASK PERSIST IN TASK PERFORMANCEPERFORMANCE

ATTENTION HELPS US FOCUS ATTENTION HELPS US FOCUS ON THE TASK AT HANDON THE TASK AT HAND

ATTENTION ENABLES US TO ATTENTION ENABLES US TO PERFORM TASKS THAT REQUIRE PERFORM TASKS THAT REQUIRE

PLANNING AND WORKING PLANNING AND WORKING MEMORYMEMORY

ATTENTION ENABLES US TO MAINTAIN ATTENTION ENABLES US TO MAINTAIN VIGILANCE WHEN MONITORING VIGILANCE WHEN MONITORING

SIGNALSSIGNALS

ATTENTION ENABLES US TO ATTENTION ENABLES US TO AVOID COSTLY ERRORSAVOID COSTLY ERRORS

HOWEVER: ATTENTION HOWEVER: ATTENTION ITSELF IS ONE OF THE MOST ITSELF IS ONE OF THE MOST

FRAGILE OF ALL MENTAL FRAGILE OF ALL MENTAL FUNCTIONSFUNCTIONS

•IT CAN BE ADVERSELY AFFECTED BY ANY NUMBER IT CAN BE ADVERSELY AFFECTED BY ANY NUMBER OF INFLUENCESOF INFLUENCES

•ALMOST EVERY NEUROPSYCHIATRIC DISORDER IS ALMOST EVERY NEUROPSYCHIATRIC DISORDER IS ACCOMPANIED BY SOME KINDS OF ATTENTION ACCOMPANIED BY SOME KINDS OF ATTENTION DEFICITSDEFICITS

•ADHD IS BUT ONE OF THE PSYCHIATRIC ADHD IS BUT ONE OF THE PSYCHIATRIC DISORDERS IN WHICH ATTENTION IF AFFECTEDDISORDERS IN WHICH ATTENTION IF AFFECTED

• ADHD MAY AFFECT SEVERAL DIFFERENT ADHD MAY AFFECT SEVERAL DIFFERENT COMBINATIONS OF ATTENTIONAL COMPONENTSCOMBINATIONS OF ATTENTIONAL COMPONENTS

DSM-IV SYMPTOMS OF ADHDDSM-IV SYMPTOMS OF ADHD

INATTENTIONINATTENTION

• CAN’T ATTEND TO CAN’T ATTEND TO DETAILSDETAILS

• CAN’T SUSTAIN CAN’T SUSTAIN ATTENTIONATTENTION

• DOESN’T LISTENDOESN’T LISTEN• FAILS TO FINISHFAILS TO FINISH• CAN’T ORGANIZE CAN’T ORGANIZE

TASKSTASKS• AVOIDS SCHOOLWORKAVOIDS SCHOOLWORK• LOSES THINGSLOSES THINGS• EASILY DISTRACTEDEASILY DISTRACTED• FORGETFULFORGETFUL

HYPERACTIVITY/IMPULSIVITYHYPERACTIVITY/IMPULSIVITY

• FIDGETSFIDGETS• CAN’T STAY SEATEDCAN’T STAY SEATED• RUN ABOUT AND CLIMBSRUN ABOUT AND CLIMBS• CAN’T PLAY QUIETLYCAN’T PLAY QUIETLY• IS OFTEN ON THE GOIS OFTEN ON THE GO• TALKS TOO MUCHTALKS TOO MUCH• BLURTS OUT ANSWERSBLURTS OUT ANSWERS• CAN’T WAIT TURNCAN’T WAIT TURN• INTERRUPTS OR INTRUDESINTERRUPTS OR INTRUDES

