Psychosocial effects of Attention Deficits Hyperactivity Deficits:
And Impulsive Mood Disorders
Bad Decision-Making,
And Impulsive Mood Disorders
Bad Decision-Making,
Following Traumatic Brian Injuries
Alcohol and Drug Misuse
By
Ronald A. Bernard
Vassar College
Brain, Mind and Self
Tuesday, July 11, 2006
For
Joe Atkins Ph.D. and Beryl Duncan Wilson Ph.D.
Alcohol and Drug Misuse
By
Ronald A. Bernard
Vassar College
Brain, Mind and Self
Tuesday, July 11, 2006
For
Joe Atkins Ph.D. and Beryl Duncan Wilson Ph.D.
Abstract
Studies have linked Decision-making deficits to drug addiction to better understand the core aspects of addictive behavior. Cognitive Psychological measures such as the gambling task have been used to identify those patients with brain damage in the ventromedial region of the prefrontal cortex. Poor performances by continuing to select from the risks decks even after accruing considerable financial debt, and fail to develop anticipation to the risky choices. The inability to use ongoing feedback to guide their future responds has been labeled ‘Myopia for the future’. Criminal behavior has been correlated with Addiction and Attention Deficit Hyperactivity disorder which can also be acquired through head trauma sometimes characterized by behavioral or cognitive dyscontrol. The proposal study will consist of a correlated study to determine do persons with Prefrontal Cortex Damage and Individuals with Criminal Behavior and history of incarceration display ADHD like symptoms develop ADHD like symptoms and if so are they more likely to be at risk of Addictive and Impulsive behaviors. Method and Tools (1) Gambling Task Test (2) SNAP IV Rating Scale: Interviews with Friends and Families of Prefrontal Cortex Damage patients to determine pre-damage behaviors. The expected results will further insights on the research on these serious co-occurring disorders. And perhaps encourage the medical and municipal communities to develop a more effect means by which to earlier identify those who suffer from Inattentive forms of ADHD that cause decision-making deficits rather than focusing drug addiction as a root cause for bad choices. Early detection linked with a through functioning knowledge of coping skills and re-patterning can be of maximum effect in the outcome of one’s entire life.
Introduction
Core aspects of addictive behavior in terms of abnormal decision making have recently identified three distinct neuropsychological subtypes in individuals with substance dependence (Bechara, A.; Damasio, H. 2002). Measures know as the Gambling Task (see fig.1) as has been used to identify that patients with brain damage in the Ventromedial region of the prefrontal cortex perform poorly by continuing to select from the risks decks even after accruing considerable financial debt, and fail to develop anticipation to the risky choices. This decision making deficit labeled ‘Myopia for the future’ being unable to used ongoing feedback to guide their future responds. In correlation Attention Deficit Hyperactivity disorder (ADHD) and traumatic brain injury; other disorders Also examined are the relationships of borderline personality disorder to Axis I affective, schizophrenic, and impulsive spectrum disorders; anxiety and panic disorders characterized by behavioral or cognitive dyscontrol (Silk, Kenneth R. 2005. Biological and neurobehavioral studies of borderline personality disorder)
Criminal behavior has been correlated with Addiction, Anti-Social Behavior and Attention Deficit Hyperactivity disorder that can be acquired through head trauma sometimes characterized by behavioral or cognitive dyscontrol. The proposal study will consist of a correlated study to determine do persons with Prefrontal Cortex Damage and Individuals with criminal behavior and history of incarceration display ADHD like symptoms and if so are they more likely to be at risk of Addictive, Anti-Social and Impulsive behaviors. Method and Tools: (1) Gambling Task (2) Interviews with Friends and Families of Prefrontal Cortex Damage patients about pre-damage behaviors. Interviews with Friends and Families of Individuals with a history of criminal behavior. Testing both groups on ADHD using the SNAP IV Rating Scale. Two response sections (very likely….not likely) the individuals with Criminal Behavior will be asked the questions directly as well as family members.
The expected results will identify the need to expand research on this serious disorder while inferring the possibility that ADHD and accompanying symptoms may be in part responsible for the decision making deficits that are observed and manifested in the prison population.
