Visual-selective attention in young adult males with Attention-Deficit/Hyperactivity Disorder

The purpose of this study was to investigate the selective atte ntion abilities of young adults (aged 18 to 22 years), diagnosed with ADHD. The study was g uided by Michael Posner’s (1990) Attention Network Theory that examines three, neural systems of visual attention. The study also surveyed the domains of visual memory and vis ual processing speed to examine factors that might account for differences found a mong the participants. The sample included young adults who have been diagnosed with Attention– Deficit/Hyperactivity Disorder combined type (ADHD), a compar ison group of young adults who have been diagnosed with Bipolar Disorder, and a Control group of y oung adults who have never been diagnosed with ADHD or Bipolar Disorder. No significant differences found among the three groups on tasks of selective visual attention, visual memory and visual processing speed. A significant difference was found, however, on a task of visual copy. Thus, the ADHD group performed worse than the Bipol ar Disorder and Control group when copying a visual stimulus from a model. ADHD and Selective Attention 9 CHAPTER ONE This chapter presents the background of the problem, the rationale and significant research, statement of the problem, the purpose of the proposed study, major research questions and potential benefits of the study. INTRODUCTION Background of the Problem Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common psychiatric disorder presenting for treatment in youth (Riccio et al, 2004; Bi ederman, 2005; Wilens, Biederman, & Spencer, 2002) and is affecting an estimated three to f iv percent of the school-aged population (Barkley, 2007). ADHD tends to be chronic and is characterized by developmentally inappropriate levels of inattention, hyper activ impulsive behavior, or a combination of both that arise in childhood and may result in cognitive, behavioral, academic, peer, familial, and emotional impairments acr oss various domains (Barkley et al, 2001). The symptoms must be present before the age of seven, must be exhibited in two or more settings, and must exist for a minimum duration of s x months (American Psychiatric Association, 2000). Approximately half of the children diagnosed with ADHD tend to exhibit symptoms by the age of five years, and most begin to exhibit behavioral diffic ulties during the first years of school (Barkley, 2002). This is expected because there a re demands that come with a child’s entry into school: they are expected to follow instructions, obey rules, remain seated at their desks, and stay focused on tasks for prolonged periods of time (Faraone & Biederman, 2005). ADHD and Selective Attention 10 Most research to date has focused on the manifestation of ADHD in childhood and adolescence (Barkley, 2007; Biederman et al, 2006). In the 1990’s, however, it became evident that individuals, diagnosed with ADHD as children, continued to exhibit difficulties in adulthood (Nylander et al, 2009). Studies estimate that 50 to 80 percent of children diagnosed with ADHD continue to manifest symptoms into adolescence (Wodushek & Neumann, 2003; Fischer et al, 2005), and that approximately 30 to 70 percent of children diagnosed with ADHD continue to exhibit symptoms into adulthood (Halmoy et al, 2009; Riccio et al, 2004; Wilens, Biederman, & Spencer, 2002). As children with ADHD grow towards adolescence and adulthood, the hyperactivity tends to diminish (Clarke, Heussler, and Kohn, 2005), but impulsivity and concentration difficulties tend to persist (Wodushek & Neumann, 2003). ADHD in Adulthood Until recently, the symptoms of ADHD were believed to remit in adolescence and early adulthood (Nylander et al, 2009; Wilens, Biederman, & Spencer, 2002). Current research supports the persistence of ADHD into adulthood (Biederman et al, 2008; Fischer et al, 2005; Clarke, Heussler, & Kohn, 2005; Wodushek & Neumann, 2003; Ossman & Mulligan, 2003), and demonstrates that children diagnosed with ADHD exhibit substantial impairment across the lifespan (Halmov et al, 2009; Nylander et al, 2009; Biederman, 2005; Torgersen et at, 2006; Fischer et al, 2005). As children with ADHD grow towards adolescence and adulthood, the hyperactivity tends to diminish (Clarke, Heussler, and Kohn, 2005), but impulsivity and concentration difficulties tend to persist (Wodushek & Neumann, 2003). The decline in childhood ADHD symptoms “is enough to put some adults at or below the threshold that ADHD and Selective Attention 11 the DSM defines for the disorder . implies that a child with ADHD may outgrow th e DSM criteria but not necessarily outgrow the disorder” (Barkley, 2002b, p. 12). Studie s also suggest that there is an atypical group of adults with ADHD, who were not diagnosed with the disorder in childhood, but demonstrate impairments in attention, impulsivity, and executive functioning (Faraone et al, 2009; Nylander et al, 2009). Prevalence Symptoms of ADHD are estimated to continue into adolescence in more than 75 percent of cases (Barkley, 2007), and symptoms persist into adulthood in approximately 65 percent of cases; affecting four percent of the adult population nationwide (Faraon e et al, 2009; Tamam et al, 2008; Kessler et al, 2006; Philipsen et al, 2005; Torgersen, Gjervan & Rasmussen, 2006). ADHD occurs at all levels of intelligence, all socioeconomic levels (Barkley, 2002), across all racial groups (Riccio et al , 2004), and has been diagnosed in “all cultures and societies studied” worldwide (Clarke, Heus sler, & Kohn, 2005). Bipolar Disorder. Current research suggests a bidirectional overlap between symptoms of Bipolar Disorder and ADHD (Biederman et al, 2008; Biederman et al , 2006). A study by Henin et al (2007) found that adults diagnosed with Bipolar Disorder had significantly higher rates of disruptive behavior disorders, ADHD, anxiety di sorders and enuresis in childhood. A recent review by Wingo and Ghaemi (2007) found that the comorbid syndrome of ADHD and Bipolar Disorder is fairly common, and is diagnosed in up to 47% of adults with ADHD and 21% of adults with Bipolar Disorder. Tamam et al (2006) assessed 44 patients who had been diagnosed with Bipolar I disorder, and found that 15.9 percent manifested symptoms of ADHD. The National Comorbidity Survey ADHD and Selective Attention 12 estimates a 10.4 percent prevalence of Bipolar I and Bipolar II Disorders a mong adults diagnosed with ADHD (Kessler et al, 2006). The onset of bipolar symptomatology, in individuals with ADHD, is approximately 5 years earlier (age 13.5 years compared to 18 years) than is ty pically observed in the general population (Sobanski, 2006). Given chronic course of these disorders, it has been suggested that ADHD may be an early marker for the ons et of Bipolar Disorder (Biederman et al, 2008; Henin et al, 2007) or that there may be a symptomalogical continuity between ADHD and Bipolar Disorder (Tamam et a l, 2008) A study by Reimherr and associates (2005) surveyed adults diagnosed with ADHD, a nd determined that approximately 33 percent demonstrated met at least moderat e impairment in emotional dysregulation including: difficulties with temper, affective l abi ity and emotional overreactivity. It is difficult to discern, however, whether thes e symptoms can be attributed to a comorbid diagnosis (Kessler et al, 2006) or are indicative of the manifestation of ADHD in adulthood (Biederman et al, 2006; Barkley, 2002). The difficulty in distinguishing ADHD and Bipolar Disorder, is due to the high prevalence of a comorbid diagnosis of ADHD among bipolar patients, and from the overlap of certain DSM-IV criteria for mania and ADHD (Kessler et al, 2006). Irritability is one of the most frequent symptoms of mania/hypomania, but it i s of little help in the differential diagnosis because of its ubiquity across a number of diagnose s, including: anxiety, major depressive disorder and antisocial personality disorde r