Transcript Genetic risk factors

Inattention & Dissociation:
Overlapping Constructs?
Dr. Allyson G. Harrison &
Dr. Jan Baker Wilson
Regional Assessment &
Resource Centre
Copy of paper
• ADHD Report (in press, 2005)
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
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)
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?
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
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.
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
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.
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
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)
Results
• Scores on DES significantly & positively
correlated with all subscales of BAADS
• Overall correlation between two scales
was .50 (p<.01)
• Even taking more “pathological” items
from DES did not help-correlations
continued to be high.
• Indicates moderate overlap between
symptoms of two disorders.
Results
• People scoring in “ADD highly probable”
range on BAADS scored significantly
higher on DES (mean=18.7) vs. those
below that range (mean=9.4)
• Using cut off of 30 on DES, 7.1% of
students endorsed clinically significant
levels of dissociation.
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.