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SPRINGER BRIEFS IN PSYCHOLOGY
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
125 pages, the series covers a range of content from professional to academic.
Typical topics might include:
• A timely report of state-of-the-art analytical techniques
• 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.
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expedited production schedules.
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
© 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
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfilms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims
in published maps and institutional affiliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Preface
v
vi Preface
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
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
Fig. 1.2 One of the first books describing in details few “ADHD” cases
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.
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Chapter 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).
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
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