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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)

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Inattention dissociation overlapping constructs l.jpg

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 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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  • 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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  • 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.

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  • 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.

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  • 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.