Tuesday, January 24, 2012

Research Proposal - Working Memory of Adults with Attention-Deficit Hyperactivity Syndrome (ADHD)


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Working Memory of Adults with Attention-Deficit Hyperactivity Syndrome (ADHD)


This proposal will discuss a study that will specifically test if adults with attention-deficit hyperactivity syndrome (ADHD) will score lower on working memory tasks than adults who do not have ADHD characteristics. In this study, the main aim is to know the difference in terms of working memory tasks among adults with ADHD symptoms and those who do not. In order to test the hypothesis, the researcher will resort to quantitative research method. Several subjects will be chosen (i.e. mathematics, grammar, and science) for college classes to set for observing both adults with and without ADHD symptoms, specifically how they fair with remembering the lessons. Those with symptoms of ADHD will be determined through an ADHD behavior checklist. Then working memory difference will be measured with the help of some working tasks such as working span and number span. The purpose of the tasks is to compare those adults who score higher on the ADHD behavior checklist with those who do not exhibit ADHD symptoms. This topic is chosen to contribute in determining the reasons why adults with symptoms of ADHD are always associated with negative status such as: high incidence of psychiatric problems; lower employment status; relationship problems; poor frustration tolerance and anger dysregulation; low self-esteem; and a high incidence of drug and alcohol abuse. The study will be important in a sense that it will confirm the memory problems of people with ADHD, which in turn, would inspire experts to create better interventions and to research more regarding the problem. Thus, the study can contribute in this field by creating more awareness about the problem.

Background of the Study


Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent developmental disorders diagnosed in childhood, characterized by excessive activity, short attention span, and impulsivity (APA, 2000). It is a neurobiological disorder that interferes with an individual’s capacity to regulate activity level (hyperactivity), inhibit behaviour (impulsivity) and attend to tasks (inattention) in developmentally appropriate ways. The cause of the disorder is found in the functioning of the brain. Attention Deficit Disorder ADD ADHD is a limiting metabolic dysfunction of the brain. When neural building materials are lacking, neurological demands cannot be fulfilled easily. This interferes with the efficient processing of information (APA, 2000). The core symptoms of ADHD include an inability to maintain attention and concentration (APA, 2000). Other symptoms include: squirming excessively; has difficulty remaining seated; easily distracted; often loses things; has difficulty following instructions; often talks excessively; has difficulty sustaining attention; often interrupts; shifts from one activity to another; and often doesn’t listen to what is said (APA, 2000).

In adults, those who have the symptoms experience a broad range of psychological problems. As mentioned in the introduction, these include a high incidence of psychiatric problems (Biederman et al, 1993), lower employment status (Mannuzza et al, 1993), relationship problems (Barkley, 1990), poor frustration tolerance and anger dysregulation (Woods, 1986), low self-esteem (Weiss and Hechtman, 1986) and a high incidence of drug and alcohol abuse (Mannuzza et al, 1993). However, its prevalence is less in the adult population, with only between 2 and 6% who have the symptoms.

The American Psychiatric Association (APA) criteria of the characteristics of ADHD is said to be developed only for children. However, their criteria can persist to adults. Similar to the APA criteria, the ‘Utah’ operational criteria for adult ADHD, which include a childhood history consistent with ADHD, involve a broader range of features, i.e. hyperactivity, inattention, mood liability, short-fuse temper, disorganization, stress sensitivity and impulsivity (Wender et al, 2001). But often, ADHD symptoms in adults is associated with other behavior disorders such as mood disorders, borderline personality disorder (BPD), antisocial personality disorder (APD) and mania (Evenden, 1999, Moeller et al, 2001). Furthermore, adult ADHD have been associated with other disorders such as depression, bipolar disorder, schizophrenia and BPD (Walker et al, 2000; Elliot et al, 1998). It co-occurs with ‘cluster B’ personality disorder of the APA criteria. Also, there are several reports of neurocognitive impairments in patients with BPD involving attention, verbal and visual memory, planning and information processing, as well as problems with cognitive inflexibility, poor self-monitoring and perseveration (Van Reekum, 1993; Stein et al, 1994).

The reports show that adults with ADHD can have poor memory. Specifically at work, the study conducted by Dowson et al (2004) in response to spatial working memory performance of adults with ADHD, the results support their claim that aspects of working memory performance are particularly impaired in adult ADHD. With the use of ANOVA, they found that the ADHD group, contrary to the BPD group, was the only patient group to show SWM impairment relative to the non-clinical controls.

