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SPRINGER BRIEFS IN PSYCHOLOGY

Petr Bob · Jana Konicarova

ADHD, Stress, and


Development

1 23
SpringerBriefs in Psychology
SpringerBriefs present concise summaries of cutting-edge research and practical
applications across a wide spectrum of fields. Featuring compact volumes of 50 to
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• A bridge between new research results as published in journal articles and a
contextual literature review
• A snapshot of a hot or emerging topic
• An in-depth case study or clinical example
• A presentation of core concepts that readers must understand to make indepen-
dent contributions
SpringerBriefs in Psychology showcase emerging theory, empirical research, and
practical application in a wide variety of topics in psychology and related fields.
Briefs are characterized by fast, global electronic dissemination, standard publishing
contracts, standardized manuscript preparation and formatting guidelines, and
expedited production schedules.

More information about this series at http://www.springer.com/series/10143


Petr Bob • Jana Konicarova

ADHD, Stress,
and Development
Petr Bob Jana Konicarova
Center for Neuropsychiatric Research of Center for Neuropsychiatric Research
Traumatic Stress of Traumatic Stress
Department of Psychiatry & UHSL Department of Psychiatry & UHSL
First Faculty of Medicine, Charles First Faculty of Medicine, Charles
University University
Prague, Czech Republic Prague, Czech Republic
TCM Klinik
Bad Kotzting, Germany

ISSN 2192-8363     ISSN 2192-8371 (electronic)


SpringerBriefs in Psychology
ISBN 978-3-319-96492-8    ISBN 978-3-319-96494-2 (eBook)
https://doi.org/10.1007/978-3-319-96494-2

Library of Congress Control Number: 2018950403

© The Author(s), under exclusive licence to Springer International Publishing AG, part of Springer
Nature 2018
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
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Preface

Attention deficit and hyperactivity disorder (ADHD), a lot of movements, feelings


and ideas that often seem to interact without clear meaning and purpose. With
respect to current knowledge, this distraction and hyperactivity may have various
reasons and conditions which may characterize ADHD development. This book
introduces new “old-fashion” concept proposed by Hughlings Jackson, who studied
hierarchical organization of the CNS during development and found that various
brain developmental stages are connected on various hierarchical levels, and closely
linked to each other in a similar way like components of a “solution” create unique
qualities of the whole system and its unity. Opposite of these healthy developmental
stages as Jackson found are various conditions and disturbances that may lead to
“dissolution,” where more primitive functions are not congruent and integrated with
later-developed neural organization. As historically proposed by Jackson in his
until-now-accepted concept of the brain development, this dysfunctional develop-
ment may be related to interference of older and later-developed brain functions
during ontogenesis. This interference may manifest in the case when emergence of
a new function that should insert the older one is not related to diminishing or suf-
ficient inhibition of this older function which leads to “neural dissolution.”
Although this Jackson’s concept significantly influenced modern neurology, psy-
chology, and psychiatry, its connection with ADHD development currently repre-
sents new field of research and clinical applications focused on disintegrated
primitive reflexes, balance deficits, and other symptoms of cognitive and motor dis-
integration that may occur in children with ADHD.
Those Jackson’s ideas inspired also Janet and Freud, who later used Jackson’s
concept of dissolution to develop psychological theory of trauma, intrapsychic con-
flict, and dissociation, where they used concept of mental “dissolution.” In connec-
tion with these historical concepts, this book links recent findings about stress and
dissociation in ADHD children with various recent and historical neuroscientific
findings which show that specific processes related to brain developmental disorga-
nization create vulnerable background that increases sensitivity to stress stimuli
from psychosocial environment, mainly in families and schools.

v
vi Preface

In this context, the purpose of this approach to ADHD development is to show


close connections between historical roots in neurology, psychology, and psychiatry
with current thinking about developmental deficits in ADHD and new psychologi-
cal findings which indicate that ADHD children are more sensitive with respect to
stress stimuli and have increased tendencies to mental dissociation. This sensitive
background that occurs in ADHD children is likely closely related to unfinished
developmental stages that tend to interfere with each other, as, for example, highly
prevalent manifestations of disinhibited primitive reflexes that likely frequently
occur in ADHD children.
This book ADHD, Stress, and Development aims to review basic and modern
findings on ADHD development, and also it suggests new horizons in context of
these “old-fashion” perspectives provided by Jackson, Janet, and Freud. Those
novel perspectives may help to understand modern findings about disinhibited prim-
itive reflexes and their links to increased psychological vulnerability and sensitivity
with respect to various stress stimuli from social environment. The book may be
useful as a comprehensive review for research, health care, and teaching practice
and also for any reader interested in the topics of ADHD and brain development.