Methods
Two types of data collection will be employed in this study.
Case studies and interviews: with patients with documented Prefrontal Cortex Injuries (head trauma), exhibiting decision making deficits with co-occurring displays of Attention-deficit/hyperactivity disorder (ADHD) is thought to implicate
Executive functions and frontal-striatal circuitry functioning.
Case studies and interviews: with individual with past criminal histories and prison incarceration. Exhibiting behavior characterized by loss of control of attention, impulses, and activity level, and the neurochemical aspects of poor impulse control need to be managed in order to decrease recidivism.
Tools
(1) Gambling Task
(See appendix 1)
In this task, subjects are presented with four decks of cards and must make a long series of decisions, picking from any deck on each go without knowing that there are ‘safe’ and ‘risky’ decks. Over 100 choices, healthy subjects typically develop a preference for the ‘safe’ decks (C and D) over the ‘risky’ decks (A and B). This learning has a physiological correlate in the development of an ‘anticipatory’ skin conductance response (SCR) prior to selection from the risky decks [4], which is assumed to reflect some awareness that the decision could result in high punishment. Patients with brain damage in the ventromedial region of prefrontal cortex (PFC) perform poorly on the Gambling Task [4]. They continue to select from the risky decks even after accruing considerable financial debt, and fail to develop anticipatory SCRs to the risky choices, despite showing normal post-choice autonomic responses to reward and punishment. Their decision-making deficit has been labeled ‘myopia for the future’ – these patients are unable to use ongoing feedback to guide future responses, and therefore evaluate each decision in terms only of the immediate reward available. This pattern is consistent with the real-life cognitive difficulties seen in patients with lesions in this area.
(2) SNAP IV Rating Scale Questions: A test was devised based on the symptoms exhibited in ADD/ADHD by a psychologist at the University of California - called the SNAP IV Rating Scale. It is based on the questions below, and the answers run from 1 to 5 (very often, often, neutral, not often, never)
(See appendix 2)
Results
Case studies and interviews are expected to reveal a high incidence of Inattentive ADHD in the general and prison populations than previously anticipated. Especially in regards to individuals experiencing borderline personality disorders; panic and anxiety disorders characterized by behavioral or cognitive dyscontrol correlated with Addiction, Anti-Social Behavior and Impulsive behaviors. It is also hoped to encourage further development of more reliable and effective means of early detection of the four subtypes of ADHD, education and etiology of the disorder. Enabling the sufferer make sense of a sometimes chaotic world.
Discussion
The expected results will raise serious questions on current methods of correctly identifying ADHD and its many subtypes: Inattentive, hyperactive/impulsive, ADHD-combined meeting both criteria Inattentive and hyperactive/impulsive and those who meet some of the criteria but enough for a full diagnosis.
Sufferers behavior their accompanying symptoms which are to often characterized as inappropriate, anti-social. And in some cases even feeble-minded.
Keeping in mind the outcome for a sufferer of this seriousness of this disorder is often institutionalization or incarceration as an outcome behavioral disinhibition and relative indifference to punishment. Other inattentive symptoms enhanced sensitivity, rage, violence, and alcoholism and drug addiction. All directly influenced by the underlying malady.
The increase in the amount of persons diagnosed is report at three fold between 1990 and 1996 indicates the development of more accurate identification, effective treatments and behavioral and drug therapies. Coupled public awareness programs, alternative sentencing and treatment options by the judicial systems would be beneficial for all concerned. ADHD is not an easy thing to live with but If found a treated, the person can lead and entirely happy and normal life.
References
References missing : > (
Clark, L.: Robbins, T. 2006. Decision-making deficits in Drug Addiction. Trends in Cognitive Science Vol. 6 No 9 September 2002
Bechara, A. and Damasio, H. (2002) Decision-making and addiction (Part I): impaired activation of somatic states in substance-dependent individuals when pondering decision with negative future consequences. Neuropsychologia 40, 1675–1689
Silk, K.R... 2005. Biological and neurobehavioral studies of borderline personality disorder Progress in psychiatry, No. 45. Washington, DC, US: American Psychiatric Association. (1994). xxix, 256 pp
Appendix (1)
(1) Gambling Task
(Fig.1) Schematic representation of the display from the Gambling Task, showing the reward and punishment contingencies in the original and variant versions.
