FIGURE 2 - uploaded by Sharon A Gutman
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Frontal View of the Brain Showing the Reticular Formation and the Locus Ceruleus.
Source publication
This paper is a discussion of the experience of adult attention deficit hyperactivity disorder (ADHD). While much is known about the diagnosis and treatment of childhood ADHD, therapists may be less familiar with the clinical signs of adult ADHD and fail to detect and address such deficits in patients. Adult ADHD often affects all occupational doma...
Contexts in source publication
Context 1
... brainstem controls our vegetative functions and houses the reticular formation-the arousal and calming mechanisms of the nervous system. The reticular formation is composed of two systems: (a) the reticular activating system (RAS)-the body's physiologic alarm re- sponse, and (b) the reticular inhibiting system (RIS)-the body's physio- logic stabilizing system (see Figure 2). The RAS acts as a screening device to all incoming sensory data and alerts the brain to attend to im- portant sensory stimuli. People with dysregulation of the reticular for- mation may be unable to screen incoming sensory data in order to distinguish between that which is important and that which is extrane- ous. They may also require significantly increased stimulation to main- tain alertness and arousal. Both of the above are common symptoms of ADHD. A significant body of research has shown that the norepine- phrine (NE) pathways of the reticular formation are compromised in people with ADHD (Pliszka, McCracken, & Maas, 1996). Researchers suggest that overactivation of the NE system in the brainstem may un- derlie an impaired ability to regulate attention and ...
Context 2
... addition to a disorder of the NE system, a number of studies have in- dicated dopaminergic hypoactivity as a prominent factor of ADHD. Al- though the dopaminergic system is widely distributed in the brain, the main dopaminergic projections originate in the substantia nigra and the red nucleus of the midbrain (in the brainstem) (see Figure 2). From the midbrain the dopaminergic pathways project into the basal ganglia, limbic system, and the frontal lobes. It is believed that a dysregulation of the dopamine (DA) system is a primary cause of the impulsivity, hyper- activity, and impaired attention of ADHD. Pharmacologic treatment us- ing stimulant drugs (e.g., methylphenidate and d-amphetamine) increases the amount of DA-and NE-available for brain use. Studies have shown an increased blood flow to the frontal lobes, basal ganglia, and the cere- bellum upon administration of stimulants ( Andreasen et al., 1995;Giedd, Blumenthal, Molloy, & Castellanos, 2001). It appears that the stimulants reactivate dopaminergic pathways-thus regulating the DA system-and facilitate a marked reduction in the symptoms of impulsivity, hyperactiv- ity, and impaired attention (Seeman & Madras, ...
Context 3
... brainstem is also home to the locus ceruleus, located in the rostral pons near the fourth ventricle (see Figure 2). The locus ceruleus is the primary site of NE production and firing. There is substantial ...
Context 4
... brainstem controls our vegetative functions and houses the reticular formation-the arousal and calming mechanisms of the nervous system. The reticular formation is composed of two systems: (a) the reticular activating system (RAS)-the body's physiologic alarm re- sponse, and (b) the reticular inhibiting system (RIS)-the body's physio- logic stabilizing system (see Figure 2). The RAS acts as a screening device to all incoming sensory data and alerts the brain to attend to im- portant sensory stimuli. ...
Context 5
... brainstem is also home to the locus ceruleus, located in the rostral pons near the fourth ventricle (see Figure 2). The locus ceruleus is the primary site of NE production and firing. ...
Context 6
... addition to a disorder of the NE system, a number of studies have in- dicated dopaminergic hypoactivity as a prominent factor of ADHD. Al- though the dopaminergic system is widely distributed in the brain, the main dopaminergic projections originate in the substantia nigra and the red nucleus of the midbrain (in the brainstem) (see Figure 2). From the midbrain the dopaminergic pathways project into the basal ganglia, limbic system, and the frontal lobes. ...
Similar publications
Objective – The aim of this study was to examine the prevalence of
attention deficit/hyperactivity disorder (ADHD) and to identify comorbid
disorders according to subtype of ADHD. Method – The
study sample included 404 children aged from 6-12 years old. Parents
completed The Child Behaviour Checklist/4-18 to detect internalizing
and externalizing p...
Citations
... These difficulties, as outlined in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013), fall within two categories: inattention and hyperactivity with impulsivity. Gutman and Szczepanski (2005) proposed that people with ADHD also have considerable difficulty in accessing and modulating their own sensory environment. ...
... Although researchers of long-term studies have discussed the pervasiveness of ADHD in adulthood-with an estimated worldwide adult prevalence of between 2.5% and 4% (APA, 2013;Stern & Maeir, 2014)-little has been published with regard to sensory processing among adults. Gutman and Szczepanski (2005) found that children with ADHD and control groups differ considerably in terms of sensory processing. When Brown and Dunn's (2008) model was applied to children with ADHD, children were found to score higher in three areas: level of activity, level of hearing, and low registration (Lufi & Tzischinsky, 2014). ...
... Difficulties with sensory processing may also have an impact on how students in a higher education environment experience that environment and learn. For example, a student with sensory underresponsivity may need background noise when studying to provide the stimulation they need (Gutman & Szczepanski, 2005). Johnson and Irving (2008) explained that transitioning to higher education requires being able to function in a more stimulating environment than previously because students have to cope with larger classes, unfamiliar environments, and life in residence halls with varying levels of noise. ...