CONFIGURATION OF DSM-IV SYMPTOMS OF CONFIGURATION OF DSM-IV SYMPTOMS OF ADHD IN PATIENT #1ADHD IN PATIENT #1

INATTENTIONINATTENTION HYPERACTIVITHYPERACTIVITY/IMPULSIVITYY/IMPULSIVITY

11 CAN’T ATTEND CAN’T ATTEND TO DETAILSTO DETAILS

YESYES FIDGETSFIDGETS YESYES

22 CAN’T SUSTAIN CAN’T SUSTAIN ATTENTIONATTENTION

NONO CAN’T STAY CAN’T STAY SEATEDSEATED

YESYES

33 DOESN’T DOESN’T LISTENLISTEN

NONO RUN ABOUT RUN ABOUT AND CLIMBSAND CLIMBS

YESYES

44 FAILS TO FAILS TO FINISHFINISH

YESYES CAN’T PLAY CAN’T PLAY QUIETLYQUIETLY

YESYES

55 CAN’T CAN’T ORGANIZE ORGANIZE

TASKSTASKS

YESYES IS OFTEN ON IS OFTEN ON THE GOTHE GO

YESYES

66 AVOIDS AVOIDS SCHOOLWORKSCHOOLWORK

NONO TALKS TOO TALKS TOO MUCHMUCH

NONO

77 LOSES THINGSLOSES THINGSEASILYEASILY

NONO BLURTS OUT BLURTS OUT ANSWERSANSWERS

NONO

88 DISTRACTEDDISTRACTED NONO CAN’T WAIT CAN’T WAIT TURNTURN

YESYES

99 FORGETFULFORGETFUL YESYES INTERRUPTS INTERRUPTS OR INTRUDESOR INTRUDES

YESYES

NUMBER OF NUMBER OF INATTENTION INATTENTION SYMPTOMSSYMPTOMS

44 NUMBER OF NUMBER OF HYPERACTIVITHYPERACTIVITY SYMPTOMSY SYMPTOMS

77

SYMPTOM CHECKLISTS FOR TWO PATIENTS SYMPTOM CHECKLISTS FOR TWO PATIENTS WHO MEET CRITERIA FOR ADHD, WHO MEET CRITERIA FOR ADHD,

HYPERACTIVE/IMPULSIVE SUBTYPEHYPERACTIVE/IMPULSIVE SUBTYPEHYPERACTIVITY/HYPERACTIVITY/

IMPULSIVITYIMPULSIVITY PATIENT #1PATIENT #1 PATIENT #2PATIENT #2

11 FIDGETSFIDGETS YESYES NONO

22 CAN’T STAY SEATEDCAN’T STAY SEATED YESYES NONO

33 RUNS ABOUT AND CLIMBSRUNS ABOUT AND CLIMBS YESYES NONO

44 CAN’T PLAY QUIETLYCAN’T PLAY QUIETLY YESYES YESYES

55 IS OFTEN ON THE GOIS OFTEN ON THE GO YESYES YESYES

66 TALKS TOO MUCHTALKS TOO MUCH YESYES YESYES

77 BLURTS OUT ANSWERSBLURTS OUT ANSWERS NONO YESYES

88 CAN’T WAIT TURNCAN’T WAIT TURN NONO YESYES

99 INTERRUPTS OR INTRUDESINTERRUPTS OR INTRUDES NONO YESYES

TOTAL”YES”TOTAL”YES” 66 66

NUMBER OF POSSIBLE OF DSM-IV NUMBER OF POSSIBLE OF DSM-IV SYMPTOM CONFIGURATIONS THAT SYMPTOM CONFIGURATIONS THAT MEET CRITERIA FOR DIAGNOSIS OF MEET CRITERIA FOR DIAGNOSIS OF

ADHDADHD

FOR HYPERACTIVE SUBTYPE ONLY:FOR HYPERACTIVE SUBTYPE ONLY:

– NUMBER OF VARIATIONS ON 9 CRITERIANUMBER OF VARIATIONS ON 9 CRITERIA9/6 = 849/6 = 849/7 = 369/7 = 369/8 = 99/8 = 99/9 = 19/9 = 1

∑ ∑ = = 130130

NUMBER OF POSSIBLE OF DSM-IV NUMBER OF POSSIBLE OF DSM-IV SYMPTOM CONFIGURATIONS THAT SYMPTOM CONFIGURATIONS THAT MEET CRITERIA FOR DIAGNOSIS OF MEET CRITERIA FOR DIAGNOSIS OF