Petr Bob
Jana Konicarova
Motto
I search my soul,
in the darkest space of night,
knocking to the door,
where is my goal to find the light.
With hands tied, looking into your eyes,
hidden map of life and fate
there I have found.
Contents

1 Definition, Diagnosis and Epidemiology of Attention Deficit


and Hyperactivity Disorder������������������������������������������������������������������������ 1
References������������������������������������������������������������������������������������������������������ 7
2 Historical and Recent Research on ADHD������������������������������������������������ 11
2.1 Brain and Cognition in ADHD ������������������������������������������������������������ 11
2.2 Attentional, Affective and Executive Dysfunctions in ADHD ������������ 12
2.3 Relationship Between ADHD and Dyslexia ���������������������������������������� 14
References������������������������������������������������������������������������������������������������������ 15
3 Attentional Functions and Stress, Implications for ADHD���������������������� 21
3.1 Stress Related Neuroimmune and Neuroendocrinological
Dysregulation���������������������������������������������������������������������������������������� 22
3.2 Stress, Memory Consolidation and Dissociative Experiences�������������� 24
3.3 Conscious Disintegration, Dissociative Experiences
and ADHD�������������������������������������������������������������������������������������������� 26
References������������������������������������������������������������������������������������������������������ 28
4 Neural Dissolution, Dissociation and Stress in ADHD ���������������������������� 33
4.1 Brain Development and Neural Dissolution ���������������������������������������� 34
4.2 Process of Dissolution and Primitive Reflexes ������������������������������������ 35
4.3 Attention Deficit and Hyperactivity Disorder (ADHD)
and Primitive Reflexes�������������������������������������������������������������������������� 36
References������������������������������������������������������������������������������������������������������ 37
5 Attention, Brain-Mind Integration and ADHD���������������������������������������� 41
References������������������������������������������������������������������������������������������������������ 43
6 Implications for Education and Therapy of ADHD Children ���������������� 47
References������������������������������������������������������������������������������������������������������ 53
Index���������������������������������������������������������������������������������������������������������������������� 57

ix
Introduction

Special features that distinguish this book from the competitive literature: According
to literature review, there is not a competitive book focused on ADHD, stress, and
dissociation that would connect basic developmental characteristics such as disin-
hibited primitive reflexes and balance deficits with influences of stress. The book
aims to develop connections and horizons of recent findings about stress and dis-
sociation in ADHD children with various recent and historical neurobiological and
psychological findings. Altogether these findings suggest that specific processes
related to brain developmental disorganization create vulnerable background that
increases sensitivity to stress stimuli from psychosocial environment, mainly in
families and schools.
In this context, the topic of the proposed book is focused on basic neurodevelop-
mental processes that connect neurobiological development of basic reflective and
cognitive functions and their interactions with various environmental influences.
These processes are closely related to developmental mechanisms of primitive func-
tions and their integration or “dissolution” based on hierarchical developmental
stages as proposed by Hughlings Jackson. These processes are closely linked to
development of consciousness, attentional mechanisms, and memory processes that
constitute awareness and psychological experience. In this context, psychopatho-
logical processes are linked to mechanisms of disturbed inhibitory functions that
may result to interference of more primitive functions with higher levels of atten-
tional and cognitive neural processes. These disturbed developmental processes
also create sensitive interactions with environmental influences, mainly with stress-
ful experiences that may lead to manifestations of pathological dissociative symp-
toms that increase attentional and affective disturbances in many children with
ADHD. In a wider context, these findings show new connections and explanations
of various interesting topics such as disinhibited primitive reflexes, balance difficul-
ties, disturbed attentional and motor functions, stress experiences, and integrative
functions of consciousness.

xi
Chapter 1
Definition, Diagnosis and Epidemiology
of Attention Deficit and Hyperactivity
Disorder

Small boy Josef K. involved in the “Trial” of life, 8 years old, who never rests with
exception of sleep he still walks, jumps and his hands look like never ending story
of irrestible movements frequently unexpected and without a clear purpose. This
boy is a typical simple and short example of ADHD with very strongly developed
hyperactivity. Case studies like this one and many others are described in historical
descriptive studies as well as in current reports on ADHD. Historical descriptions of
these symptoms that preceded diagnostic definitions but also current formulations
included in basic diagnostic classification systems such as ICD-10, DSM-IV and
DSM-V dealing with ADHD are most frequently defined by descriptions of behav-
ioral characteristics which similarly as in other neuropsychological disorders are
related to deficits in “executive functions” that enable to control and regulate cogni-
tive processes and “self-control”. In the case of ADHD as a typical developmental
disorder these neurocognitive characteristics frequently manifest in various typical
ontogenetic stages from early childhood to adulthood, which are mainly related to
specific deficits in attentional and executive functions (for example, Hallowell and
Ratey 2005; Seidman 2006; Cherkasova et al. 2013).
Most typical symptoms according to DSM-IV-TR are excessive motor activity,
inattention, and impulsiveness that manifest in childhood (American Psychiatric
Association 2000). In addition, most modern definition of ADHD based on nearly
two decades of research provides evidence that ADHD can continue from childhood
to adulthood. According to DSM-V (American Psychiatric Association 2013)
definiton ADHD is characterized by a pattern of behavior that can be divided into
two categories of inattention and hyperactivity, and impulsivity. Children must have
at least six symptoms from either (or both) the inattention group of criteria and the
hyperactivity and impulsivity criteria, while older adolescents and adults (over age
17 years) must have at least five symptoms. According to DSM-V ADHD symptoms
must be present prior to age 12 years, compared to 7 years as the age of onset in
DSM-IV, which is supported by research evidence since 1994. In addition DSM-V
does not include exclusion criteria for people with autism spectrum disorder because
symptoms of both disorders may co-occur but may not occur exclusively during the

