Clinical foundations of hyperactivity research

https://doi.org/10.1016/S0166-4328(97)00165-4Get rights and content

Abstract

Clinical research into the psychopathology of attention deficit/hyperactivity disorder (AD/HD) has established reliable measures of the defining behavioural problems: inattentiveness, overactivity, and impulsiveness. Experimental measures have defined them with increasing accuracy, but research is still needed before it is clear what processes need to be explained at the level of brain dysfunction. Understanding the associations of AD/HD, and the way they change over time, requires the approach of developmental psychopathology. This paper outlines some key concepts. The possible heterogeneity of AD/HD is stressed, with substantial differences being associated with the predominant type of symptom, the situations in which it is expressed, and the types of co-existing problems. Developmental influences on course need not be the same as initiating causes and a transactional model is outlined. Cultural and familial factors modulate the course of this biologically initiated disorder. Genetic influences appear to be strong and a combination of behavioural and molecular genetics with longitudinal study offers hope of advances in nosology.

Section snippets

Psychopathology of hyperactivity

The psychopathology of hyperactivity has been described by many clinicians. It is generally thought to consist of the behavioural problems of inattentiveness, overactivity and impulsiveness. This clinical category is the starting point for research in developmental psychopathology and experimental analysis of attention deficit.

This description of the psychopathology has been repeated so often that it can sometimes be accepted uncritically. In fact, it is somewhat problematic. Efforts to base

Historical issues

Schachar [25]has described the very early history of thinking about hyperactivity. The concepts of social Darwinism were still potent: much psychopathology was seen as the regression to or persistence of a primitive and savage-like state; in which the reason failed sufficiently to control atavistic impulses. Still’s [31]phrase, ‘disorders of moral control’, embodied this kind of thinking. Indeed, the current idea still retains something of the notion that impulsiveness represents a biological

Inattentiveness

The terminology of attention deficit disorder is a little confusing. ADHD, the disorder, has two main subtypes in DSM-IV. The first is inattentiveness and the second is overactivity-impulsivity. It is, therefore, possible to have ADHD without being inattentive. In the ICD-10 terminology, inattentiveness is a necessary requirement for the diagnosis, but the disorder is called hyperkinetic disorder. Another confusion, therefore, arises; inattentiveness is necessary for the diagnosis of

Subtyping of problems of activity and attention

The argument so far has been for a need to distinguish separable components of inattentive behaviour (which can be further subdivided at the cognitive level), excess activity and impulsiveness. This is already a considerable deconstruction of ADHD. However, this does not end the need for discrimination that is raised by clinical analyses of psychopathology. Other important sources of heterogeneity need to be recognised.

Developmental aspects of psychopathology

So far the behavioural problems that comprise hyperactivity have been considered as though they were constant throughout development. This may well not be the case. It is far from clear, for instance, that inattentiveness at the age of 3 will have the same significance as that at the age of 17. This leads on to the need for several different kinds of enquiry. Firstly, what is the continuity or discontinuity between different stages of development? It is evident that there is some; longitudinal

References (38)

  • J.T. Enns et al.

    A developmental study of covert orienting to peripheral visual cues

    J Exp Child Psychol

    (1989)
  • R. Schachar et al.

    Changes in family function and relationships in children who respond to methylphenidate

    J Am Acad Child Adolesc Psychiatry

    (1987)
  • E. Taylor et al.

    Hyperactivity and conduct problems as risk factors for adolescent development

    J Am Acad Child Adolesc Psychiatry

    (1996)
  • T.A. Achenbach et al.

    Child/adolescent behavioural and emotional problems: implications of cross-informant correlations for situational specificity

    Psychol Bull

    (1987)
  • T.S. Altepeter et al.

    Situational variation in problem behavior at home and school in attention deficit disorder with hyperactivity: a factor analytic study

    J Child Psychol Psychiatry

    (1992)
  • R.A. Barkley

    Impaired delayed responding: a unified theory of attention deficit, hyperactivity disorder

  • L.A. Champion et al.

    Behaviour problems in childhood and stressors in early adult life: 1. A 20 year follow-up of London school children

    Psychol Med

    (1995)
  • L.L. Davidson et al.