In this task, subjects are presented with four decks of cards and must make a long series of decisions, picking from any deck on each go without knowing that there are ‘safe’ and ‘risky’ decks. Over 100 choices, healthy subjects typically develop a preference for the ‘safe’ decks (C and D) over the ‘risky’ decks (A and B). This learning has a physiological correlate in the development of an ‘anticipatory’ skin conductance response (SCR) prior to selection from the risky decks [4], which is assumed to reflect some awareness that the decision could result in high punishment. Patients with brain damage in the ventromedial region of prefrontal cortex (PFC) perform poorly on the Gambling Task [4]. They continue to select from the risky decks even after accruing considerable financial debt, and fail to develop anticipatory SCRs to the risky choices, despite showing normal post-choice autonomic responses to reward and punishment. Their decision-making deficit has been labeled ‘myopia for the future’ – these patients are unable to use ongoing feedback to guide future responses, and therefore evaluate each decision in terms only of the immediate reward available. This pattern is consistent with the real-life cognitive difficulties seen in patients with lesions in this area.
Appendix (2)
(2) SNAP IV Rating Scale Questions: Based on the questions below, and the answers run from 1 to 5 (very often, often, neutral, not often, never)
1) Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2) Often has difficulty sustaining attention in tasks or play activities.
3) Often does not seem to listen when spoken to directly.
4) Often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5) Often have difficulty organizing tasks and activities.
6) Often avoids, dislikes, or has difficulties engaging in tasks.
7) Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools).
8) Is often easily distracted by extraneous stimuli.
9) Often forgetful in daily activities.
10) Often fidgets with hands or feet or squirms in seat.
11) Often leaves seat in classroom or in other situations in which remaining seated are expected.
12) Often may be limited to subjective feelings of restlessness.
13) Often has difficulty engaging in leisure activities quietly.
14) Is always "on the go" or often acts if "driven by a motor".
15) Often talks excessively.
16) Often blurts out answers to questions before the questions have been completed.
17) Often has difficulty waiting turn.
18) Often interrupts or intrudes on others (e.g. butts into conversations or games).
19) Often stares into space and reports daydreaming.
20) Often appears to be low in energy level, sluggish, or drowsy.
21) Often appears to be apathetic or unmotivated to engage in goal directed activities.
22) Often engages in physically dangerous activities without considering possible consequences.
23) Often shifts from one uncompleted activity to another.
24) Often fails to finish things he or she starts.
25) Has difficulty concentrating on tasks requiring sustained attention.
26) Has difficulty sticking to a play activity.
27) Frequently calls out in situations when silence is expected.
28) Needs a lot of supervision.
29) Moves about excessively (e.g., even during sleep at home)
30) Often acts before thinking.
31) Often loses temper.
32) Often argues with others.
33) Often actively defies or refuses requests or rules.
34) Often deliberately does things that annoy other people.
35) Often blames others for his or her mistakes or misbehavior.
36) Often touchy or easily annoyed by others.
37) Is often angry and resentful.
38) Is often spiteful or vindictive.
39) Often swears or uses obscene language.
40) Often manifests provocative behavior.
41) Often shows excessive stubbornness.
The expected results will raise serious questions on current methods of correctly identifying ADHD and its many subtypes: Inattentive, hyperactive/impulsive, ADHD-combined meeting both criteria Inattentive and hyperactive/impulsive and those who meet some of the criteria but enough for a full diagnosis.
Sufferers behavior their accompanying symptoms which are to often characterized as inappropriate, anti-social. And in some cases even feeble-minded.
Keeping in mind the outcome for a sufferer of this seriousness of this disorder is often institutionalization or incarceration as an outcome behavioral disinhibition and relative indifference to punishment. Other inattentive symptoms enhanced sensitivity, rage, violence, and alcoholism and drug addiction. All directly influenced by the underlying malady.