On the other hand, Karatekin (2004) state that children with ADHD have deficits in divided attention (i.e., the central executive component but there was no evidence for gross deficits in the buffers or rehearsal processes. Thus, these results suggest that the impairments observed in complex tasks of working memory in ADHD may be attributable to a dysfunction in the central executive component rather than in the verbal or spatial buffers or rehearsal processes. The findings here can be a great support like that of Mariani and Barkley (1997), who found deficits in spatial working memory in unmedicated preschool boys with ADHD on a task that required the children to remember the spatial location of pictures; and who also found that there were no deficits among adolescent boys. Also, the result in Karatekin’s study supports the suggestions that that individuals with ADHD perform poorly on complex tasks that rely heavily on central executive (e.g., Barnett et al., 2001; Kuntsi, Oosterlaan, and Stevenson, 2001; Pennington and Ozonoff, 1996; Schweitzer et al., 2000). However, it also disproves the other result of the same studies – which it also relies heavily on buffers. It deviates from its framework – the Baddeley and Hitch’s (1974) model – which means that working memory, involves buffers for holding information for 2–3 s at a time, rehearsal mechanisms to refresh this information over a longer period, and a central executive component that coordinates the activities of these buffers and controls attention.

Statement of the Problem


            The problem in the study is to determine the difference between the verbal written and spatial memory tasks capability of adults who have ADHD symptoms and those who haven’t. This can be answered with less difficulty by addressing the following queries:

1.            How do adults with ADHD perform with working memory tasks?

2.            Do they perform in a satisfactory level?

3.            Does their achievement in spatial memory tasks have any difference with the achievement of those who don’t have the symptoms?
4.            Does their achievement in verbal memory tasks have any difference with the achievements of those who don’t have the symptoms?
5.            Does their achievement with written memory tasks have any difference with those who don’t have the symptoms?
6.            Does the difference, if there’s any, considerably high?
7.            Which type of memory task do the ADHD adults have more difficulty with?



Hypothesis


            The hypothesis of the study is that adults with ADHD will score lower on working memory tasks than adults who do not have ADHD characteristics. This is because of the observed and studied facts that such condition can affect one’s capability to memorize.

Significance of the Study


            This study is significant to the field of ADHD research because it would support previous studies that find ADHD to be related with the difficulty in memorizing visual and verbal contexts. Furthermore, this can help fill the lack of specificity on the behavioral features of adult ADHD and can help in identifying it clearly, particularly in terms of their behavioral features when being engaged with a spatial, written or verbal memory task. In addition, perhaps the most promising importance of this study is that it will help in creating awareness regarding the problem of ADHD in engaging with working memory tasks. Such problems can affect their academic performance and their social status. Professionals should realize the need for an effective intervention that would ADHD adults. This study can also contribute to future studies that will tackle the same issue. The results that would be found here can serve as a valuable references, and further, can open up new issues that are worthy of being investigated. The study will benefit those in the academe, in psychiatry, in psychology, and people who are concerned with ADHD adult issues.

Objectives of the Study

            The main objective of the study is to be able to differentiate the performance of adults with ADHD symptoms from the performance of adults who do not have the symptoms. Through this main objective, come the sub-objectives such as researching literatures related to the topic for better understanding of issues, conducting quantitative working memory tasks such as digit span, word span, and visual span. Finally, another objective of the study is to be able to create awareness regarding the problem of ADHD adult in engaging with working memory span.

Scope and Limitation


            The study will only cover adults with ADHD and will not cover any other disorders that would comparable with the main topic. The areas to be investigated are limited only to spatial working memory, verbal working memory, and written working memory. On the other hand, the study will only be limited to quantitative research method, using the working tasks to test the hypothesis statistically. The researcher will only resort to the ANOVA method. Furthermore, college classes will be the venue of the research, and from there, the respondents will be acquired.

Methodology

Primary and secondary research will be used in the study. Primary research will be conducted through an experiment with selected college students. First, an ADHD behavior checklist will be distributed to the students to determine who among them have the symptoms of the disorder. Then, the researcher will conduct several working tasks that will include visual span, digit span, letter span and verbal span. Then from that, the researcher will compare the performance of those who score higher on the ADHD behavior checklist with those who do not exhibit ADHD symptoms. Although some may not be confirmed they actually have ADHD, the symptoms will categorize the class.