ADHD—ALL SUBTYPESADHD—ALL SUBTYPES

HYPERACTIVE SUBTYPE: 130HYPERACTIVE SUBTYPE: 130

INATTENTIVE SUBTYPE: 130INATTENTIVE SUBTYPE: 130

COMBINED SUBTYPE: 260COMBINED SUBTYPE: 260

SUM OF POSSIBLE CONFIGURATIONS: 520SUM OF POSSIBLE CONFIGURATIONS: 520

DOMAIN OF ADHD SYMPTOMS

1

3

2

4

10

17

8

1814

13

7

9

12

6516

11

15

ADHD SYMPTOMS AS SUBDOMAIN OF MORE INCLUSIVE DOMAIN OF ALL

SYMPTOMS OF NEUROPSYCHIATRIC DISORDER

1

32

4

811

796

5

10

13

15

12

1617

18

14

INDIVIDUAL WITH “PURE”ADHD, REPRESENTED AS SUBSET OF SYMPTOMS IN ADHD SUB-DOMAIN,

EXCLUSIVE OF ALL NON-ADHD SYMPTOMS IN LARGER DOMAIN OF ALL MALADAPTIVE BEHAVIORS

1

32

4

811

7

9

65

10

13

15

12

16

1718

14

MORE COMMON CASE: INDIVIDUAL WHO MEETS DSM-IV DIAGNOSTIC CRITERIA FOR ADHD, BUT

ALSO PRESENTS WITH SYMPTOMS NOT CONSIDERED DIAGNOSTIC OF ADHD

1

3

2

4

8

11

7

96

5

1013

15

12

16

1718

14

IS THIS ADHD? INDIVIDUAL STILL MEETS DSM-IV DIAGNOSTIC CRITERIA FOR ADHD, BUT ALSO PRESENTS

WITH MANY MORE SYMPTOMS NOT CONSIDERED DIAGNOSTIC CRITERIA FOR ADHD

1

32

4

811

7

9

65

1013

15

12

1617

18

14

PROBLEM: MANY CONFIGURATIONS PROBLEM: MANY CONFIGURATIONS OF MALADAPTIVE BEHAVIOR ARE OF MALADAPTIVE BEHAVIOR ARE

LABELED “ADHD” LABELED “ADHD” •Should the label, ADHD, be assigned Should the label, ADHD, be assigned to a potpourri of disorders with only to a potpourri of disorders with only some features in common?some features in common?

•Are there “core” features of “true” Are there “core” features of “true” ADHD? ADHD?

•What are the most common non-core What are the most common non-core accompaniments of ADHD?accompaniments of ADHD?

•When do these non-core features When do these non-core features signify that a diagnosis other than signify that a diagnosis other than ADHD is more appropriate?ADHD is more appropriate?

BIOLOGICAL EVIDENCE FOR A BIOLOGICAL EVIDENCE FOR A CORE ADHD SYNDROMECORE ADHD SYNDROME

1.1. NEUROCHEMICALNEUROCHEMICAL

2.2. GENETICGENETIC

3.3. ELECTROPHYSIOLOGICAL ELECTROPHYSIOLOGICAL

4.4. FUNCTIONAL IMAGINGFUNCTIONAL IMAGING

5.5. NEUROPSYCHOLOGICALNEUROPSYCHOLOGICAL

NEUROCHEMICAL NEUROCHEMICAL

MOST EFFECTIVE TREATMENT--CNS MOST EFFECTIVE TREATMENT--CNS STIMULANTSSTIMULANTS

• DEXTROAMPHETAMINESDEXTROAMPHETAMINES

• METHYLPHENIDATESMETHYLPHENIDATES

• EFFECTS:EFFECTS:– Improved classroom behaviorImproved classroom behavior– Improved academic productivityImproved academic productivity– Improved peer/adult interactionsImproved peer/adult interactions– Less frequent oppositional conductLess frequent oppositional conduct– Reduced aggression Reduced aggression

GENETICGENETIC

BEFORE MOLECULAR BIOLOGYBEFORE MOLECULAR BIOLOGY

Catecholamine hypothesis—genetic variations Catecholamine hypothesis—genetic variations in brain neurochemistry (Wender, 1971)in brain neurochemistry (Wender, 1971)

Family genetic studies (e.g., Faroane, Family genetic studies (e.g., Faroane, Biederman, Chen et al., 1992)Biederman, Chen et al., 1992)

AFTER MOLECULAR BIOLOGYAFTER MOLECULAR BIOLOGY

Subsensitive dopamine receptor hypothesis; Subsensitive dopamine receptor hypothesis; DRD4 gene (LaHoste, Swanson, Wigal, et al., DRD4 gene (LaHoste, Swanson, Wigal, et al., 1996) 1996)

Dopamine transporter gene (Cook, Stein, Dopamine transporter gene (Cook, Stein, Krasowski, et al., 1995)Krasowski, et al., 1995)

