Would You Recognize ADHD?

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This article will take a look at Attention Deficit/Hyperactivity Disorder (ADHD) and what it takes to receive the diagnosis. For those of you who are just starting on the ADHD journey, it is critical that we start here.

There is a lot information in the news on ADHD, but for most of us parents, it is still a perplexing disorder. Zoe Kessler, author of the ADHD from A to Zoe blog, posted about her bewilderment surrounding ADHD and said, “I’ve also heard it referred to as a disorder, a mental illness, and a childhood disease from which we’ll outgrow.” Her humorous outlook on ADHD illustrates the confusion felt by many and her entire post is definitely worth a read.

So what does it really take to receive a diagnosis? ADHD is a psychiatric disorder where the individual exhibits a higher than typical level of inattention, hyperactivity, or combination of both.

There are three subtypes of ADHD according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Ed. IV (DSM-IV).  Before we look at the subtypes, let’s take a look at the diagnostic criteria as specified in the DSM-IV. Please note, these criteria have been reworded and condensed and should be used only for informational purposes:

I. Either A or B must be true:

A. Six or more of the following signs of inattention must be present for at least six months to the extent that it is inappropriate for the child’s developmental level:

Inattention

1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention or play activities on tasks.
3. Often does not seem to listen when spoken to directly.
4. 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).
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for an extended period of time (e.g., schoolwork or homework).
7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Is often forgetful in daily activities.

B. Six or more of the following symptoms of hyperactivity and/or impulsivity must be present for at least six months to the extent that it is disruptive and inappropriate for the child’s developmental level:

Hyperactivity

1. Often fidgets with hands or feet or squirms in seat when sitting still is expected.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or doing leisure activities quietly.
5. Is often “on the go” or often acts as if “driven by a motor”.
6. Often talks excessively.

Impulsivity

1. Often blurts out answers before questions have been finished.
2. Often has trouble waiting one’s turn.
3. Often interrupts or intrudes on others (e.g., butts into conversations or games).

II. Some signs that cause impairment were present before age 7 years.

III. Some impairment from the signs  is present in two or more settings (e.g. at school/work and at home).

IV. There must be clear evidence of clinically significant impairment in social, school, or work functioning.

V. The signs do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The signs are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Now that the criteria have been presented, here are the three subtypes of ADHD:

ADHD Predominantly Inattentive Type: This subtype is used if six or more symptoms of inattention, but fewer than six symptoms of hyperactivity-impulsivity are present for at least six months. There may still be some degree of hyperactivity-impulsivity.

ADHD Predominantly Hyperactive-Impulsive Type: This subtype is used if six or more symptoms of hyperactivity-impulsivity, but fewer than six of inattention are present for at least six months. There may still be some degree of inattention.

ADHD Combined (Hyperactive-Impulsive and Inattentive) Type: This subtype is used if six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present for at least six months. Most children with ADHD fit this type.

The American Psychiatric Association is currently revising the  DSM and the DSM-V is scheduled to be published in 2013. The proposed changes, along with the criticisms has been made available for the public to view.

Reference:

ADHD DSM-IV material from BehaveNet Clinical Capsule.