On the other hand, secondary research will be conducted by acquiring data from related literatures i.e. from books, journal articles, research and studies, news features, medical releases, etc.
The study will use quantitative research because it involves counting and measuring the events and performing the statistical analysis of a body of numerical data (Smith, 1988). It is compatible with the study because it allows the research problem to be conducted in a very specific and set terms (Frankfort-Nachmias & Nachmias, 1992). Furthermore, quantitative research clearly and precisely specifies both the independent and the dependent variables under investigation (Matveev, 2002). It also follows firmly the original set of research goals, arriving at more objective conclusions, testing hypothesis, determining the issues of causality and eliminates or minimises subjectivity of judgment (Kealey & Protheroe, 1996). In addition, this method allows for longitudinal measures of subsequent performance of research subjects (Matveev, 2002). Finally, it provides achieving high levels of reliability of gathered data due to controlled observations, laboratory experiments, mass surveys, or other form of research manipulations (Balsley, 1970).
Data Collection

The behavior check list to be used in the study will be adopted from Dr. Daniel Amen of Irvine College of Medicine in California. The checklist (see Appendix), is not a tool for self-diagnosis, but merely to help determining whether ADHD may be a factor in the behavior of the person being assessed. He explained that an actual diagnosis can be made only by an experienced professional (Amen, 2004). Nonetheless, the checklist can help categorize the students and can help considerably in the development of the study. In the checklist, more than 20 items with a score of three or more indicates a strong tendency toward ADHD. The behavior or symptoms checklist includes asking the respondent’s past history, short-attention span or distractibility, restlessness, impulsivity, poor organization, problems getting started and following through, negative internal feelings, relational difficulties, short fuse, frequent search for high stimulation, tendency to get stuck, switches things around, writing fine/motor coordinating difficulties, sleep/wake difficulties, low energy, or sensitive to noise or touch.

The checklist will be based on sort of a five-point Likert Scale where 0 is equivalent to never, 1= rarely, 2 = occasionally, 3 = frequently , and 4 = very frequently.

On the other hand, digit span, letter span, and verbal span will be constructed by the researcher to test and compare the performance of the respondents toward working memory tasks.
Data Analysis

           The SPSS 3 software will be used in the data analysis of the study. The performance of the respondents will be tested with the one-way analysis of variance. This is to test the means of the performance of the respondents on each of the working memory tasks. On the other hand, the checklist will be analyzed with the use of percentage and weighted mean computation. To interpret, this is how the formulae should look like:
1.     Percentage – to determine the magnitude of the responses to the questionnaire.
            n
% = -------- x 100        ;           n – number of responses
            N                                 N – total number of respondents
2.     Weighted Mean
            f1x1 + f2x2  + f3x3 + f4x4  + f5x5
x = ---------------------------------------------  ;
                        xt
where:            f – weight given to each response
                        x – number of responses
                        xt – total number of responses

References:

Amen, D.G. (2004). Adult ADHD Symptoms Checklist (online). Available at: http://www.addresources.org/article_checklist_amen.php [Accessed: 11/04/04].

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: DSM-IVTR (4th edn: Text revision). Washington: American Psychiatric Association.

Baddeley, A.D., and Hitch, G.J. (1974). Working memory. In G.A. Bower (Ed.), The psychology of learning and motivation (pp. 47–89). New York: Academic Press.
Balsley, H.L. (1970). Quantitative research methods for business and          economics. New York: Random House.
Barkley R. (1990). Attention deficit hyperactivity disorder. A handbook for diagnosis and treatment. New York: Guilford Press.

Barnett, R., Maruff, P., Vance, A., Luk, E.S.L., Costin, J., Wood, C., and Pantelis, C. (2001). Abnormal executive function in attention deficit and hyperactivity disorder: The effect of stimulant medication and age on spatial working memory. Psychological Medicine, Vol.31; pp. 1107–1115.

Biederman J, Faraone S, Spencer T et al.(1993).Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. American Journal of Psychiatry, Vol.150; pp.1792-1798.