© The Author(s), under exclusive licence to Springer International 1


Publishing AG, part of Springer Nature 2018
P. Bob, J. Konicarova, ADHD, Stress, and Development,
SpringerBriefs in Psychology, https://doi.org/10.1007/978-3-319-96494-2_1
2 1 Definition, Diagnosis and Epidemiology of Attention Deficit and Hyperactivity…

Fig. 1.1 Destiny of many


ADHD children reminds
fatality that experienced
Josef K. in Kafka’s novel
“Trial”

course of schizophrenia or another psychotic disorder and may not be better


explained by another mental disorder, such as a depressive or bipolar disorder, anxi-
ety disorder, dissociative disorder, personality disorder, or substance intoxication or
withdrawal (Fig. 1.1).
This most modern definition is preceeded by long history initiated by Alexander
Crichton in 1798 who published a book: “An inquiry into the nature and origin of
mental derangement” with subtitle: “comprehending a concise system of the physi-
ology and pathology of the human mind and a history of the passions and their
effects”. In the second chapter of this book (volume II): “On Attention and its
Diseases” he described possibilities of abnormal inattention as increased distracti-
bility by extraneous and even slight stimuli and also a considerable restlessness and
impulsivity (Crichton 1798; Burd and Kerbeshian 1988; Lange et al. 2010). These
symptoms according to current criteria may be associated with ADHD.
Other historical description of ADHD was published by Heinrich Hoffmann,
who in his book of stories “Struwwelpeter” described cases of typical “ADHD”
behavior (Hoffman 1845/2002) (Fig. 1.2).
Another historical description of ADHD symptoms provided Still (1897), which
today is called “Still’s disease” (Burd and Kerbeshian 1988; Farrow 2006; Lange
et al. 2010). Still (1902) in his work discussed psychic conditions which are con-
cerned with abnormal defects of moral control in children and divided these cases
into two groups (1) including children with physical disease (such as a cerebral
tumor, meningitis, epilepsy, head injury or typhoid fever), and (2) children without
general impairment of intellect and without physical disease. This differentiation is
the origin for the later definition of minimal cerebral dysfunction, historically
related to ADHD (Burd and Kerbeshian 1988; Rothenberger and Neumärker 2005;
Lange et al. 2010; Leahy 2017).
Later in 1932 Kramer and Pollnow reported detailed descriptions of motor rest-
lessness in their work “On a hyperkinetic disease of infancy” (“Über eine hyperki-
netische Erkrankung im Kindesalter”) (Kramer and Pollnow 1932; Burd and
Kerbeshian 1988; Lange et al. 2010). Another important historical addition to the
ADHD literature was published by Bradley in 1937, who reported positive influ-
1 Definition, Diagnosis and Epidemiology of Attention Deficit and Hyperactivity… 3

Fig. 1.2 One of the first books describing in details few “ADHD” cases

ence of stimulant medication on children’s behavior, mainly by the use of benze-


drine (the first pharmaceutical amphetamine) that remarkably improved school
performance in approximately half of the children (Bradley 1937; Burd and
Kerbeshian 1988; Lange et al. 2010). Further important investigations were pub-
lished by Laufer et al. (1957), who introduced therapy by methylphenidate which
is nowadays considered as drug of first choice (Leonard et al. 2004; Morton and
Stockton 2000).
Another scientific discovery of hyperactivity was reported by Ross and Ross
(1976), who described a causal connection between brain damage and behavioral
disorders similar to the postencephalitic behavior disorder. This finding later sig-
nificantly influenced the concept of “minimal brain damage” proposed by Kessler
(1980), who hypothesized that hyperactivity in children may be caused by brain
damage (Barkley 2006). In this context Knobloch and Pasamanick (1959) proposed
that the cerebral damage may manifest continuously in the range from minimal dam-
age to severe abnormalities, such as cerebral palsy and mental deficiency. This mini-
mal damage even in cases when it cannot be objectively demonstrated may cause
­hyperactive behavior (Barkley 2006; Ross and Ross 1976; Burd and Kerbeshian 1988)
and later this concept of minimal brain damage or “minimal brain dysfunction” was
associated with descriptions of a specific syndrome (Conners 2000).
4 1 Definition, Diagnosis and Epidemiology of Attention Deficit and Hyperactivity…