FUNCTIONAL BRAIN IMAGINGFUNCTIONAL BRAIN IMAGING

Evidence before modern imaging Evidence before modern imaging methodsmethods

MBD hypothesis (Clements et al, 1963)MBD hypothesis (Clements et al, 1963) Neuropsychology of MBD (Crinella, 1972)Neuropsychology of MBD (Crinella, 1972)

Evidence from modern imaging Evidence from modern imaging methodsmethods

Methods used: PET; SPECT; fMRIMethods used: PET; SPECT; fMRI Results: Variations in size and symmetry of Results: Variations in size and symmetry of

brain structures (e.g., Swanson & brain structures (e.g., Swanson & Castellanos, 1997)Castellanos, 1997)

Structures involved:Structures involved:

FRONTO-STRIATAL FRONTO-STRIATAL NETWORKNETWORK

CAUDATE NUCLEUSCAUDATE NUCLEUS BASAL GANGLIABASAL GANGLIA

RECENT BRAIN IMAGING STUDIES RECENT BRAIN IMAGING STUDIES IN ADHDIN ADHD

0

1

2

3

4

5

6

7

8

9Caudate

DL Frontal

Putamen-gp

Occipital

Temporal

Insula

A. Cingulate

Premotor

Thalamus

Hippocampus

Insula

CC (genu)

CC (splenium)

Periventricular

Premotor

basal gangial

ELECTROPHYSIOLOGYELECTROPHYSIOLOGY

Early studies of analog EEG Early studies of analog EEG

Satterfield, J.H., & Schell, A.M. (1984). Childhood brain Satterfield, J.H., & Schell, A.M. (1984). Childhood brain function differences in delinquent and non-delinquent function differences in delinquent and non-delinquent

hyperactive boys. hyperactive boys. Electroencephalography and Clinical Electroencephalography and Clinical NeurophysiologyNeurophysiology, 57, 199-207., 57, 199-207.

Finding: Abnormal maturational effects of auditory Finding: Abnormal maturational effects of auditory event-event- related potential differentiated ADHD from non-ADHD related potential differentiated ADHD from non-ADHD subjectssubjects

Recent brain mapping studiesRecent brain mapping studies

Pliszka, S.R., Liotti, M., & Woldorff, M.G. (2000). Pliszka, S.R., Liotti, M., & Woldorff, M.G. (2000). Inhibitory Inhibitory control in children with control in children with attention-deficit/hyperactivity attention-deficit/hyperactivity disorder. disorder. Biological Biological PsychiatryPsychiatry, 48,238-46., 48,238-46.

Finding: Event related potentials identify the processing Finding: Event related potentials identify the processing component and timing of an impaired right-frontal component and timing of an impaired right-frontal

response-response- inhibition mechanism. inhibition mechanism.

COGNITIVE NEUROPSYCHOLOGYCOGNITIVE NEUROPSYCHOLOGY

BASED ON TRADITIONAL APPROACH TO BASED ON TRADITIONAL APPROACH TO STUDYING BRAIN-BEHAVIOR RELATIONSHIPSSTUDYING BRAIN-BEHAVIOR RELATIONSHIPS

1.1. Experimental removal of brain structuresExperimental removal of brain structures

2.2. Observation of effect on specific Observation of effect on specific behavioral functionsbehavioral functions

3.3. Identification of brain structures/networks Identification of brain structures/networks that are correlated with ADHD-like that are correlated with ADHD-like behaviorbehavior

DISTINCT ANATOMICAL NETWORKS DISTINCT ANATOMICAL NETWORKS CARRY OUT SPECIFIC ASPECTS OF CARRY OUT SPECIFIC ASPECTS OF ATTENTIONATTENTION• ALERTING NETWORKALERTING NETWORK

– LOCATION: ARAS, ETC.LOCATION: ARAS, ETC.– FUNCTION: ACHIEVE AND MAINTAIN STATE OF FUNCTION: ACHIEVE AND MAINTAIN STATE OF

READINESSREADINESS

• ORIENTING NETWORKORIENTING NETWORK– LOCATIONS: PARIETAL LOBE, SUPERIOR COLLICULUS & LOCATIONS: PARIETAL LOBE, SUPERIOR COLLICULUS &

PULVINARPULVINAR– FUNCTION: REACT TO SENSORY STIMULIFUNCTION: REACT TO SENSORY STIMULI

• EXECUTIVE NETWORKEXECUTIVE NETWORK– LOCATION: ANTERIOR CINGULATE; DORSOLATERAL LOCATION: ANTERIOR CINGULATE; DORSOLATERAL

