Inattention & Dissociation: Overlapping Constructs?

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.

Inattention & Dissociation: Overlapping Constructs?