Inattentive ADHD, Not Impulsive but Lacks Perseverance

Perseverance training may help Inattentive ADHD

Happy summer!!  I am out of town for most of the summer but I found this interesting and I thought that I would write a quick post.

A recently published study confirms that people with Inattentive ADHD are not impulsive but they do lack perserverance.

 This study found that they were able to separate out people with the Combined type vs the Inattentive type of ADHD by using an Impulsive and Perserverance Behavior scale known as the UPPS.  I have included a copy of the scale at the bottom of this post.

The UPPS scale measures four different behaviors including:

1. Urgency

2. Premeditation

3. Perseverance, and

4. Sensation Seeking

This behavioral test or scale was found to be very sensitive in discriminating people with Inattentive ADHD not only from people with Combined type ADHD but it could also tease out the individuals with Combined type ADHD with Oppositional Defiance Disorder and the people without ADHD.  The authors concluded that the brain pathways for impulsive behavior, urgency, sensation seeking and perserverance may explain the symptoms of the different types of ADHD.

The most interesting part of this study was that this scale, unlike many others, could be used to differentiate kids with all types of ADHD from non-ADHD controls. Perseverance training is, I think, something that we, who have symptoms of Inattentive ADHD or who have children with Inattentive ADHD, need to work on if we are to improve the symptoms of ADHD-PI.  Different tools and strategies that encourage perseverance such as ADHD behavior rewards and punishment are helpful in this regard.

 I have included the abstract from the UPPS study.

Journal of Psychopatholy and Behavioral Assessment. 2010 Sep;32(3):323-332.
Impulsivity and Attention Deficit-Hyperactivity Disorder: Subtype Classification Using the UPPS Impulsive Behavior Scale.
Miller DJ, Derefinko KJ, Lynam DR, Milich R, Fillmore MT.
Abstract

This study examined the classification accuracy of the UPPS Impulsive Behavior Scale (UPPS) in discriminating severalattention deficit/hyperactivity disorder (ADHD) subtypes, including predominantly inattentive type (ADHD/I), combined type (ADHD/C), and combined type with behavioral problems (ADHD/ODD), between each other and a non-ADHD control group using logistic regression analyses. The sample consisted of 88 children ranging in age from 9.0 years to 12.8 years, with a mean of 10.9 years. Children were predominantly male (74%) and Caucasian (86%) and in grades 3-7. Results indicated that the UPPS performed well in classifying ADHD subtypes relative to traditional diagnostic measures. In addition, analyses indicated that differences in symptoms between subtypes can be explained by specific pathways to impulsivity. Implications for the assessment of ADHD and conceptual issues are discussed.

UPPS

Below are a number of statements that describe ways in which people act and think. For each statement, please indicate how much you agree or disagree with the statement.  If you Agree Strongly circle 1, if you Agree Somewhat circle 2, if you Disagree somewhat circle 3, and if you Disagree Strongly circle 4.  Be sure to indicate your agreement or disagreement for every statement below. Also, there are questions on the following pages.

1.   I have a reserved and cautious attitude toward life.

2.   I have trouble controlling my impulses.

3.   I generally seek new and exciting experiences and sensations.

4.   I generally like to see things through to the end.

5.   When I am very happy, I can’t seem to stop myself from doing things that can have bad consequences.

6.   My thinking is usually careful and purposeful.

7.   I have trouble resisting my cravings (for food, cigarettes, etc.).

8.   I'll try anything once.

9.   I tend to give up easily.

10. When I am in great mood, I tend to get into situations that could cause me problems.

11. I am not one of those people who blurt out things without thinking.

12. I often get involved in things I later wish I could get out of.

13. I like sports and games in which you have to choose your next move very quickly.

14. Unfinished tasks really bother me.

15. When I am very happy, I tend to do things that may cause problems in my life.

16. I like to stop and think things over before I do them.

17. When I feel bad, I will often do things I later regret in order to make myself feel better now. 

18. I would enjoy water skiing.

19. Once I get going on something I hate to stop.

20. I tend to lose control when I am in a great mood.              

21. I don't like to start a project until I know exactly how to proceed.

22. Sometimes when I feel bad, I can’t seem to stop what I am doing even though it is making me feel worse.

23. I quite enjoy taking risks.

24. I concentrate easily.

25. When I am really ecstatic, I tend to get out of control.      

26. I would enjoy parachute jumping.

27. I finish what I start.

28. I tend to value and follow a rational, "sensible" approach to things.

29. When I am upset I often act without thinking.

30. Others would say I make bad choices when I am extremely happy about something.

31. I welcome new and exciting experiences and sensations, even if they are a little frightening and unconventional.

32. I am able to pace myself so as to get things done on time.

33. I usually make up my mind through careful reasoning.

34. When I feel rejected, I will often say things that I later regret.

35. Others are shocked or worried about the things I do when I am feeling very excited.

36. I would like to learn to fly an airplane.

37. I am a person who always gets the job done.

38. I am a cautious person.

39. It is hard for me to resist acting on my feelings.

40. When I get really happy about something, I tend                to do things that can have bad consequences.

41. I sometimes like doing things that are a bit frightening.

42. I almost always finish projects that I start.

43. Before I get into a new situation I like to find out what to expect from it.

44. I often make matters worse because I act without thinking when I am upset.

45. When overjoyed, I feel like I can’t stop myself from going overboard.

46. I would enjoy the sensation of skiing very fast down a high mountain slope.

47. Sometimes there are so many little things to be done that I just ignore them all.

48. I usually think carefully before doing anything.

49. Before making up my mind, I consider all the advantages and disadvantages.

50. When I am really excited, I tend not to think of the consequences of my actions.

51. In the heat of an argument, I will often say things that I later regret.

52. I would like to go scuba diving.

53. I tend to act without thinking when I am really excited.

54. I always keep my feelings under control.

55. When I am really happy, I often find myself in situations that I normally wouldn’t be comfortable with.

56. I would enjoy fast driving.

57. When I am very happy, I feel like it is ok to give in to cravings or overindulge.

58. Sometimes I do impulsive things that I later regret.

59. I am surprised at the things I do while in a great mood.