LITERARY REVIEW 2 Literary Review It was estimated in 2000 that 879,000 children were abused or neglected (Wolf,Reinhard, Cozolino, Caldwell, & Asamen, 2008). This study will examine the possibility thatchildren suffering from Posttraumatic Stress Disorder (PTSD) are more likely to experienceAttention-Deficit Hyperactivity Disorder (ADHD). The hypothesis is that ADHD and PTSD arepositively correlated in children aged seven years. The examiners will also be aware of thequestions related to the possibility that some children are misdiagnosed with ADHD when in factthey have PTSD (Buczynski, 2011). There have been suggestions of an association between ADHD and PTSD (Wozniak,Crawford, Biederman, Faraone, Pil et al, 1999). This study will consist of personal interviewsand psychometric testing using the Minnesota Multiphasic Personality Inventory – 2 to ascertainthe presence of either disorder (Wolf, et al, 2008). The questions this study will answer are: 1.) Is there a correlation between ADHD andPTSD? 2.) Are children being misdiagnosed with ADHD, when in fact they have PTSD? 3.)Would treatment for all children be more effective if it targeted only PTSD? The Diagnostic Statistical Manual, fourth edition, Desk Reference states the criterionnecessary for diagnosing ADHD and PTSD (American Psychiatric Association, 2005). Thesymptoms for ADHD are as follows: A. Either (1) or (2) 1. six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
LITERARY REVIEW 3 Inattention (a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities (b) often has difficulty sustaining attention in tasks or play activities (c) often does not seem to listen when spoken to directly (d) 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) (e) often has difficulty organizing tasks and activities (f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) (g) often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books, or tools) (h) is often easily distracted by extraneous stimuli (i) is often forgetful in daily activities (2) six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: (a) often fidgets with hands or feet or squirms in seat (b) often leaves seat in classroom or in other situation in which remaining seated is expected (c) often runs about or climbs excessively in situations in which it is inappropriate
LITERARY REVIEW 4 (d) often has difficulty playing or engaging in leisure activities quietly (e) is often “on the go” or often acts as if “driven by a motor” (f) often talks excessively Impulsivity (g) often blurts out ensures before questions have been completed (h) often has difficulty awaiting turn (i) often interrupts or intrudes on others (e.g. butts into conversations or games) B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years C. Some impairment from the symptoms is present in two or more settings (e.g. at school, [or work], and at home) D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, of other mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, of a Personality Disorder).The criterion from the DSM-IV-TR (2005) for PTSD are as follows: A. The person has been exposed to a traumatic event in which both of the following were present: (1). The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
LITERARY REVIEW 5 (2). The person’s response involved fear, helplessness, or horror B. The traumatic event is persistently re-experienced in one (or more) of the followingways: (1). recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions (2). recurrent distressing dreams of the event (3). acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated) (4). intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. C. Persistent avoidance of stimuli associated with the trauma and numbing of generalresponsiveness (not present before the trauma), as indicated by three (or more) of the following: (1). efforts to avoid thoughts, feelings, or conversations associated with the trauma (2). efforts to avoid activities, places, or people that arouse recollections of the trauma (3). inability to recall an important aspect of the trauma (4). markedly diminished interest or participation in significant activities
LITERARY REVIEW 6 (5). feeling of detachment or estrangement from others (6). restricted range of affect (e.g. unable to have love feelings) (7). sense of a foreshortened future (e.g. does not expect to have a career, marriage, children, or a normal life span) D. Persistent symptoms of increased arousal (not present before the trauma) as indicatedby two (or more) of the following: (1). difficulty falling or staying asleep (2). Irritability or outburst of anger (3). difficulty concentrating (4). hypervigilance (5). exaggerated startle response E. Duration of the disturbance (symptoms in Criteria B,C, and D) is more than 1 month F. The disturbance causes clinically significant distress or impairment in social,occupational, or other important areas of functioning. The purpose of the study is to answer the questions about ADHD and PTSD beingrelated. One thousand seven year old children will be tested. Studies done in the past have hadsignificantly fewer participants, which means that their findings may not be considered norms ofthe general population of the United States (Ford, Racusin, Daviss et al, 2010).
LITERARY REVIEW 7 Stratified random sampling will be used to ensure that this study can be normed to thepopulation of the United States (Argosy, 2011. Shaughnessy, Zechmeister & Zechmeister,2012). Percentages of various groups and diversity will be gathered from the United StatesCensus Report, 2010(www.census.gov, 2010) The study will also compare and contrast symptoms of ADHD and PTSD and thosechildren exhibiting signs of either disorder will be categorized using the DSM-IV-TR (AmericanPsychiatric Association, 2005). Ethical concerns with this project include the inability to manipulate the variable ofabuse, as it is unethical to cause abuse in order to study it. Parents and children will be informedof the purpose of the study and the method by which information is to be gathered. There willbe no use of deception in this study. Those children identified as having either disorder will betreated immediately. There will also be counseling available to all participants at the end of thestudy.
LITERARY REVIEW 8 ReferencesAmerican Psychiatric Association (2005). Desk Reference to the DiagnosticCcriteria from the DSM-IV-TR. American Psychiatric Association. Arlington, VA.Argosy Online (2011). Retrieved from www.myeclassonline.com (9/27/2011).Buczynski, R. (2011). PTSD and ADHD: Are we misdiagnosing? (9/27.2011).Ford, J.D.,Racusin, R., Daviss, W.B., Ellis, C.G., Thomas, J., Rogers, K…Senguipa, A., (1999). Trauma exposure among children with oppositional defiant disorder and attention-deficit hyperactivity disorder. Journal of Consulting and Clinical Psychology. 67 (5). 786-789. doi: 10.637/0022-006X. 67.5.786.Shaughnessy, J.J., Zechmeister, E.B., Zechmeister, J.S, (2012). Research Methods in Psychology. (9th ed.). New York. McGraw Hill.United States Census (2010). Retrieved from www.census.gov (10/2/2011).Wolf, G.K., Reinhard, M., Cozolino, L.J., Caldwell, A., Asamen, J.K. (2009). Neuropsychiatric symptoms of complex posttraumatic stress disorder: A Preliminary Minnesota Multiphasic Personality Inventory scale to identify adult survivors of childhood abuse. Psychological Trauma Theory: Practice
LITERARY REVIEW 9 and Policy. 1 (1). 49-64. Educational Publishing Foundation.Wozniak, J., Harding Crawford, M., Biederman, J., Faraone, S.V., Pil, D., Spencer, T.J…Slier, H.K. (1999). Antecedents and complications of trauma in boys with ADHD: Findings from a longitudinal study. American Academy of Child and Adolescent Psychiatry.38 (1).48-55.