FRONTAL CORTEX & BASAL GANGLIAFRONTAL CORTEX & BASAL GANGLIA– FUNCTIONS: FUNCTIONS:

• CONTROL NEURAL RESPONSES TO STIMULICONTROL NEURAL RESPONSES TO STIMULI• GENERATE NEW INFORMATION FROM LONG TERM MEMORYGENERATE NEW INFORMATION FROM LONG TERM MEMORY• PRIORITIZE OPERATION OF OTHER BRAIN AREASPRIORITIZE OPERATION OF OTHER BRAIN AREAS

ADHD IS A DISORDER THAT ADHD IS A DISORDER THAT PRIMARILY AFFECTS THE PRIMARILY AFFECTS THE

EXECUTIVE NETWORKEXECUTIVE NETWORK

SOME FEATURES OF SOME FEATURES OF EXECUTIVE FUNCTION—EXECUTIVE FUNCTION—

STERNBERG (1985)STERNBERG (1985)• Decision as to just what the problem is Decision as to just what the problem is

that needs to be solvedthat needs to be solved• Selection of lower-order componentsSelection of lower-order components• Selection of one or more Selection of one or more

representations of organizations for representations of organizations for informationinformation

• Selection of a strategy for combining Selection of a strategy for combining lower order componentslower order components

• Decision regarding tradeoffs in the Decision regarding tradeoffs in the speed and accuracies with which speed and accuracies with which various components are executedvarious components are executed

• Solution monitoringSolution monitoring

TESTS OF EXECUTIVE FUNCTION IN TESTS OF EXECUTIVE FUNCTION IN THE HUMAN NEUROPSYCHOLOGY THE HUMAN NEUROPSYCHOLOGY

LABORATORYLABORATORY• By definition, no test can be performed in By definition, no test can be performed in

the absence of executive controlthe absence of executive control

• Executive functions must be differentiated Executive functions must be differentiated from other cognitivefrom other cognitive– abstract reasoningabstract reasoning– crystallized problem solvingcrystallized problem solving– long term memorylong term memory– sensory-perceptual processing sensory-perceptual processing – motor control systemsmotor control systems– Motivational statesMotivational states

• Which tests do this best?Which tests do this best?

SPECIFIC NEUROPSYCHOLOGICAL SPECIFIC NEUROPSYCHOLOGICAL APPROACHES TO IDENTIFICATION APPROACHES TO IDENTIFICATION

OF ADHDOF ADHD

EXAMPLE OF LABORATORY MEASURE EXAMPLE OF LABORATORY MEASURE OF EXECUTIVE FUNCTION--OF EXECUTIVE FUNCTION--CONTINUOUS PERFORMANCE TEST CONTINUOUS PERFORMANCE TEST (CPT)(CPT)

– FOCUSES ON SPECIFIC AREAS OF FOCUSES ON SPECIFIC AREAS OF EXECUTIVE FUNCTIONEXECUTIVE FUNCTION• TASK PERSISTENCETASK PERSISTENCE

• VIGILANCEVIGILANCE

• IMPULSE CONTROLIMPULSE CONTROL

• REGULATION OF AROUSAL LEVELREGULATION OF AROUSAL LEVEL

PRESS BUTTON EVERY TIME A LETTER APPEARSPRESS BUTTON EVERY TIME A LETTER APPEARS

A

EXCEPT WHEN THE LETTER “X” APPEARSEXCEPT WHEN THE LETTER “X” APPEARS

X

CONTINUOUS PERFORMANCE TESTCONTINUOUS PERFORMANCE TEST

SCORING CATEGORIES:SCORING CATEGORIES:

• OmissionsOmissions• CommissionsCommissions• Overall Processing SpeedOverall Processing Speed• Overall Attentional VariabilityOverall Attentional Variability• Perceptual SensitivityPerceptual Sensitivity• Risk TakingRisk Taking• PerseverationsPerseverations• Speed Decrement Over timeSpeed Decrement Over time• Variability Over timeVariability Over time• Activation/arousal Activation/arousal

