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Attention Deficit and Hyperactivity Disorder

by Samuel Law 

There has been a significant amount of research done in the field of Attention Deficit and Hyperactivity Disorder and problem gambling. The core features of ADHD are a persistent pattern of inattention and high level of non-productive activity, often impulsively performed. Inattentiveness may be manifested in an inability to sustain attention in school or at work, manifested by fidgeting, squirming, impatience, difficulty in delaying response, etc. Clients are usually impaired in functioning and are predominantly inattentive and/or hyperactive.

Screening
See the brief screening scale: Assessment and Screening Tools This is an untested questionnaire — refer for proper assessment if client scores 2 or higher on more than a third of the items.

Research Findings on Relationship Between Problem Gambling and ADHD

There has been a recent surge in recognizing, diagnosing and treating adults who have adhd. The traditional belief is that one grows out of adhd and stimulant medications (e.g., Ritalin® (methylphenidate), Cylert® (pemoline). These cause harm that outstrips the benefit when used in adults. As well, adults are presumed to have learned appropriate behaviours and can cope with adhd more effectively. But that view is under some reconsideration, particularly with problem gamblers, as some studies have shown a possible association between problem gambling and adhd (Goldstein et al., 1985, Carleton et al., 1987; Carlton and Manowitz, 1992; Rugle and Melamed, 1993).

Studies show around 20% of (a sample of 40) pathological gamblers had adhd and another 18% had some symptoms while not qualifying for a full diagnosis (Specker et al., 1995). There has been some observation that men with adhd tend to be hyperactive and impulsive, and women tend to be more inattentive. However, these differentiations remain controversial, as a recent report found no such differences (personal communication, APA Conference, 2000).

Counselling Issues

Clinically, it may be understandable that people with ADHD would find the fast-paced, highly stimulating, consistently structured nature and environment of gambling attractive and conducive to their short attention spans and easily distracted tendencies. It can be hypothesized that those clients with ADHD are particularly easily drawn to fast-paced, quickly rewarded forms of gambling (e.g., video gambling). Careful inquiry of the nature of their gambling may help to clarify this diagnosis.

Psychiatric experts are still divided in their opinions on whether pharmacological ADHD treatment’s benefits outweigh the potential harm. The decision will remain largely a personal one, as there are many strong believers on this issue. Some see it as a drug to be abused; others as a cure.

Stimulant medications such as Ritalin® and Dexedrin® have been proven to be most effective. However, they may have some side-effects such as cardiac arrhythmia, sleep disturbance, anorexia and abuse potential.

The current treatment trend is to use medication that has fewer side effects (e.g., SSRI has the potential of becoming a first-line treatment).

Note that a client’s subjective positive response to the use of stimulant medications is not a reliable indicator of adhd, as it is common for those without adhd to experience some improvement in energy, alertness and concentration after taking stimulant medications.

When to Refer for a Psychiatric Assessment

  • when the diagnosis is unclear, needing more sophisticated diagnostic process and instruments
  • when the medication is ineffective or needs re-evaluation or adjustment
  • when the client would like to know about more recent developments in treatment for ADHD
  • when the family needs psychoeducation about the disorder and advice on how to cope with a hyperactive family member who gambles.

References

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Bland, R.C., Newman, S.C., Orn, H. & Stebelsky, G. (1993). Epidemiology of pathological gambling in Edmonton. Canadian Journal of Psychiatry, 38, 108-112. Blaszczynski, A. (1998). Overcoming Compulsive Gambling: A Self-Help Guide Using Cognitive Behavioural Techniques. London: Robinson.

Blaszczynski, A. & McConaghy, N. (1989). Anxiety and/or depression in the pathogenesis of addictive gambling. The International Journal of the Addictions, 24, 337-350.

Carlton, P.L. & Manowitz, P. (1992). Behavioural restraint and symptoms of attention deficit disorder in alcoholics and pathological gamblers. Neuropsychobiology, 25, 44-48.

Carlton, P.L., Manowitz, P., McBride, H., Nora, R., Swartzburg, M. & Goldstein, L. (1987). Attention deficit disorder and pathological gambling. Journal of Clinical Psychiatry, 48, 47-48.

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Crockford, D.N. & el-Guebaly, N. (1998b). Psychiatric comorbidity in pathological gambling: A critical review. Canadian Journal of Psychiatry, 43 (1), 43-50.

Cunningham-Williams, R.M., et al. (1998). Taking chances: Problem gamblers and mental health disorders — results from St. Louis Epidemiological Catchment Area Study. American Journal of Public Health, 88 (7), 1093-1096.

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Goldstein, L., Manowitz, P., Nora, R., Swartzburg, M. & Carlton, P.L. (1985). Differential eeg activation and pathological gambling. Biological Psychiatry, 20, 1232-1234.

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Kernberg, O.F. (1984). Severe Personality Disorder: Psychotherapeutic Strategies. New Haven: Yale University Press. Lesieur, H.R. & Rosenthal, R.J. (1991). Pathological gambling: a review of the literature. Prepared for the American Psychiatric Association Task Force on the dsm-iv Committee on Disorders of Impulse Control Not Elsewhere Classified. Journal of Gambling Studies, 7 (1), 5-39.

Lesieur, H.R. (1984). The Chase: The Compulsive Gambler (2nd ed.). Rochester VT: Schenkman Books, Inc.

Linden, M.D., Pope Jr., H.G. & Jonas, J. M. (1986). Pathological gambling and major affective disorder: preliminary findings. Journal of Clinical Psychiatry, 47, 201-203.

Lopez, V.C. & Miller,W.R. (1997). Treatment approaches for pathological gamblers. Clinical Psychology Review 17 (7), 689-702.

McCormick, R.A., Russo, A.M., Ramirez, L.F. & Taber, L.F. (1984). Affective disorders among pathological gamblers seeking treatment. American Journal of Psychiatry, 141, 215-218.

McCormick, R.A., Taber, L., Kruedelbach, N. & Russo, A. (1987). Personality profiles of hospitalized gamblers: the California Personality Inventory. Journal of Clinical Psychology, 43, 521-527.

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Specker, S.M., Carlson, G.A., Christenson, G.A. & Marcotte, M. (1995). Impulse control disorders and attention-deficit disorder in pathological gamblers. Annals of Clinical Psychiatry, 7 (4), 175-179.

Specker, S.M., Carlson, G.A., Edmonson, K.M. & Johnson, P.E. (1996).Psychopathology in pathological gamblers seeking treatment. Journal of Gambling Studies, 12 (1), 67-81.

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