The term “minimal brain dysfunction” was in 1968 replaced by conceptualiza-


tion and definition of hyperactivity even it was still understood mainly as a result of
some biological origin more than environmental causes (Barkley 2006, Burd and
Kerbeshian 1988; Lange et al. 2010). This concept was later incorporated into the
official diagnostic nomenclature described in the second edition of the Diagnostic
and Statistical Manual of Mental Disorders (DSM-II) (Barkley 2006; Volkmar
2003) as the disorder characterized by overactivity, restlessness, distractibility, and
short attention span, especially in young children that usually diminishes in adoles-
cence (American Psychiatric Association 1968; Barkley 2006; Burd and Kerbeshian
1988; Lange et al. 2010).
Later in the 1970s “Attention Deficit Disorder: with and without hyperactivity”
in the third edition of the diagnostic and statistical manual of mental disorders
(DSM-III) was defined and conceptualized with predominant focus on attention
deficits, whether “International Classification of Diseases (ICD-9)” by the World
Health Organization continued its focus on hyperactivity. This new formulation
enables to define subtypes of Attention Deficit Disorder (ADD) that may occur
with or without hyperactivity (Burd and Kerbeshian 1988; Barkley 2006; Lange
et al. 2010).
Later in 1987 the Diagnostic and Statistical Manual of Mental Disorders (DSM-­
III-­R) changed the concept of the two subtypes and introduced Attention deficit-­
Hyperactivity Disorder (ADHD) subdivided into three subtypes: (1) a predominantly
inattentive type; (2) a predominantly hyperactive-impulsive type; and (3) a com-
bined type including symptoms of both dimensions (American Psychiatric
Association 1994). In addition historical concepts of brain damage or dysfunction
were supported by new evidence about structural brain abnormalities in children
with ADHD using neuroimaging techniques (Burd and Kerbeshian 1988; Lahey
et al. 1994; Barkley 2006; Lange et al. 2010). Following development of DSM-IV
diagnostic descriptions, in ICD-10 were used almost identical criteria how to
describe and identify inattentive, hyperactive, and impulsive symptoms but ICD-10
is more demanding and requires presence of all criteria. In addition to DSM IV and
ICD-10, DSM V provides some additional criteria that taken into account combined
diagnosis of ADHD and Autistic Spectrum Disorders (Ramtekkar 2017; American
Psychiatric Association 2013; Ustun et al. 2017).
Recent findings indicate that ADHD is most frequently diagnosed in school chil-
dren but according to these research and clinical data it may frequently manifest
also in pre-school age, which in this early age also usually include all typical symp-
toms such as hyperactivity, decreased self-control and attentional deficits (Egger
et al. 2006; Posner et al. 2007; Cherkasova et al. 2013; Caye et al. 2016). These
pre-­school children also may have some co-morbid symptoms such as oppositional
disorder, communication difficulties or anxiety disorders. In majority of the pre-
school children may manifest combined forms of various typical symptoms, which
mainly include attentional symptoms co-existing with hyperactivity and impulsivity
(Lahey et al. 1994, 2004, 2005; Galera et al. 2011; Caye et al. 2016; Weissenberger
et al. 2017). Typical deficits of pre-school children with ADHD in comparison to
healthy children most usually are inhibitory dysfunctions linked to hyperactivity
and impulsivity. These dysfunctions at pre-school age are more prevalent than in
1 Definition, Diagnosis and Epidemiology of Attention Deficit and Hyperactivity… 5