Dowson, JH, McLeam, A., Bazanisi, E., Toone, B., Young, S., Robbins, C.W. and Sahakian, B.J. (2004). Impaired spatial working memory in adults with attention-deficit/hyperactivity disorder: comparisons with performance in adults with borderline personality disorder and in control subjects. Acta Psychiatr Scand Vol.2, No.10: pp.45–54.

Elliott R, Sahakian BJ, Michael A, and Paykel ES (1998). Abnormal neural response to feedback on planning and guessing tasks in patients with unipolar depression. Psychol Med, Vol.28; pp.559–571.

Evenden J. (1999).  Impulsivity: a discussion of clinical and experimental findings. J Psychopharmacol, No13; pp.180-192.

Frankfort-Nachmias, C., & Nachmias, D. (1992). Research methods in the          social sciences (4th ed.). New York: St. Martin's Press.
Karatekin, C. (2004). A test of the integrity of the components of Baddeley’s model of working memory in attention-deficit/hyperactivity disorder (ADHD). Journal of Child Psychology and Psychiatry, Vol.45, No.5; pp 912–926
Kealey, D.J., & Protheroe, D.R. (1996). The effectiveness of cross-cultural       training for expatriates: An assessment of the literature on the issue.             In International Journal of Intercultural Relations, Vol. 20 No. 2, pp. 141-   165.
Kuntsi, J., Oosterlaan, J., & Stevenson, J. (2001). Psychological mechanisms in hyperactivity: I. Response inhibition deficit, working memory impairment, delay aversion, or something else? Journal of Child Psychology and Psychiatry, Vol.42; pp.199–210.

Mannuzza S, Klein R, Bessler A, Malloy P, LaPadula M. (1993). Adult outcomes of hyperactive boys. Educational achievement, occupational rank, and psychiatric status. Archives of General Psychiatry; Vol.50; pp.565–576.

Mariani, M.A., & Barkley, R.A. (1997). Neuropsychological and academic functioning in preschool boys with Attention Deficit Hyperactivity Disorder. Developmental Neuropsychology, Vol.13; pp. 111–129.
Matveev, A.V. (2002). The Advantages Of Employing Quantitative And       Qualitative Methods In Intercultural Research: Practical Implications From       The Study Of The Perceptions Of Intercultural Communication          Competence By American And Russian Managers. New York: Russian        Communication Association.
Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swan AC (2001). Psychiatric Aspects of Impulsivity. Am J Psychiatry, Vol.158: pp.1783–1793.

Pennington, B.F., & Ozonoff, S. (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry, Vol.37; pp.51–87.

Schweitzer, J.B., Faber, T.L., Grafton, S.T., Tune, L.E., Hoffman, J.M., & Kilts, C.D. (2000). Alterations in the functional anatomy of working memory in adult Attention Deficit Hyperactivity Disorder. American Journal of Psychiatry, Vol.157; pp. 278–280.

Stein DJ, Hollander E, Cohen L et al. (1994). Neuropsychiatric impairment in impulsive personality disorders. Psychiatry Res, Vol.48: pp.257–266.

Van Reekum R. (1993). Acquired and developmental brain dysfunction in borderline personality disorder. Canadian Journal of Psychiatry Vol.38 (Suppl. 1): pp.S4–S10.

Walker AJ, Shores EA, Trollor JN, Lee T, and Sachdev PS (2000). Neuropsychological functioning of adults with attention de.cit hyperactivity disorder. J Clin Exp Neuropsychology, Vol.22:115–124.

Weiss G, Hechtman LT. (1986). Hyperactive children grown up. New York: Guilford.

Wender PH, Wolf LE, Wasserstein J. (2000). Adults with ADHD. An Overview. Ann NY Acad Sci, No.931; pp.1–16.

Woods, D.  (1986). The diagnosis and treatment of attention deficit disorder, residual type. Psychiatric Annals, Vol. 6; pp.23–28.