HIT REACTION TIME

300

325

350

375

400

425

450

475

500

525

550

575

600

625

650

675

700

MIL

LIS

EC

ON

DS

TYPICAL

ADHD 1 SEC

2 SEC

4 SEC

STANDARD ERROR OF HIT REACTION TIME

0

10

20

30

40

50

60

70

80

90

100

MIL

LIS

EC

ON

DS

TYPICAL

ADHD

1 SEC

2 SEC

4 SEC

COMMISSION ERRORS

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

MIL

LIS

EC

ON

DS

CONTROLSADHD

1 SEC2 SEC 4 SEC

NON-ADHD CONDITIONS THAT CAN NON-ADHD CONDITIONS THAT CAN AFFECT SCORES ON CPT:AFFECT SCORES ON CPT:

• Commissions: anxiety; toxic irritabilityCommissions: anxiety; toxic irritability• Omissions: depression; dyspraxia; schizophreniaOmissions: depression; dyspraxia; schizophrenia• Overall Processing Speed: depression; anxiety; Overall Processing Speed: depression; anxiety;

metabolic conditions (e.g., hypoglycemia)metabolic conditions (e.g., hypoglycemia)• Perceptual Sensitivity: Visual acuity; dyseidetic Perceptual Sensitivity: Visual acuity; dyseidetic

dyslexia; cataracts; dyslexia; cataracts; • Risk Taking: psychopathy; anxiety; bipolar Risk Taking: psychopathy; anxiety; bipolar

disorder disorder • Perseverations: psychomotor retardation; Perseverations: psychomotor retardation;

frontal lobe damage; frank mental retardationfrontal lobe damage; frank mental retardation• Speed Decrement Over time: depression; Speed Decrement Over time: depression;

diabetes; hypothyroidismdiabetes; hypothyroidism• Activation/arousal: schizotypal conditions Activation/arousal: schizotypal conditions

(blocking); obsessional states; malnutrition(blocking); obsessional states; malnutrition

CPT AND DSM-IV COMMONALITIES FOR INDIVIDUALS WITH ADHD AND INDIVIDUALS WITH ANXIETY

UNDERAROUSED

IMPERSISTENT

RECKLESS

PERSEVERATIVE

IMPULSIVE

RESTLESS AND ON EDGE

DIFFICULTY CONCENTRATING

IRRITABLETENSE

DISTURBED SLEEP

CPT DSM-IV

CPT AND DSM-IV COMMONALITIES FORINDIVIDUALS WITH ADHD AND INDIVDUALS WITH DEPRESSION

IMPULSIVEIMPERSISTENT

RECKLESS

PERSEVERATIVE

UNDERAROUSED

LOW ENERGY OR FATIGUE

POOR CONCENTRATION

INSOMNIA/HYPERSOMNIAHOPELESSNESS

POOR APPETITE

CPT DSM-IV

CONCLUSIONS REGARDING THE CONCLUSIONS REGARDING THE DIAGNOSTIC SPECIFICITY OF TESTS DIAGNOSTIC SPECIFICITY OF TESTS

OF EXECUTIVE FUNCTIONOF EXECUTIVE FUNCTION

The capacity to maintain attention is The capacity to maintain attention is fragile, and may be affected by virtually fragile, and may be affected by virtually any psychiatric and/or neurological any psychiatric and/or neurological condition condition

Even on tests of executive function, Even on tests of executive function, thought to be quite specific for the thought to be quite specific for the “core” deficits found in ADHD, problems “core” deficits found in ADHD, problems other than ADHD will affect performanceother than ADHD will affect performance

CONCLUSIONSCONCLUSIONSMany individuals thought to have ADHD may Many individuals thought to have ADHD may

have behavioral deficits that are commonly have behavioral deficits that are commonly found among individuals with ADHD, but found among individuals with ADHD, but these deficits are also found in individuals these deficits are also found in individuals with a host of other psychiatric disorderswith a host of other psychiatric disorders

The incidence and prevalence of persons who The incidence and prevalence of persons who have true ADHD, a hereditarily-transmitted have true ADHD, a hereditarily-transmitted disorder of the brain’s dopaminergic disorder of the brain’s dopaminergic networks is probably much less than claimed networks is probably much less than claimed by ADHD professionals and advocatesby ADHD professionals and advocates

Nevertheless: Those whose attentional Nevertheless: Those whose attentional processes are affected by neuropsychiatric processes are affected by neuropsychiatric conditions other than ADHD are as deserving conditions other than ADHD are as deserving of treatment and accommodations for their of treatment and accommodations for their attentional deficits as are those with “true” attentional deficits as are those with “true” ADHDADHD