Dimensions and Types of Attention Deficit Disorder

doi:10.1097/00004583-198805000-00011

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 27, Issue 3, May 1988, Pages 330-335

https://doi.org/10.1097/00004583-198805000-00011 Get rights and content

Abstract

DSM-III-R provides a unidimensional definition of attention deficit-hyperactivity disorder (ADHD), based on the assumption that inattention, impulsivity, and motor hyperactivity are unitary aspects of the same dimension. The definition of undifferentiated attention deficit disorder (UADD), however, contradicts this assumption by treating inattention as a separate dimension. The present study evaluated these assumptions empirically. A cluster analysis of three factors derived from factor analyses of teacher ratings of ADD symptoms and a broader list of ADD symptoms produced three distinct clusters: patients without ADD, those with both inattention and hyperactivity, and a group that exhibited inattention and sluggish tempo but not hyperactivity. The association was very strong between the empirically derived clusters and clinical DSM-III diagnoses of ADD with and without hyperactivity. These findings do not support the DSM-III-R unidimensional definition of ADHD.

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Cited by (234)

Report of a Work Group on Sluggish Cognitive Tempo: Key Research Directions and a Consensus Change in Terminology to Cognitive Disengagement Syndrome
2023, Journal of the American Academy of Child and Adolescent Psychiatry
The aim of this work was 2-fold: (1) to evaluate current knowledge and identify key directions in the study of sluggish cognitive tempo (SCT); and (2) to arrive at a consensus change in terminology for the construct that reflects the current science and may be more acceptable to researchers, clinicians, caregivers, and patients.
An international Work Group was convened that, in early 2021, compiled an online archive of all research studies on SCT and summarized the current state of knowledge, noted methodological issues, and highlighted future directions, and met virtually on 10 occasions in 2021 to discuss these topics and terminology.
Major progress has been made over the last decade in advancing our understanding of SCT across the following domains of inquiry: construct measurement and stability; genetic, environmental, pathophysiologic, and neuropsychological correlates; comorbid conditions; functional impairments; and psychosocial and medication interventions. Findings across these domains are summarized, and potential avenues to pursue in the next generation of SCT-related research are proposed. Following repeated discussions on terminology, the Work Group selected “cognitive disengagement syndrome” (CDS) to replace “SCT” as the name for this construct. This term was deemed to best satisfy considerations that should apply when selecting terms for a condition or syndrome, as it does not overlap with established terms for other constructs, is not offensive, and reflects the current state of the science.
It is evident that CDS (SCT) has reached the threshold of recognition as a distinct syndrome. Much work remains to further clarify its nature (eg, transdiagnostic factor, separate disorder, diagnostic specifier), etiologies, demographic factors, relations to other psychopathologies, and linkages to specific domains of functional impairment. Investigators are needed with interests and expertise spanning basic, clinical, and translational research to advance our understanding and to improve the lives of individuals with this unique syndrome.
Sluggish cognitive tempo in autism, ADHD, and neurotypical child samples
2020, Research in Autism Spectrum Disorders
Citation Excerpt :
The construct of sluggish cognitive tempo (SCT) originated in the 1980s (e.g., Lahey et al., 1988) and has experienced a recent resurgence of interest.
Sluggish cognitive tempo (SCT) recently experienced a resurgence of interest in children with ADHD, but only three small studies have investigated SCT in autism.
Mothers rated 1,436 children with autism, 1,056 with ADHD without autism, and 186 typical controls, 2-17 years, on six SCT items from the Pediatric Behavior Scale.
Almost half (49%) of children with autism scored 1.5 standard deviations or more above the typical SCT mean, as did 40% with ADHD-Inattentive and 31% with ADHD-Combined. The significantly greater prevalence in autism versus ADHD is largely explained by the high frequency of ADHD in autism and the increased risk of SCT when both disorders are present. However, the higher than normal prevalence of SCT in autism is not accounted for by co-occurring ADHD because SCT scores were higher than the norm in children with autism who did not have ADHD and SCT scores did not differ significantly between children with autism without ADHD and children with ADHD without autism.
Previous research indicated SCT was associated with ADHD-Inattentive type, but our findings show that SCT is even more prevalent in autism. SCT is most common when autism and ADHD co-occur. Because autism without ADHD is rare (whereas ADHD without autism is not), it is important to assess both SCT and ADHD in children referred for autism evaluations and rule-out autism in children referred for ADHD. SCT may be another neurocognitive problem shared by children with autism and children with ADHD in need of assessment and intervention.
Striatal dynamics as determinants of reduced gambling vulnerability in the NHE rat model of ADHD
2020, Progress in Neuro-Psychopharmacology and Biological Psychiatry
Citation Excerpt :
The temptation to refer to a unique impulsivity/inattention dimension is powerful, but it could be incorrect. Thus, it seems more useful to consider Attention Deficit and/or Hyperactivity as multidimensional (Lahey et al., 1988). There is, maybe, a unique impulsivity dimension described by factors like impatience (e.g. difficulty in staying still) and inability to delay gratification.
