Dr. Cindy Taylor

Clinical Psychologist

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Attention Impairment Index

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ATTENTIONAL IMPAIRMENT INDEX (AI)  How bad is my ADD?

Most of my clients, when diagnosed with ADHD, ask how severe their problem is.  They understandably want to know how they perform in comparison to others - how bad is the problem - how much impairment is really there? Sometimes just saying you have ADHD does not say enough.  It explains a lot, but then let’s face it - some ADHD is worse than others.  We’ve heard debates about whether one can have “borderline ADD” or “mild ADD”; but we have not had a way to measure the severity of it... until now!   We have created a new variable to measure the severity of one’s attentional deficits.  Isn’t all attention the same?  Not exactly.  One person may have problems sustaining attention, another can’t selectively focus, another can’t shift his/her attention, and some just have poor overall concentration.  Measuring the individual components of attention is important because let’s say a child is distractible.  In that case, providing a quiet, distraction free environment
may be the best solution.  On the other hand, what if the problem also includes difficulties with focusing and beginning a task. Then you’ve got a kid who is isolated and doing nothing because he/she doesn’t know where to begin.  So there also needs to be some assistance in getting the child to begin the appropriate task.  What about a kid who is easily distracted and has difficulty focusing and beginning a task and also has trouble sustaining his/her attention?  Now you have someone in a nice secluded environment who knows what he/she is supposed to be doing - does it for a few minutes, and runs out of steam -- he/she may still not be able to complete any work.  In this case you may need to add frequent reminders to stay on task in order to help the person complete the work.  So not all attentional problems are the same.  There are lots of different kinds of problems and just because a person is diagnosed with ADHD doesn’t necessarily describe the type of attentional problem he/she is having, nor does it give clues about the specific interventions necessary to help the individual be successful.  This is also of interest in medical treatment, as most studies of drug efficacy evaluate whether or not the subject’s sustained attention has improved by measuring his/her performance on a Continuous Performance Test or test of processing speed.  Very little research has been done on selective attention, and there is mixed evidence.  One study noted that the performance of children with ADHD did not improve significantly on the Stroop Color and Word Test, which measures selective attention. Some people who are evaluated, and not diagnosed with ADHD, at times, mistakenly hear that they do not have attentional problems and leave feeling misunderstood or discounted.  This is rarely the case, though.  More often than not, they do have attentional deficits - those deficits are simply due to another disorder.

Perhaps the future of assessment of attentional problems is going to be more refined and is already starting to emphasize the individual components of attention.  But future assessments of ADHD and other attentional problems also need to provide an overall assessment of the severity of impairment, similar to what is seen in some methods of neuropsychological testing.  Both of these methods will provide the client with more information,  rather than a simple “yes” or “no” answer to the question of whether or not one has ADHD. What we have done in our research at ADDTRC is to create a variable which both accurately and cumulatively represents attentional impairment (AI).  So instead of saying that two individuals who are very differentially impaired both have ADHD, we can now say one has an AI score of 1 and the other has an AI score of 7.  This is much more meaningful information as the individual with an AI of 7 is probably severely impaired in many areas of
his/her life, and in many forms of attention. For example, an AI of 1 may mean the individual drifts off occasionally while trying to read the paper.  An AI of 7 may mean the individual is unable to hold down a job, unable to complete an education, unable to attend to others enough to achieve intimacy in interpersonal relationships, etc.  

AI is significantly correlated with the number of diagnoses one receives.  Therefore, a person who has anxiety may be just as impaired as one who has ADHD, only the type of impairment will be slightly different.  And the individual who has anxiety, depression, and a substance abuse problem will typically be more severely impaired than the individual who just has ADHD.  So no matter
what the condition, attentional impairment needs to be considered and evaluated, as it is a major key to the treatment of many of these disorders.

Last Updated on Monday, 25 August 2014 23:58  


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