OBJECTIVE. Research regarding sensory processing and adults with attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) is limited. This study aimed to compare sensory processing patterns of groups of higher education students with ADHD or ASD and to explore the implications of these disorders for their college life.
METHOD.The Adolescent/Adult Sensory Profile was administered to 28 students with ADHD and 27 students with ASD. Students and professionals were interviewed.
RESULTS. The majority of students received scores that differed from those of the general population. Students with ADHD received significantly higher scores than students with ASD in relation to sensation seeking; however, there were no other major differences.
CONCLUSION. Few differences exist between the sensory processing patterns of students with ADHD and ASD; however, both groups differ significantly from the general population. Occupational therapists should consider sensory processing patterns when designing supports for these groups.
Exploring occupational adaptation among adults with attention deficit hyperactivity disorder (ADHD) is essential due to associated occupational difficulties. Occupational Performance History Interview scales—identity, competence, and environments—were compared between 51 adults with and 50 without ADHD who participated in occupations. Internal and external resources supporting occupational participations were represented by the competence and environment scales, respectively. The group with ADHD reported fewer internal and external occupational resources compared to the group without ADHD, despite occupational identity similarities. Study findings suggest that occupational interventions aimed at increasing internal and external occupational resources may support occupational adaptation among adults with ADHD.
OBJECTIVE. The objectives of this study were to better understand the cognitive profile of adults with attention deficit hyperactivity disorder (ADHD), their occupational performance, and their quality of life (QoL) and to examine the validity of a cognitive-functional evaluation (CFE) battery for these adults. METHOD. Eighty-one adults with ADHD and 58 without ADHD completed ADHD symptom ratings, the Behavior Rating Inventory of Executive Function-Adult Version, and the Adult ADHD Quality-of-Life Scale. An occupational performance interview was administered to the ADHD group. RESULTS. A broad range of occupational concerns were reported. We found significant differences between groups on all measures. In the ADHD group, we found medium significant correlations among the measures. CONCLUSION. Adults with ADHD experience cognitive and functional difficulties in their daily lives associated with QoL. The results support the use of a CFE battery that has been shown to be sensitive and specific for these adults.
Objective: An increasing number of adults with ADHD face problems with everyday activities, and occupational therapists play an important role regarding interventions for this particular group. However, there is a knowledge gap within occupational therapy regarding how adults with ADHD experience engagement in everyday activities. The aim of this study was to understand the experiences of engagement in, and describe how adults with ADHD performed everyday activities. Methods: Twelve people with ADHD between the ages of 21 and 38 were interviewed using a semi-structured interview guide. Data were analysed based on a qualitative content analysis. Results: The results showed how engagement in and performance of everyday activities depended on inspiration, facilitating support, and feelings of togetherness with other people. Conclusions: These results show how adults with ADHD can find strategies to become more independent in their performance of everyday activities. Furthermore, this study suggests how occupational therapists can increase opportunities for adults with ADHD to engage in different activities, make choices, and find meaning in everyday activities.
Background
ADHD is a common neurodevelopmental disorder that persists into adulthood. Its symptoms cause impairments in a number of social domains, one of which is employment. We wish to produce a consensus statement on how ADHD affects employment.
Methods
This consensus development conference statement was developed as a result of a joint international meeting held in July 2010. The consensus committee was international in scope (United Kingdom, mainland Europe, United Arab Emirates) and consisted of individuals from a broad range of backgrounds (Psychiatry, Occupational Medicine, Health Economists, Disability Advisors). The objectives of the conference were to discuss some of the occupational impairments adults with ADHD may face and how to address these problems from an inclusive perspective. Furthermore the conference looked at influencing policy and decision making at a political level to address impaired occupational functioning in adults with ADHD and fears around employing people with disabilities in general.
Results
The consensus was that there were clear weaknesses in the current arrangements in the UK and internationally to address occupational difficulties. More so, Occupational Health was not wholly integrated and used as a means of making positive changes to the workplace, but rather as a superfluous last resort that employers tried to avoid. Furthermore the lack of cross professional collaboration on occupational functioning in adults with ADHD was a significant problem.
Conclusions
Future research needs to concentrate on further investigating occupational functioning in adults with ADHD and pilot exploratory initiatives and tools, leading to a better and more informed understanding of possible barriers to employment and potential schemes to put in place to address these problems.
Knowledge regarding neuropsychiatric disabilities has increased in recent years, resulting in an increasing number of adults requesting neuropsychiatric evaluation. The aim of this qualitative study was to describe adult clients' experiences of participating actively in a supportive assessment process in which they received a diagnosis of either autism spectrum disorder (ASD) and/or attention-deficit hyperactivity disorder (ADHD) and then received follow-up counselling, guidance, and compensatory resources that were immediate and directly integrated into the diagnostic experience. The Occupational Performance History Interview – Second Version (OPHI-II) was selected because it is client-centred. It measures how a significant life event affects a person's occupational identity, occupational competence, and interaction with the environment. The OPHI-II was administered to capture 15 participants' experiences of being diagnosed with ASD and/or ADHD as the significant life event of focus. Three categories were formed by using qualitative content analysis: (i) strengthened occupational identity; (ii) compensatory support enhances occupational competence, and (iii) effects of the social environment on relationships. Findings indicated that the diagnostic experience had transformative effects on participants' occupational identities, occupational competence, and ability to self-advocate for increased understanding and resources within their environments. The implications of these findings and future research are discussed.
