Shirah Vollmer MD

The Musings of Dr. Vollmer

Attention Spectrum Disorder

Posted by Dr. Vollmer on January 24, 2010

This blog is part of my series on psychopathology.

In my previous blog I spoke about how ADHD is both a cognitive issue and an ego or personality issue. Children with ADHD have a problem with inhibition and as such, they do not wait to hear what the other person has to say. In turn, friendships can be quite challenging. When severe, ADHD children can be very lonely and subsequently depressed. This clinical picture of the lonely, depressed ADHD child can resemble a child with Asperger’s Syndrome.

My six year old female patient who is highly intelligent, unable to focus, hyperactive, has poor frustration tolerance and has no friends. What is the diagnosis? As I have mentioned many times, all psychiatric diagnoses are clinical diagnoses and as such they are subjective. One doctor would call her Asperger’s, another would call her ADHD and a third would say she has both. What do I say? I say that her primary diagnosis is ADHD as she has trouble with focus, trouble controlling her body and trouble containing her frustration. If these problems could be addressed then she would be able to have friends.

Theory of mind is the ability to attribute mental states-beliefs, intents, desires, pretending, knowledge-to oneself and others and to understand that others have beliefs, desires and intentions are different from one’s own. It is typically assumed that others have minds by analogy with one’s own. Based on the reciprocal nature of social interaction, as observed in joint attention, the functional use of language and understanding of others’ emotions and actions. Having a theory of mind allows one to attribute thoughts, desires and intentions to others, to predict or explain their actions and to posit their intentions.

Joint attention is key to a theory of mind, such that a problem with attention will lead to problems in theories of mind. Hence, with my six year old patient, I say that her primary diagnosis is ADHD and not Asperger’s Syndrome. As such, I propose that the explosion in the diagnosis of autism spectrum disorders is in part a result of clinicians missing the diagnosis of ADHD. It seems to me that since clinicians think of ADHD as a series of cognitive deficits and they think of Asperger’s Syndrome as a series of social deficits, there is an artificial separation between these two diagnoses. I propose that we see ADHD as a spectrum disorder and as such, put children into the category of Attention Spectrum Disorder. Once again, I hear my critics worried about funding, since Autism Spectrum Disorders receive state and federal funding, whereas the diagnosis of ADHD does not, in our current system, warrant such funding. I do not want to take funding away from children who need it. At the same time, I do want to focus on having more accurate diagnoses so that we can better comprehend what we are dealing with. We need to give the child and his family greater insight into their struggles. Understanding is our first step.

4 Responses to “Attention Spectrum Disorder”

  1. There is so much information here! I’m trying to remember all of it so I can put it to work.

  2. Rob Caleffi said

    I searched in google for ‘Attention Spectrum Disorder,’ (as I have been thinking about this for a little while) and found your very insightful thoughts here. Thank you for taking the time to share them, and I couldn’t agree more. I actually was thinking about ADHD vs OCD when the term “Attention Spectrum Disorder” occured to me, but I truly am in agreeement with the connection to Aspergers, and thus Autism Spectrum Disorder as well.

  3. bipolar depression symptoms…

    […]Attention Spectrum Disorder « Shirah Vollmer MD[…]…

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