    Hyperactivity in school-age boys and subsequent risk of injury

    Pediatrics

    (1992)
  • H. Dienske et al.

    Quantitative criteria for attention and activity in child psychiatric patients

    J Child Psychol Psychiatry

    (1985)
  • V.I. Douglas

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

    Can J Behav Sci

    (1972)
  • J.J. Enns et al.

    A developmental study of filtering in visual attention

    Child Dev

    (1989)
  • R. Goodman et al.

    A twin study of hyperactivity: I. An examination of hyperactivity scores and categories derived from Rutter teacher and parent questionnaires. II. The aetiological role of genes, family relationships, and perinatal adversity

    J Child Psychol Psychiatry

    (1989)
  • M. Gordon

    The assessment of impulsivity and mediating behaviors in hyperactive and nonhyperactive boys

    J Abnorm Child Psychol

    (1979)
  • J.M. Halperin et al.

    Validation of hyperactive, aggressive, and mixed hyperactive/aggressive childhood disorders: a research note

    J Child Psychol Psychiatry

    (1990)
  • Heptinstall EM. Hyperactivity and Psychosocial Adversity as Risk Factors of Accidents in Childhood, Ph.D Thesis,...
  • T.P. Ho et al.

    Situational versus pervasive hyperactivity in a community sample

    Psychol Med

    (1996)
  • L. Kanner

    Autistic disturbances of affective contact

    Nervous Child

    (1943)
  • P.W.L. Leung et al.

    The diagnosis and prevalence of hyperactivity in Chinese schoolboys

    Br J Psychiatry

    (1996)
  • P.M. Levin

    Restlessness in children

    Arch Neurol Psychiatry

    (1938)
  • Cited by (115)

    • Review of rodent models of attention deficit hyperactivity disorder

      2022, Neuroscience and Biobehavioral Reviews
      Citation Excerpt :

      Since ADHD is a developmental disorder, a good model should have a developmental onset (Willner, 1986). Impulsivity is a prominent ADHD symptom (Taylor, 1998; Johansen et al., 2002) that is seen on tasks requiring timed responses, usually delayed responses. Rodents with this characteristic perform poorly on schedules of reinforcement because the impulsivity interferes with waiting before a rewarded response becomes available.

    • A behavioral economic theory of cue-induced attention- and task-switching with implications for neurodiversity

      2021, Journal of Economic Psychology
      Citation Excerpt :

      Meanwhile, individuals with ADHD tend to switch activities more often than their peers. In children, this tendency is commonly equated to hyperactivity, as evident by a high rate of “task shifts” — whether between academic tasks or between different toys presented by an examiner — with frequent “terminations of sitting” during activities that involve sitting, as well as a high propensity to move from one “station” to another in free play settings (see, in particular, Roberts, Ray, & Roberts, 1984, Dienske et al., 1985, and Taylor, 1998). As with their atypical attention-switching propensities, these atypical propensities to switch “tasks” (broadly speaking) seem to generalize to several domains.

    • Objective measurement of weekly physical activity and sensory modulation problems in children with attention deficit hyperactivity disorder

      2013, Research in Developmental Disabilities
      Citation Excerpt :

      Attention-deficit hyperactivity disorder (ADHD) is a developmental disorder with high prevalence worldwide, 3–10% (Graetz, Sawyer, Hazell, Arney, & Baghurst, 2001; Wolraich, Hannah, Pinnock, Baumgaertel, & Brown, 1996), and around 50% of referrals to pediatric psychiatric clinics are for the assessment and treatment of ADHD (McGee, Clark, & Symons, 2000). One of its core symptoms, hyperactivity (American Psychological Association, 2000), often causes substantial disturbances for children with ADHD and for their parents (Barkley, 1998; Lin & Chung, 2002; Taylor, 1998). For example, hyperactivity may cause children with ADHD to run in a class that requires sitting quietly, and may interrupt their learning, result in rejection by their peers, and increase pressure for their parents (Lin & Chung, 2002).

    View all citing articles on Scopus
    View full text