19.2 Attention and Executive Function Disorders

Attention and executive functions are crucial cognitive processes that shape how we interact with the world. They allow us to focus on important information, manage complex tasks, and control our behavior. Understanding these processes helps explain how we navigate daily life and solve problems.

ADHD is a disorder that affects attention and executive functions, impacting both children and adults. It can cause difficulties with focus, impulse control, and organization. Exploring ADHD provides insights into how these cognitive processes work and how they can be disrupted.

Understanding Attention and Executive Functions

Attention and executive functions

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• Attention
  • Selective focus on specific stimuli in environment filters out distractions (cocktail party effect)
  • Sustained concentration over time maintains vigilance (air traffic control)
  • Divided attention between multiple tasks allows multitasking (driving while talking)
• Executive functions
  • Higher-order cognitive processes control and regulate other abilities (frontal lobe functions)
  • Components include:
    • Working memory holds and manipulates information (mental math)
    • Cognitive flexibility adapts to changing situations (task switching)
    • Inhibitory control suppresses inappropriate responses (Stroop test)
    • Planning and organization structures tasks and goals (project management)
    • Task initiation and completion starts and finishes activities (overcoming procrastination)
• Roles in cognitive processing
  • Attention
    • Filters incoming information prioritizes relevant stimuli (cocktail party effect)
    • Enhances perception and memory encoding improves learning (focused studying)
  • Executive functions
    • Coordinate complex cognitive tasks enables problem-solving (chess strategy)
    • Enable goal-directed behavior facilitates achievement (long-term projects)
    • Facilitate decision-making weighs options and consequences (career choices)

Characteristics of ADHD

• ADHD in children
  • Inattention symptoms
    • Difficulty focusing on tasks leads to incomplete schoolwork
    • Easily distracted by external stimuli (noises, visual distractions)
    • Forgetfulness in daily activities misses assignments or chores
  • Hyperactivity symptoms
    • Excessive fidgeting or squirming appears restless in class
    • Difficulty sitting still during meals or lectures
    • Constant motion or restlessness climbs or runs excessively
  • Impulsivity symptoms
    • Interrupting others blurts out answers before questions completed
    • Difficulty waiting for turn in games or conversations
    • Acting without thinking potential safety risks
• ADHD in adults
  • Inattention symptoms
    • Poor time management often late for appointments
    • Difficulty multitasking struggles with complex projects
    • Procrastination delays important tasks until last minute
  • Hyperactivity symptoms
    • Inner restlessness feels on edge or driven by a motor
    • Excessive talking dominates conversations
    • Difficulty relaxing unable to enjoy leisure activities
  • Impulsivity symptoms
    • Making rash decisions without considering consequences
    • Interrupting conversations finishes others' sentences
    • Engaging in risky behaviors impulsive spending or driving
• Impact on daily functioning
  • Academic or occupational challenges underachievement relative to potential
  • Relationship difficulties strains partnerships and friendships
  • Low self-esteem develops negative self-image over time

Neurology of executive function disorders

• Neurological basis
  • Prefrontal cortex involvement
    • Reduced activation in tasks requiring executive functions (fMRI studies)
    • Abnormal connectivity with other brain regions affects information processing
  • Neurotransmitter imbalances
    • Dopamine and norepinephrine dysregulation impacts attention and motivation
• Cognitive underpinnings
  • Working memory deficits
    • Difficulty holding and manipulating information affects problem-solving
  • Inhibitory control impairments
    • Challenges in suppressing inappropriate responses leads to impulsivity
  • Cognitive flexibility issues
    • Trouble adapting to changing situations or rules perseverative behaviors
• Developmental factors
  • Delayed maturation of prefrontal cortex in ADHD affects executive function development
  • Genetic influences on executive function development hereditary component

Assessment and treatment options

• Assessment methods
  • Clinical interviews
    • Patient history and symptom evaluation identifies patterns and triggers
  • Neuropsychological testing
    • Continuous Performance Tests (CPT) measures sustained attention
    • Wisconsin Card Sorting Test (WCST) assesses cognitive flexibility
  • Rating scales and questionnaires
    • Behavior Rating Inventory of Executive Function (BRIEF) evaluates everyday behaviors
  • Observational assessments
    • Classroom or workplace observations provides real-world data
• Treatment options
  • Pharmacological interventions
    • Stimulant medications improve focus and reduce hyperactivity (Ritalin, Adderall)
    • Non-stimulant medications alternative options for some patients (Strattera, Intuniv)
  • Behavioral therapies
    • Cognitive Behavioral Therapy (CBT) develops coping strategies
    • Social skills training improves interpersonal interactions
  • Educational interventions
    • Individualized Education Programs (IEPs) tailors learning approaches
    • Classroom accommodations provides support (extended time, quiet spaces)
  • Cognitive training
    • Working memory exercises strengthens information retention (n-back tasks)
    • Attention training programs improves focus (computerized exercises)
• Multimodal treatment approach
  • Combining medication with behavioral interventions enhances overall effectiveness
  • Tailoring treatment to individual needs and symptoms personalized approach