school age children but on the other hand attentional difficulties manifest in pre-
school children less frequently than in the school aged children. The school aged
children frequently have combined disorder which may manifest in at about 60–80%
of child population with diagnosis of ADHD (Dalen et al. 2004; Seidman 2006;
Cherkasova et al. 2013; Caye et al. 2016).
But unfortunately majority of ADHD related difficulties are recognized later in
the school age, when these children have difficulties and related stressful experi-
ences in the school, which frequently co-occur with various psychiatric comorbidi-
ties [at about 70% of children with ADHD in school age manifest other psychiatric
symptoms mainly anxiety and depression] (Barkley 2006; Jensen et al. 2001; Caye
et al. 2016; Weissenberger et al. 2017). In the school age attentional difficulties typi-
cally increase but hyperactivity and impulsivity in comparison to the pre-school age
may continue without significant changes (Lahey et al. 1994, 2004; Cherkasova
et al. 2013; Caye et al. 2016).
According to epidemiological data ADHD symptoms developed later in adoles-
cence are very similar to ADHD in children with typically increased attentional
deficits that are more frequent than hyperactivity and impulsivity, and also treatment
procedures in adolescence are very similar (Biederman et al. 2000; Molina et al.
2009; Caye et al. 2016). Positive feature of adolescent and adult development is
significant occurrence of spontaneous remissions in at about 1/3 (Cherkasova et al.
2012). Recent studies show that at age 25 ADHD persists in at about 65% of ADHD
population (Faraone et al. 2006; Biederman et al. 2000; Molina et al. 2009; Caye
et al. 2016).
But although the 1/3 of the adult ADHD is without symptoms, in comparison to
healthy controls, there is evidence that they have stastically higher levels of various
difficulties in later school education, in work and professional carreer, in communi-
cation and relationships, for example increased promiscuity and unstable marriages,
increased prevalence of various types of injuries and accidents, and comorbid psy-
chiatric disorders (Barkley et al. 2008; Cherkasova et al. 2013; Caye et al. 2016;
Biederman et al. 1996. 2006; Klein et al. 2012; Mannuzza et al. 1993, 1997, 1998,
2008; Molina et al. 2009; Weiss and Hechtman 1993; Yan 1998).
According to reported evidence adult ADHD symptoms are significantly
related to higher prevalence of antisocial personality disorder and behavioral dis-
orders. These data show that antisocial personality disorder manifests in 12–28%
of adults with ADHD (in healthy controls it is 2–8%) and behavioral disorders
manifest in 22–62% of adults with ADHD (healthy controls just 4–8%) (Barkley
et al. 2008; Biederman et al. 2006; Klein et al. 2012; Mannuzza et al. 1997, 1998;
Molina et al. 2009; Cherkasova et al. 2013; Caye et al. 2016; Weiss and Hechtman
1993). These highly prevalent antisocial personality disorders and behavioral
disorders in adults with ADHD are also related to increased manifestations of
criminal behavior, mood disorders, anxiety disorders and addictive behavior in
comparison to healthy ­controls (Kessler et al. 2006; Sobanski 2006; Barkley et al.
2008). In addition reported data show that antisocial behavior in children is fre-
quently related to the same difficulties in adulthood in at about 20–45% of adult
persons with ADHD diagnosis (Barkley 2006; Biederman et al. 2006; Cherkasova
et al. 2013; Caye et al. 2016). For example according to reported data at about 10%
6 1 Definition, Diagnosis and Epidemiology of Attention Deficit and Hyperactivity…

or more individuals in prison have ADHD diagnosis (Serfontein 1994; Black et al.
2004; Gunter et al. 2008).
Most significant factors that predict these difficulties are related to genetic influ-
ences (Faraone et al. 2005), smoking during pregnancy (Cornelius and Day 2009;
Galéra et al. 2011; Linnet et al. 2003), drinking alcohol and using drugs or psycho-
thropic medication in pregnancy (Linnet et al. 2003; Rodriguez et al. 2009) and also
maternal stress during pregnancy (Galéra et al. 2011; Millichap 2008; Linnet et al.
2003; Rodriguez et al. 2009). Important prediction factors of later difficulties are
also early manifestations of ADHD symptoms and reported data show that later
manifestations of ADHD symptoms indicate better prognosis (Berlin et al. 2003;
Brocki et al. 2007; Latimer et al. 2003; LeBlanc et al. 2008; Wahlstedt et al. 2008;
Chronis et al. 2007). Other very important negative factors for future prognosis rep-
resent early occurrence of oppositional disorder, mood disorder and anxiety, and
lower level of intelligence (Barkley et al. 2008; Biederman et al. 1996, 2011; Molina
et al. 2009; Swanson et al. 2007). Major negative factors represent also occurrence
of psychopathology in parents, ADHD in other family members, social and eco-
nomical status of families, and frequent conflicting situations (Biederman et al.
1996, 2011; Weiss and Hechtman 1993).
Nevertheless as recent research indicates most negative factor in adulthood with
respect to future prognosis represents persistence of ADHD symptoms in adoles-
cence and in later stages of life in adulthood (Barkley et al. 2008; Biederman et al.
1996, 2008, 2010; Klein et al. 2012; Weiss and Hechtman 1993; Caye et al. 2017).
In addition “Multimodal Treatment Study of Children with ADHD” (MTA) shows
that psychiatric treatment does not present important factor determining long-term
development of ADHD (MTA-Cooperative-Group 1999). Nevertheless some find-
ings indicate that psychiatric treatment in certain cases may have positive outcome
in later development of ADHD (Swanson et al. 2007). Some studies also show that
stimulant treatment may be important for treatment of comorbid diagnoses such as
anxiety and depression (Biederman et al. 2009; Powers et al. 2008) although effect
of the treatment in some cases may be just temporary without long-term conse-
quences (Molina et al. 2009).
In summary, historical and recent research indicates that certain developmental
and environmental factors may have significant influence for future pathogenesis of
ADHD and indicate important preventive criteria for family care, education, respon-
sible parenthood planning, healthy life style during pregnancy, exposition to stress-
ful events and some other factors that may influence ADHD and its treatment.