Appendix

Past History

1.__*History of ADHD symptoms in childhood, such as distractibility, short attention span, impulsivity or restlessness. ADHD doesn't start at age 30.
2.__History of not living up to potential in school or work (report cards with comments such as "not living up to potential")
3.__History of frequent behavior problems in school (mostly for males)
4.__History of bedwetting past age 5
5.__Family history of ADHD , learning problems, mood disorders or substance abuse problems

Short Attention Span/Distractibility

6.__*Short attention span, unless very interested in something
7.__*Easily distracted, tendency to drift away (although at times can be hyperfocused)
8.__Lacks attention to detail, due to distractibility
9.__Trouble listening carefully to directions
10.__Frequently misplaces things
11.__Skips around while reading, or goes to the end first, trouble staying on track
12.__Difficulty learning new games, because it is hard to stay on track during directions
13.__Easily distracted during sex, causing frequent breaks or turn-offs during lovemaking
14.__Poor listening skills
15.__Tendency to be easily bored (tunes out)

Restlessness

16.__Restlessness, constant motion, legs moving, fidgeting
17.__Has to be moving in order to think
18.__Trouble sitting still, such as trouble sitting in one place for too long, sitting at a desk job for long periods, sitting through a movie
19.__An internal sense of anxiety or nervousness

Impulsivity

20.__Impulsive, in words and/or actions (spending)
21.__Say just what comes to mind without considering its impact (tactless)
22.__Trouble going through established channels, trouble following proper procedure, an attitude of "read the directions when all else fails"
23.__Impatient, low frustration tolerance
24.__A prisoner of the moment
25.__Frequent traffic violations
26.__Frequent, impulsive job changes
27.__Tendency to embarrass others
28.__Lying or stealing on impulse

Poor Organization

29.__Poor organization and planning, trouble maintaining an organized work/living area
30.__Chronically late or chronically in a hurry
31.__Often have piles of stuff
32.__Easily overwhelmed by tasks of daily living
33.__Poor financial management (late bills, check book a mess, spending unnecessary money on late fees)

Problems Getting Started and Following Through

34.__Chronic procrastination or trouble getting started
35.__Starting projects but not finishing them, poor follow through
36.__Enthusiastic beginnings but poor endings
37.__Spends excessive time at work because of inefficiencies
38.__Inconsistent work performance

Negative Internal Feelings

39.__Chronic sense of under achievement, feeling you should be much further along in your life than you are
40.__Chronic problems with self-esteem
41.__Sense of impending doom
42.__Mood swings
43.__Negativity
44.__Frequent feeling of demoralization or that things won't work out for you 

Relational Difficulties

45.__Trouble sustaining friendships or intimate relationships, promiscuity
46.__Trouble with intimacy
47.__Tendency to be immature
48.__Self-centered; immature interests
49.__Failure to see others' needs or activities as important
50.__Lack of talking in a relationship
51.__Verbally abusive to others
52.__Prone to hysterical outburst
53.__Avoids group activities
54.__Trouble with authority

Short Fuse

55.__Quick responses to slights that are real or imagined
56.__Rage outbursts, short fuse

Frequent Search For High Stimulation

57.__Frequent search for high stimulation (bungee jumping, gambling, race track, high stress jobs, ER doctors, doing many things at once, etc.)
58.__Tendency to seek conflict, be argumentative or to start disagreements for the fun of it

Tendency To Get Stuck (thoughts or behaviors)

59.__Tendency to worry needlessly and endlessly
60.__Tendency toward ADHD ictions (food, alcohol, drugs, work)

Switches Things Around

61.__Switches around numbers, letters or words
62.__Turn words around in conversations

Writing/Fine Motor Coordination Difficulties

63.__Poor writing skills (hard to get information from brain to pen)
64.__Poor handwriting, often prints
65.__Coordination difficulties

The Harder I Try The Worse It Gets

66.__Performance becomes worse under pressure.
67.__Test anxiety, or during tests your mind tends to go blank
68.__The harder you try, the worse it gets
69.__Work or schoolwork deteriorates under pressure
70.__Tendency to turn off or become stuck when asked questions in social situations
71.__Falls asleep or becomes tired while reading

Sleep/Wake Difficulties

72.__Difficulty falling asleep, may be due to too many thoughts at night
73.__Difficulty coming awake (may need coffee or other stimulant or activity before feeling fully awake)

Low Energy

74.__Periods of low energy, especially early in the morning and in the afternoon
75.__Frequently feeling tired

Sensitive To Noise Or Touch

76.__Startles easily
77.__Sensitive to touch, clothes, noise and light

When you have completed the above checklist, calculate the Total Score: _______
Total Number of Items with a score of three (3) or more: _______
Score for Item #1: _______
Score for Item #6: _______
Score for Item #7: _______