Inattention

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Inattention Dissociation Overlapping
Constructs?
Dr. Allyson G. Harrison Dr. Jan Baker
Wilson Regional Assessment Resource Centre
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Copy of paper

• ADHD Report (in press, 2005)

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Prevalance of ADHD

• Estimate 3-6 of school-age children (Tannock
  Rucklidge, 2002)
• Less than half will go on to have clinically
  impairing symptoms in adulthood
• (Searight, Burke, Rottnek, 2000)
• Information from Post-Secondary statistics
  indicates 1 identify as having ADHD

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Dx criteria for ADHD

• Symptoms have to have appeared early in life
  (usually before age 7, certainly before age 12)
• Symptoms have been chronic
• Symptoms cause significant impairment in at least
  TWO major life areas
• Symptoms are not the result of co-existing
  disorders (rule out clause)

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Dx criteria for ADHD

• DSM-IV specifically says one cannot diagnose ADHD
  if the symptoms could be better explained by a
  dissociative disorder
• Question remains-how different are the symptoms
  of dissociation and inattention? ie. How easy is
  it to differentiate inattention from dissociation?

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Dissociation

• Dissociation s/o vs inattention
• Dissociation refers to disruption in the
  normally integrated functions of consciousness,
  memory, identity perception of the environment
• Symptoms include inattention, forgetfulness,
  distractibility, as well as more serious symptoms
  such as depersonalization amnesia for events.
• Symptoms may emerge in childhood secondary to
  trauma, and often continue into adulthood

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Dissociation continued

• Dissociation often found in PTSD
• Many symptoms of ADHD, including inattentive s/o,
  overlap with s/o of PTSD Weinstein, Stafflebach,
  and Biaggio (2000)
• Screening for dissociation s/o, or even asking
  about trauma hx typically not part of assessment
  for ADHD.

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Difficulties dx ADHD in adults

• In ideal world, clinicians could collect
  retrospective history of symptoms provided by a
  collateral source (e.g., a parent), to help with
  differential diagnosis
• Issues Parents may not always disclose abuse
  may be dead/unavailable
• Establishment of onset after age 12 can help with
  differentiation of ADHD from other disorders (cf
  Rucklidge Tannock, 2000).
• Sadly, not always possible with adults

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Purpose of present study

• To investigate the extent to which reported
  symptoms of ADHD and Dissociation are related or
  overlap.
• Establish whether or not the symptoms of ADHD
  overlap with those of dissociation.

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Present study

• 224 students presenting to Health/ Counselling
  Service first 2 weeks January
• Exclusion criteria was prior dx ADHD
• 180 students from Health
• 32 Counselling Academic skills
• 12 Psychiatry
• Median age 21
• 65 female, but no difference by sex

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Procedure

• As part of survey about attention problems, asked
  participants to complete the Dissociative
  Experiences Scale (DES).
• Also completed the Brown Attention Activation
  Disorders Scale (BAADS-2)

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Results

• Scores on DES significantly positively
  correlated with all subscales of BAADS
• Overall correlation between two scales was .50
  (plt.01)
• Even taking more pathological items from DES
  did not help-correlations continued to be high.
• Indicates moderate overlap between symptoms of
  two disorders.

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Results

• People scoring in ADD highly probable range on
  BAADS scored significantly higher on DES
  (mean18.7) vs. those below that range (mean9.4)
• Using cut off of 30 on DES, 7.1 of students
  endorsed clinically significant levels of
  dissociation.

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Conclusions

• ADHD inattentive symptoms overlap substantially
  with symptoms of dissociation
• Concern because dissociative disorder one of the
  main rule outs in diagnosis of ADHD
• Always screen for dissociative symptoms and ask
  about past or current abuse/trauma
• Engage in further research to improve
  differentiation of two constructs.