Attention Deficit Hyperactivity Disorder and Asperger's Syndrome: Extremes on an Attention-Stimulation-Integration Continuum Determined by Cognitive Structure
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Authors
Silver, Stephen Aaron
Issue Date
1996
Type
Thesis
Language
en
Keywords
Alternative Title
Abstract
In this thesis, two disorders of childhood psychopathology, Attention Deficit Hyperactivity Disorder (ADHD) and Asperger's syndrome are explored with regard to their hypothesized relationship. ADHD is characterized by symptoms of impulsivity, inability to sustain attention, hyperactivity, diminished rule-governed behavior, and increased variability of task performance. Asperger's syndrome, considered to be a form of autism (Kanner's syndrome), is characterized by an inability to focus attention on individuals or to make an emotional connection with others. Both disorders manifest behaviorally in an incongruence with social norms and a misreading or incomprehension of social cues by the affected individual. During problem-solving activities, ADHD has been associated with lower-than-normal levels of cortical arousal, while autism has been associated with higher-than-normal levels of cortical arousal. Both disorders involve deficits in cerebral functioning, especially in the area of sensory modulation. Both occur with greater frequency in males, within families, and especially among identical twins, thus suggesting genetic influences. Finally, cognitive patterns of thought for persons affected with ADHD tend to be highly integrated but poorly structured, and thus follow a pattern previously hypothesized for describing "intuitive" thought, while those for persons affected with Asperger's syndrome appear to be highly structured but poorly integrated, and thus tend to emulate a structure suggested to describe "analytical" thought. An analysis of extant research on these two disorders thus far supports the author's contention that there is a correlation between several attributes of ADHD and Asperger's syndrome. An "attention-stimulation-integration continuum" is proposed, in which ADHD and Asperger's syndrome are diagnoses reflecting the manifested behavior resulting from extremes in cognitive structure along a continuum of strength and complexity of associations among mental elements. An organically-based defect (hyperactive or hypoactive) in the regulation of attention and cognitive associations and in the modulation of internal and external sensory stimuli -- manifesting in an intuitive or analytical pattern of cognitive organization, and resulting in the corresponding ADHD or Asperger's syndrome behavior -- is suggested as the primary cause of the disorder. Primary (cognitive) characteristics resulting from these structural patterns include the individual's under- or over-utilization of superordinate goal inferences in guiding or constraining cognitive associations, resulting in impairments in communication and behavior control due to the individual's inability to perceive and respond appropriately to social cues, organize thoughts coherently, and respect conversational maxims in the course of interpersonal interactions; as well as an abnormally excessive or deficient use of pretense and imagination in the affected individual's play and system of mental representations. Secondary (behavioral) characteristics resulting from the individual's underlying pattern of cognitive structure include the individual's ability to wilfully focus or need to extricate and shift his or her attention; the individual's craving for or inability to tolerate novel stimuli; the individual's interest in or resistance to distractions from external stimulation; the individual's ability to perceive and comprehend subtle social cues, including understanding the intentions of his or her conversational partner(s) and responding with appropriate social cues consistent with his or her own intentions; and the individual's difficulties with learning, maintaining an awareness of, and acting in accordance with social rules and personal responsibilities. It is also suggested that ADHD individuals may have an innate capacity for creative thought, and Asperger's syndrome individuals may have a similar capacity for analytical thought as a result of the respective cognitive structures of these individuals. In addition to a comprehensive review of empirical research data, the author's observations from clinical interviews with three individuals (and their families) diagnosed with ADHD and one individual (and his family) diagnosed with Asperger's syndrome are reported as well. These observations, while fascinating to the author and tangentially supportive of the theories proposed here, must be regarded as essentially anecdotal observations -- the subject sample used in gathering data for the clinical observation portion of this paper is too small and not representative of the general population for one to extrapolate any conclusions to the general population. Nevertheless, the author believes that these observations have scientific value sufficient to justify their being reported in detail in this thesis, both because these findings in their raw data form provide the reader with a vivid image of young individuals of varying ages who are affected by these disorders, as well as because the author's observations of these individuals generally support the extant research on the subject: the ADHD individuals displayed impulsive, highly integrated, but significantly less structured than normal behaviors and thought patterns, a need for excessive stimulation, an inability to sustain attention on activities and tasks when not the center of attention, and a tendency toward creative thinking and behavior. The Asperger's syndrome individual, by contrast, acknowledged an astounding ability to perform rote memorization skills (and a tremendous persistence in acquiring such information), a strong desire for stability, reliance upon rituals, a lack of inclination toward external stimulation from friends or family members, the experience of feeling "overwhelmed" and overstimulated, and a tendency toward highly structured behaviors and thought patterns, albeit with a breadth and degree of integration that is exceptionally high for an Asperger's syndrome individual. All four subjects expressed or were reported to have had a general sense of being "different" from others, frequent experiences of social ostracism to varying degrees, and difficulties reading the intentions and emotions of others. Poor gross motor coordination was present in three of the four subjects (all except the youngest ADHD individual). The author's hypothesized attention-stimulation-integration continuum is thus supported by the observational portion of this study, although more research is clearly needed to examine the theory proposed here.