The Naples High-Excitability (NHE) is a validated rat strain to model for a mesocortical variant of Attention Deficit Hyperactivity Disorder (ADHD). NHE rats' brains have a tuned-down cortical and a potentiated limbic loop (Zoratto et al., 2017). ADHD and comorbid pathological gambling (PG) involve similar deficits of prefrontal-striatal dialogue. This work aimed to understand if NHE rats (compared to normal random-bred rats, NRB) can be a useful model for gambling vulnerability in ADHD. Experiment 1 evaluated gambling proneness in NHE rats, namely attraction/avoidance in nose-poking for a “Large & Luck-Linked” (LLL) reward (versus a “Small & Sure” one, SS), when the probability of LLL delivery was progressively reduced. Experiment 2 assessed (by phMRI) differential responsivity of ventral (vStr) versus dorsal (dStr) striatum following a methylphenidate (MPH, 4 mg/kg I.P.) challenge. In NHE rats, reduced attraction by secondary cues (associated with uncertain, rarefying LLL delivery) comes along with little or no activation of dStr and enhanced activation of vStr by MPH. Together, such evidences from NHE rats indicate distinctive roles of ventral (enhanced value given to actual primary reward) and dorsal (lower encoding of repeated stimulus-reward associations into a habit) striatum. In conclusion, the dynamics of reward systems could link an attention deficit with a decreased vulnerability to pathological gambling.
Creativity in children with ADHD: Effects of medication and comparisons with normal peers
2020, Psychiatry Research
Citation Excerpt :
People with ADHD are described as frequently switching between activities, daydreaming and having the following struggles: staying focused on one task, paying attention to schoolwork, completing some tasks, getting organized, maintaining work performance, and self-regulating or remembering things. They are also often distracted and can disturb others (Barkley, McMurray, Edelbrock, and Robbins, 1990; Barkley, 2013; Fenollar Cortés et al., 2014; Lahey et al., 1988). Some of the symptoms persist into adulthood, for example, being easily distracted, “zoning out,” frequently switching between activities, and difficulty staying attentive or taking instructions (Millstein et al., 1997; Nigg et al., 2002).
This study is to identify the performance of children with and without ADHD in open-ended and closed-ended creativity assessments, and investigate the moderating effect of medicated and unmedicated Children. The study subjects included third to sixth graders: 43 children with ADHD and 43 typically developing children. The participants with ADHD were those who were identified by local Committees of Identification, Placement and Consultation for Children with Special Needs or those who were diagnosed by medical institutions. Children with ADHD were further divided into medicated (22 participants) and unmedicated groups (21 participants) based on their current medication treatment. This study employed the New Tests of Creative Thinking to gauge the participants’ open-ended creativity, while Remote Associates Test and the Insight Test were used to assess the participants’ closed-ended creativity. Although previous evidence for creativity in children with ADHD have been mixed, this study includes medication as moderation variable and suggests that the performance of unmedicated children with ADHD in the open-ended creativity assessments was better than medicated children with ADHD and typically developing children. The study results can further explore the creativity characteristics of children with ADHD.
The neurocognitive nature of children with ADHD comorbid sluggish cognitive tempo: Might SCT be a disorder of vigilance?
2018, Psychiatry Research
Sluggish Cognitive Tempo (SCT) refers to a clinical construct including several symptoms such as sluggishness, absentmindedness, low energy. In the present study, we compared neurocognitive laboratory outcomes of ADHD children with or without SCT. Method: The CNS Vital Signs Battery was utilized to measure neurocognitive measure of the participants. The SCT+ADHD group comprised of 42 subjects, ADHD group was 41 subjects and control group was 24 subjects. Results: The cognitive flexibility score was found to be more severely impaired in ADHD children with SCT in comparison to the ADHD-only. Additionally, greater deficits in the Shifting Attention Test (p = 0.014) and the Continuous Performance Test (reaction time score, p < 0.01) were found in the SCT+ADHD group relative to ADHD group. Processing speed, visual/auditory memory, psychomotor speed and reaction time were not found to more impaired in those comorbid with SCT. Conclusion: Impairments in the cognitive flexibility and more specifically shifting attention and continuous performance may be indicative of vigilance and orientation problems rather than executive functions for the SCT construct.
University students with attention deficit hyperactivity disorder (ADHD): A literature review
2018, Irish Journal of Psychological Medicine

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ArticlesDimensions and Types of Attention Deficit Disorder

Abstract

J. Am. Acad. Child Adolesc. Psychiatry

J. Am. Acad. Child Adolesc. Psychiatry

J. Am. Acad. Child Adolesc. Psychiatry

J. Am. Acad. Child Adolesc. Psychiatry

A comparison of objective classroom measures and teacher ratings of attention deficit disorder

J. Abnorm. Child Psychol.

Factor structure of teacher rating scales for children

School Psychol. Rev.

The scree test for the number of factors

Mulitvar. Behav. Res.

A teacher rating scale for use in drug studies with children

Am. J. Psychiatry

Stop, look, and listen: the problem of sustained attention and impulse control in hyperactive and normal children

Can. J. Behav. Sci.

Sustained attention and impulse control: implications for the handicapped child

Toward a clear definition of the attentional deficit of hyperactive children

Cluster Analysis

Articles
Dimensions and Types of Attention Deficit Disorder