The increase in the amount of persons diagnosed is report at three fold between 1990 and 1996 indicates the development of more accurate identification, effective treatments and behavioral and drug therapies. Coupled public awareness programs, alternative sentencing and treatment options by the judicial systems would be beneficial for all concerned. ADHD is not an easy thing to live with but If found a treated, the person can lead and entirely happy and normal life.
References
References missing : > (
Clark, L.: Robbins, T. 2006. Decision-making deficits in Drug Addiction. Trends in Cognitive Science Vol. 6 No 9 September 2002
Bechara, A. and Damasio, H. (2002) Decision-making and addiction (Part I): impaired activation of somatic states in substance-dependent individuals when pondering decision with negative future consequences. Neuropsychologia 40, 1675–1689
Silk, K.R... 2005. Biological and neurobehavioral studies of borderline personality disorder Progress in psychiatry, No. 45. Washington, DC, US: American Psychiatric Association. (1994). xxix, 256 pp
Appendix (1)
(1) Gambling Task
(Fig.1) Schematic representation of the display from the Gambling Task, showing the reward and punishment contingencies in the original and variant versions.
In this task, subjects are presented with four decks of cards and must make a long series of decisions, picking from any deck on each go without knowing that there are ‘safe’ and ‘risky’ decks. Over 100 choices, healthy subjects typically develop a preference for the ‘safe’ decks (C and D) over the ‘risky’ decks (A and B). This learning has a physiological correlate in the development of an ‘anticipatory’ skin conductance response (SCR) prior to selection from the risky decks [4], which is assumed to reflect some awareness that the decision could result in high punishment. Patients with brain damage in the ventromedial region of prefrontal cortex (PFC) perform poorly on the Gambling Task [4]. They continue to select from the risky decks even after accruing considerable financial debt, and fail to develop anticipatory SCRs to the risky choices, despite showing normal post-choice autonomic responses to reward and punishment. Their decision-making deficit has been labeled ‘myopia for the future’ – these patients are unable to use ongoing feedback to guide future responses, and therefore evaluate each decision in terms only of the immediate reward available. This pattern is consistent with the real-life cognitive difficulties seen in patients with lesions in this area.
Appendix (2)
(2) SNAP IV Rating Scale Questions: Based on the questions below, and the answers run from 1 to 5 (very often, often, neutral, not often, never)
1) Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2) Often has difficulty sustaining attention in tasks or play activities.
3) Often does not seem to listen when spoken to directly.
4) Often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5) Often have difficulty organizing tasks and activities.
6) Often avoids, dislikes, or has difficulties engaging in tasks.
7) Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools).
8) Is often easily distracted by extraneous stimuli.
9) Often forgetful in daily activities.
10) Often fidgets with hands or feet or squirms in seat.
11) Often leaves seat in classroom or in other situations in which remaining seated are expected.
12) Often may be limited to subjective feelings of restlessness.
13) Often has difficulty engaging in leisure activities quietly.
14) Is always "on the go" or often acts if "driven by a motor".
15) Often talks excessively.
16) Often blurts out answers to questions before the questions have been completed.
17) Often has difficulty waiting turn.
18) Often interrupts or intrudes on others (e.g. butts into conversations or games).
19) Often stares into space and reports daydreaming.
20) Often appears to be low in energy level, sluggish, or drowsy.
21) Often appears to be apathetic or unmotivated to engage in goal directed activities.
22) Often engages in physically dangerous activities without considering possible consequences.
23) Often shifts from one uncompleted activity to another.
24) Often fails to finish things he or she starts.
25) Has difficulty concentrating on tasks requiring sustained attention.
26) Has difficulty sticking to a play activity.
27) Frequently calls out in situations when silence is expected.
28) Needs a lot of supervision.
29) Moves about excessively (e.g., even during sleep at home)
30) Often acts before thinking.
31) Often loses temper.
32) Often argues with others.
33) Often actively defies or refuses requests or rules.
34) Often deliberately does things that annoy other people.
35) Often blames others for his or her mistakes or misbehavior.
36) Often touchy or easily annoyed by others.
37) Is often angry and resentful.
38) Is often spiteful or vindictive.
39) Often swears or uses obscene language.
40) Often manifests provocative behavior.
41) Often shows excessive stubbornness.
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