ADHD: Is it as simple as that?

Kalum Bodfield, Dr Philip Carey, Professor David Putwain & Dr Avril Rowley

Liverpool John Moores University

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ADHD: What is it?

• ADHD is a neurodevelopmental condition characterised

by the cardinal symptoms of inattention, hyperactivity and

impulsivity.

• It is categorised in the DSM-V (diagnostic and statistical

manual of mental health disorders (American

Psychological Association, 2013) as either:

– ADHD of the inattentive type.

– ADHD of the hyperactive-impulse type.

– ADHD of the combined type.

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ADHD: The Complexities

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• ADHD rarely appears alone, it usually manifests with one

or multiple comorbidities.

• These include (but aren’t limited to): • Oppositional defiant disorder (ODD) (Jensen et al., 2001)

• Depression (Wilens et al., 2002)

• Anxiety (Schatz & Rostain, 2006)

• Autism (Simonoff et al., 2008)

• Attachment related issues (Jensen & Steinhausen, 2015)

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ADHD: The

Complexities

Image taken from MyHealthyFeeling (http://www.myhealthyfeeling.com/adhd-and-add-difference-adhd-types/)

But how complex is ADHD and the complexities?

• Consider, individuals can show traits of ADHD without having ADHD. For

example, impulsivity (Hart & Dempster, 1997).

• Individuals can show symptoms of depression without having depression,

consider dysthymia (Weissman, Leaf, Bruce & Florio, 1988), bereavement

etc.

• Autism is already considered a spectrum model (Volkmar, State & Klin,

2009).

• Anxiety is experienced by all but only becomes pathological when chronic

without a reasonable trigger (American Psychological Association, 2013) –

also consider defensive pessimism (Norem & Cantor, 1986).

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What Complex ADHD looks like in the classroom?

Consider an individual

with traits of ADHD,

but then also consider

them to have

comorbid traits of

depression, or autism,

or even anxiety. How

will this impact the

manifestation of traits

on behaviours?

• Figure taken from http://newideas.net/different-types-

adhd/three-adhd-disorders

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How do you manage this?

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The Proposed Model

• ADHD and many conditions can be explored as

spectrums, with traits manifesting in individuals.

• At some level these traits become pathological.

• This research will look at whether traits exist in an

adolescent population and to what extent the culmination

of them leads to a greater experienced deficit in academic

functioning.

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A Constellation of Deficit

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Anxious Traits Depressive Traits

Educational Attainment

Deficit Autistic Traits

ADHD Traits

Maladaptive Attachment

Patterns

The Research Project

• Research questions:

– To what extent do multiple, adverse mental health traits impact academic

attainment?

– At what level of severity do these traits begin to impact educational attainment?

• Hypothesis:

• The presence of multiple adverse mental health traits will have a greater

effect on educational attainment than the presence of singular traits.

• The initial phase of the study will comprise of three construct validations on

measures of attachment, ADHD traits and autistic traits.

• The final phase will comprise of a multiple regression analysis on a questionnaire

given to GCSE students and their GCSE results collected in August 2019.

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Possible Outcomes?

• There are multiple outcomes possible, presented are a few of the possible

outcomes:

– The greater amount of traits present the greater the deficit in educational

attainment. Traits do become pathological at a level.

– Only certain traits negatively impact academic attainment. Only certain

traits become pathological.

– There is not a significant impact on academic attainment by any of the

mental health traits explored and none of the traits are pathological by

nature.

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Next Steps?

• To begin the research project;

• To explore the relationship between comorbid traits and

their impact on attainment and the severity of this impact.

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How you can be involved!

• We’re currently looking for schools to participate in the

project!

• Initially this is taking part in the construct validations – we

need pupils to complete an interview and then a cohort to

complete a survey

• Following the completion of this we can collect data to

explore the relationship, which is again a questionnaire.

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Questions?

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References • American Psychological Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Washington, DC.

• Hart, S. D., & Dempster, R. J. (1997). Impulsivity and psychopathy. Impulsivity: Theory, assessment, and treatment, 212-232.

• Jensen, P. S., Hinshaw, S. P., Kraemer, H. C., Lenora, N., Newcorn, J. H., Abikoff, H. B., ... & Elliott, G. R. (2001). ADHD comorbidity

findings from the MTA study: comparing comorbid subgroups. Journal of the American Academy of Child & Adolescent

Psychiatry, 40(2), 147-158.

• Jensen, C. M., & Steinhausen, H. C. (2015). Comorbid mental disorders in children and adolescents with attention-

deficit/hyperactivity disorder in a large nationwide study. ADHD Attention Deficit and Hyperactivity Disorders, 7(1), 27-38.

• Kim, M. J., Park, I., Lim, M. H., Paik, K. C., Cho, S., Kwon, H. J., ... & Ha, M. (2017). Prevalence of attention-deficit/hyperactivity

disorder and its comorbidity among Korean children in a community population. Journal of Korean medical science, 32(3), 401-406.

• Norem, J. K., & Cantor, N. (1986). Defensive pessimism: Harnessing anxiety as motivation. Journal of personality and social

psychology, 51(6), 1208.

• Schatz, D. B., & Rostain, A. L. (2006). ADHD with comorbid anxiety: a review of the current literature. Journal of Attention

disorders, 10(2), 141-149.

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References • Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism

spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American

Academy of Child & Adolescent Psychiatry, 47(8), 921-929.

• Volkmar, F. R., State, M., & Klin, A. (2009). Autism and autism spectrum disorders: diagnostic issues for the coming decade. Journal

of Child Psychology and Psychiatry, 50(1‐2), 108-115.

• Weissman, M. M., Leaf, P. J., Bruce, M. L., & Florio, L. (1988). The epidemiology of dysthymia in five communities: rates, risks,

comorbidity, and treatment. The American Journal of Psychiatry, 145(7), 815.

• Wilens, T. E., Biederman, J., Brown, S., Tanguay, S., Monuteaux, M. C., Blake, C., & Spencer, T. J. (2002). Psychiatric comorbidity

and functioning in clinically referred preschool children and school-age youths with ADHD. Journal of the American Academy of Child

& Adolescent Psychiatry, 41(3), 262-268.

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