References

American Psychiatric Association. (1968). Diagnostic and statistical manual of mental disorders
(DSM-II) (2nd ed.). Washington, DC: American Psychiatric Association.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders
(DSM-IV) (4th ed.). Washington, DC: American Psychiatric Association.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(DSM-II) (4th ed text revision). Washington, DC: American Psychiatric Association.
References 7

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(DSM-V) (5th ed.). Arlington: American Psychiatric Publishing.
Barkley, R. A. (2006). Attention deficit hyperactivity disorder: A handbook for diagnosis and treat-
ment (3rd ed.). New York: Guilford Press.
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Chapter 2
Historical and Recent Research on ADHD

Current conceptualization and definition of ADHD is a result of long term history of


clinical research and epidemiological findings that partially uncovered ADHD etiol-
ogy and ontogenetic development. In this chapter historical context and recent theo-
ries of ADHD development will be introduced with main focus on hypofrontality
and its connection with inhibitory deficits that are frequently related to cognitive
disturbances and impulsivity. In the current perspective very useful conceptualiza-
tion of ADHD also describes the so-called “hot and cool” theory which might enable
to understand connections between inhibitory deficits and emotional enhancement
in ADHD etiopathogenesis.

2.1 Brain and Cognition in ADHD

ADHD represents historically heterogenous concept of long term clinical research


which was started by introduction of “minimal brain dysfunction” by Still in 1902
(Still 1902), who provided detailed descriptions of hyperactivity and hyperkinetic
symptoms, and much later attentional dysfunctions were described by Douglas in
1970s (Douglas 1972). In this historical context recent diagnostic conceptualization
includes all these basic types of symptoms “inattentive”, “hyperactive-impulsive”
and “combined” (Valera et al. 2009).
Following very interesting clinical research documented certain similarities
between ADHD and frontal lobe dysfunctions, which suggested a hypothesis that
ADHD is closely linked to disturbances in frontal brain regions (Mattes 1980).
Later findings in addition suggested that also some subcortical structures may play
an important role in ADHD development (Rubia et al. 1999), and mainly those
with predominant noradrenergic and dopaminergic receptors (Pliszka 2005; Nigg
2001). These research findings reported decreased volumes of corpus striatum, pre-
frontal cortex, corpus callosum and cerebellum that likely are closely related to
functional cognitive and affective changes observed in ADHD (Seidman et al. 2005;

© The Author(s), under exclusive licence to Springer International 11


Publishing AG, part of Springer Nature 2018
P. Bob, J. Konicarova, ADHD, Stress, and Development,
SpringerBriefs in Psychology, https://doi.org/10.1007/978-3-319-96494-2_2
12 2 Historical and Recent Research on ADHD

Nigg 2001; Castellanos et al. 2006; Valera et al. 2007; Castellanos and Proal 2012).
But taken together recent findings show that although certain structures might be
more related to ADHD, most likely the brain as a whole is affected, which is mainly
manifested as the decreased brain volumes in comparison to healthy control popula-
tion (Castellanos and Proal 2012).
In addition in context of research about brain correlates of consciousness and
cognition recent findings show that also other structures related to attentional func-
tions with widespread and distributed localizations in various brain structures may be
closely related to ADHD symptoms and dysfunctions (Willcutt et al. 2005; Castellanos
and Proal 2012). Taken together recent findings indicate that various widespread spe-
cific functional and morphological changes may be related to behavioral, cognitive
or affective abnormalities in ADHD (Semrud-Clikeman et al. 2000; Bush et al. 2005;
Castellanos et al. 2002; Valera et al. 2009; Pievsky and McGrath 2017).

