Attention, Development and Psychopathology.

Stars lead off, Moonbeams bring up the rear, with precious metals and gems along the way! This activity-based workbook is designed to assisThe stated goal of the book is to provide an initial forum for researchers within specific areas of development such as attention and memory, as they relate to development and different types of psychopathology. The book is a compilation of separately authored chapters divided into four sections of varying lengths. The first section contains a single introductory chapter entitled: Attention, Development and Psychopathology: Bridging Disciplines – by the editors. This chapter provides a brief historical summary of the young field of developmental psychopathology. It contrasts the constructivist view of development of psychopathology, which focuses on the “understanding and documenting of universal laws for a holistically organized organism”, with the de-constructivist and mechanistic discipline of psychopathology, which focuses on “impairments in specific processes and mechanisms. ” The book also addresses different perspectives from which attention has been studied including the developmental, the evolutionary, theoretical perspectives and research approaches. Gibson sees a progression from undifferentiated attention to increasing differentiation and integration. Still others see it as the development of the skills to perform a task of responding to stimuli, analyzing, synthesizing, and coordinating the sensory experiences. The distributive systems approach sees development as the process of bringing the processing of information from the primary sensory systems progressively under higher level (cortical) control. Section 2, reviews the development of visual and selective attention across the lifespan. Section 3, Infancy Attention and the Psychopathology, discusses the limited research on attention regulation in infants born at-risk including: prematurity, cocaine exposure, Down Syndrome and Attention-deficit/Hyperactivity Disorder. The research to date is generally limited. It was useful to learn that pre-term and cocaine exposed infants show different patterns of attention impairment with different developmental implications. Pre-term infants are less efficient in quoting information during sustained attention, and have longer latencies before shifting attention, while cocaine exposed infants show problems in regulation of arousal, which in turn affects attention. If arousal level in cocaine-abused infants can re-stabilize to achieve attention, they are able to process and encode information similar to non-exposed infants. The next chapter on ADHD was most interesting. It focused on attentional processes in infants that may be related to attentional processes in ADHD. It related identified attentional deficiencies in ADHD to comparable deficiencies in infancy, focusing in particular on the discrimination problem-solving approach and on commonalities across the age groups. The authors make the point that the problems with sustained and selective attention (which is common in ADHD) cannot be identified with certainty as a primary attention problem. Review of the research leads to the conclusion that attention skills in ADHD patients is more inefficient and variable with an either slower or variable response time. Attention in ADHD, therefore, has to be assessed dynamically taking into account how attention may actually be deployed under the demands of solving a particular problem or task. The discrimination problem-solving task which has been used in the study of infants below one year, as well as in five- to seven- year old ADHD children is proposed, as such an approach focuses on the assessment of “attentional functioning” as opposed to attentional performance. The preliminary research shows that both infants and older children use hypothesis to guide their attention to solve problems and that hypothesis testing appears to be deficient in ADHD. It appears that such testing was not available outside of the research setting at the time of publication of the book. The fourth and last section of the book addresses attention problems in several psychiatric disorders under the heading: ‘Childhood, Attention and Psychopathology’. In eight chapters it covers the teratogenic effects of alcohol on attention; ADHD in mental retardation; executive dysfunction in autism; attention problems in Alzheimer’s; attention problems in individuals at risk for schizophrenia; attention problems in anxiety and depression; as well as attention problems in psychopaths. A middle chapter on: The Study of Selective Visual Attention in Cognitive Neuroscience, seems out of place, though quite interesting. Of most interest were the chapters on alcohol exposure, schizophrenia, depression and anxiety. It was surprising how few conclusive research findings there are in these areas regarding the relationship of attention to specific psychopathology. Pre-natal alcohol exposure appears to be causally related to attention problems, especially to vigilance in infancy, that are still detectable in adolescence, and to be a manifestation of alcohol related CNS dysfunction. Attention problems in children at risk for schizophrenia are multiple and varied and do not fit a single explanatory theory. In anxiety and depression, the focus has been more on the content aspects of the attention problem. This was disappointing since these disorders often co-occur with ADHD, requiring the need to diagnose and treat differentially the attention as part of the anxiety or depression, or as part of ADHD. Between anxiety and depression, anxiety is marked by selective attentional bias towards negative or threatening aspects of the environment with a future orientation, while in depression, attention is biased selectively towards past memories and the encoding of emotionally negative stimuli in both children and adults. The contribution of development is still a matter of theoretical speculation. The material covered in this book is often quite involved, requiring more background knowledge of neuroscience than the average child psychiatrist has, but detailed descriptions of key studies keep the reader interested, though fully challenged. Most chapters contain a summary paragraph crystallizing the take-home lessons. Most also evaluate the quality of the research and point to future directions, sometimes with specific proposals. Tables and diagrams help in assimilating the information. This book is intended mainly for students in the field of developmental psychopathology with a research focus or interest. Although not comprehensive in the breadth of content, it can provide a very useful reference in the areas covered. There were minor typographical errors. Despite these flaws, I would recommend this as a very useful reference for students in the field, as well as for teachers and clinical researchers in the area of ADHD who wish to deepen their understanding of the clinical phenomena. The book was already more than five years old at the time of review. An updated edition would no doubt contain additional useful and current information. Well recommended.