2.2  ttentional, Affective and Executive Dysfunctions


A
in ADHD

Major results in recent ADHD research supported by clinical evidence are focused
on processes of executive control which is typically affected in ADHD (Nigg 2001;
Hofmann et al. 2012; Martinez et al. 2016). Mainly these typical deficits include
dysfunctions in inhibitory control. The inhibitory control is related to voluntary
processes that influence information selection during attentional processing and
resolution of conflincting situations that needs to suppress less dominant incongru-
ent information— for example in experiments with conflicting Stroop taks, when
stimuli are presented in ambiguous forms, which involves a word that describes a
color written by a different color and the task is to name the color or word, i.e.
“What color is this?”: WHITE (Barkley 1997; Schachar et al. 2000; Nigg 1999
2001; Sergeant et al. 2003; Roessner et al. 2007; Martinez et al. 2016).
New empirical findings and theoretical conceptualizations strongly suggest that
altogether with inhibitory dysfunctions also increased emotional excitation may
play a role in ADHD deficits. For example the so-called “cool” cognitive deficits in
executive functions are closely linked to attentional dysfunctions and on the other
hand “hot”, which means affective deficits related to dysfunctional ability to process
emotional information that produces hyperactivity and impulsivity (Castellanos
et al. 2006; Toplak et al. 2005; Antonini et al. 2015; Martinez et al. 2016). As a
consequence of this dysbalance ADHD children tend to experience very strong and
overwhelming positive and negative emotions which on behavioral levels may man-
ifest as impulsivity (Martel 2009).
These recent findings indicate that ADHD cannot be explained only as a conse-
quence of frontal lobe executive dysfunctions and an important role can be attrib-
uted to emotional dysfunctions related to increased excitability in the limbic system,
which may cause ADHD dysregulation in cases without frontal executive dysfunc-
tions (Castellanos et al. 2006; Toplak et al. 2005; Antonini et al. 2015; Martinez
et al. 2016).
2.2 Attentional, Affective and Executive Dysfunctions in ADHD 13

Altogether these findings suggest the so-called “dual-pathway” concept of the


two basic developmental trajectories that may lead to ADHD (Sonuga-Barke 2003).
The first is represented by frontal executive dysfunctions (Barkley 1997; Solanto
et al. 2001; Sonuga-Barke 2003; Antonini et al. 2015; Martinez et al. 2016) and the
second is mainly linked to dysfunctions in brain systems related to emotions and
motivation (Sagvolden et al. 1998). These findings indicate basic differences
between deficits of the so-called behavioral inhibition and inhibitory dysfunctions
related to motivation (Nigg 2001). In addition these two basic inhibitory functions
are related to different neural network systems that define basic conceptualization of
the dual-pathway model (Sonuga-Barke 2003). These findings implicate that atten-
tional disorders and hyperkinetic-impulsive symptoms may represent two indepen-
dent but co-existing forms of ADHD.
Implications of these findings are also very important for diagnostic concep-
tualizations and considerations of therapeutic interventions with the main focus
on attentional deficits that are more or less related to the other specific symptoms
linked to hyperactivity and impulsivity, and their combination. Important factors for
diagnostic identification of these symptoms represent mainly age, other psychiatric
diagnoses and also influences of pharmacological treatment that need to be carefully
taken into account (Valera et al. 2009; Cherkasova et al. 2013; Antonini et al. 2015).
In addition these basic conceptualizations are also in agreement with epidemio-
logical findings that at about 50% of children with ADHD have various motor
abnormalities and difficulties (Pitcher et al. 2002). These motor abnormalities usu-
ally have higher prevalence in children with attentional deficits and combined type
than in children with predominant symptoms of hyperactivity and impulsivity (Piek
et al. 1999; Pitcher et al. 2003; Antonini et al. 2015; Martinez et al. 2016).
In addition recent findings indicate that attentional and executive dysfunctions
may be related to impulsivity that manifests frequently in ADHD and may be related
to various social dysfunctions and also higher vulnerability to stress influences
(Martinez et al. 2016). For example, recent findings show that children with ADHD
frequently manifest antisocial behavior most likely due to deficits in executive func-
tions, impulsivity and aggressive behavior related to stressful situations (McKay
and Halperin 2001; Thapar et al. 2006; Seidman 2006; Antonini et al. 2015; Martinez
et al. 2016). These deficits in executive functions in ADHD likely represent signifi-
cant predictor of drug addiction (van Emmerik-van Oortmerssen et al. 2012). At
about 1/3 of children with ADHD reach remission in adulthood (Cherkasova et al.
2012). Nevertheless majority of ADHD children may have the same or similar
symptoms also in later age as was shown in some studies in 1990s (Wender 1995;
Goldstein 1997) and symptoms as well as treatment in adults with ADHD are very
similar, and the symptoms mainly include hyperactivity a impulsivity (Biederman
et al. 2000; Molina et al. 2009; Antonini et al. 2015). Impulsivity is frequently
related to antisocial behavior that occurs in 20–45% of adults with ADHD and inter-
personal ­problems (Barkley 2006; Biederman et al. 2006; Cherkasova et al. 2013;
Caye et al. 2016). According to some data at about 10% or more individuals from
population who commit various forms of criminal behavior have ADHD (Serfontein
1994; Black et al. 2004; Gunter et al. 2008; Cherkasova et al. 2013).
14 2 Historical and Recent Research on ADHD

2.3 Relationship Between ADHD and Dyslexia

Another dysfunction that has been observed in ADHD is impaired phonological


processing and poor word identification related to reading difficulties, which are
typical for dyslexia (Bradley and Bryant 1983; Laasonen et al. 2010, 2012; Gray
and Climie 2016). On the other hand behavioral symptoms of ADHD such as hyper-
activity, impulsivity, inattention or short-term and working memory deficits also
frequently occur in children with dyslexia (Siegel 1994; Hari and Renvall 2001;
Carroll et al. 2005; Laasonen et al. 2012). Some authors also reported that dyslexia
(similarly as ADHD) could be related to deficits in visual attention processes which
may cause that reading based on sensitive spatial discrimination may become sub-
jectively very difficult (Bosse et al. 2007; Facoetti et al. 2010; Laasonen et al. 2012).
Typical disturbances similar in ADHD and dyslexia also include significant and
high error rates in various tasks most likely due to deficits in activation of a self-­
monitoring systems, mainly when they are confronted with conflicting situations or
very difficult tasks (Hajcak and Simons 2008; O’Connell et al. 2009). These data
indicate that typical dysfunctions in ADHD and dyslexia are related to disturbances
in error monitoring as a consequence of deficits in higher-order executive monitor-
ing system that enables control processes in daily life which are necessary for learn-
ing from previous experiences and behavior (Garavan et al. 2002; Schachar et al.
2004; Van De Voorde et al. 2010).
In this context, children with ADHD and dyslexia typically have high occurrence
of reading and spelling errors, attentional deficits, various behavioral problems such
as involuntary and uncontrolled speech and movements, and high sensitivity to psy-
chosocial stress. For example, they make spelling errors under dictation or in text
production and have difficulties to develop an appropriate orthographic representa-
tion of words (Goswami 1999; Re and Cornoldi 2010, 2013; Re et al. 2007, 2008).
Current findings also indicate that these spelling difficulties most likely are
related to attentional and self-regulatory disturbances, even in children with ADHD
and dyslexia these problems may have different neurocognitive mechanisms (Kroese
et al. 2000; Re and Cornoldi 2013). In general context, Ehri (1986, 1995) proposed
a stage theory of reading and writing development which suggests qualitatively dif-
ferent stages of learning to spell that is mainly based on visual and morphological
information that may be disturbed from various reasons.
Well known model for learning of reading and writing was developed also by
Frith (1985), who proposed that associative learning of a particular graphic configu-
ration in which children discover phonemes may lead to errors due to incorrect
association between a grapheme and the corresponding phoneme. Specific and
­crucial role in associative learning have various brain systems that enable informa-
tion integration in the “procedural memory system” which enables learning of new
information and also control and monitoring mechanisms of long-established cog-
nitive information and motor skills (Mishkin et al. 1984; Squire and Knowlton
2000). This procedural memory processing enables basic functions underlying sym-
bolic and language functions that are typically represented as grammar, lexical
References 15

retrieval and related mental imagination in working memory processing (Ullman


and Pierpont 2005). According to several findings, procedural memory deficits
could explain some basic processes responsible for deficits in learning language that
result in grammatical impairments and lexical retrieval deficits such as difficulties
to follow appropriate word order patterns, producing questions or representing
grammatical elements that depend on functional categories (Leonard 1995; Ullman
and Pierpont 2005). In addition children with learning language difficulties also
show disturbances in assigning thematic roles in passive sentences or assigning ref-
erence to pronouns or reflexives (van der Lely 1994, 1996), have troubles to judge
the syntactic acceptability of sentences (Liles et al. 1977; Rice et al. 1999), to iden-
tify errors of syntax such as of word order and phonological representations of real
words suggesting impairment of procedural declarative memory (Kamhi and Koenig
1985; Ullman and Pierpont 2005). For example, children with learning language
deficits typically have difficulties to use phonetic properties of words and to catego-
rize, differentiate and generalize among words and their parts (Botting and Conti-
Ramsden 2001; Weismer et al. 2000) which indicates phonological working memory
difficulties (Gathercole and Baddeley 1990; Ullman and Pierpont 2005).
In addition these learning difficulties in schools frequently represent another
important condition that may influence social dysfunctions and related other stress
experiences. Taken together these stress influences may determine emotional dys-
functions and lability related to increased excitability in the limbic system, which
may increase ADHD dysfunctions also in cases without prenatally caused or innate
frontal executive dysfunctions (Teicher et al. 2003; Toplak et al. 2005; Castellanos
et al. 2006; Ouyang et al. 2008; Sobanski et al. 2010; Martinez et al. 2016).

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