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ADHD Diagnosis
ADHD Overview
Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often continues into adulthood. ADHD includes a combination of persistent problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior.
Children with ADHD may also struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age. However, some people never completely outgrow their ADHD symptoms. But they can learn strategies to be successful.
While treatment won't cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions. Early diagnosis and treatment can make a big difference in outcome.
Symptoms
The primary features of ADHD include inattention and hyperactive-impulsive behavior. ADHD symptoms start before age 12, and in some children, they're noticeable as early as 3 years of age. ADHD symptoms can be mild, moderate or severe, and they may continue into adulthood.
ADHD occurs more often in males than in females, and behaviors can be different in boys and girls. For example, boys may be more hyperactive and girls may tend to be quietly inattentive.
There are three subtypes of ADHD:
Predominantly inattentive. The majority of symptoms fall under inattention.
Predominantly hyperactive/impulsive. The majority of symptoms are hyperactive and impulsive.
Combined. This is a mix of inattentive symptoms and hyperactive/impulsive symptoms.
Inattention
•A child who shows a pattern of inattention may often:
•Fail to pay close attention to details or make careless mistakes in schoolwork
•Have trouble staying focused in tasks or play
•Appear not to listen, even when spoken to directly
•Have difficulty following through on instructions and fail to finish schoolwork or chores
•Have trouble organizing tasks and activities
•Avoid or dislike tasks that require focused mental effort, such as homework
•Lose items needed for tasks or activities, for example, toys, school assignments, pencils
•Be easily distracted
•Forget to do some daily activities, such as forgetting to do chores
Hyperactivity and impulsivity
•A child who shows a pattern of hyperactive and impulsive symptoms may often:
•Fidget with or tap his or her hands or feet, or squirm in the seat
•Have difficulty staying seated in the classroom or in other situations
•Be on the go, in constant motion
•Run around or climb in situations when it's not appropriate
•Have trouble playing or doing an activity quietly
•Talk too much
•Blurt out answers, interrupting the questioner
•Have difficulty waiting for his or her turn
•Interrupt or intrude on others' conversations, games or activities
Typical developmental behavior vs. ADHD
Most healthy children are inattentive, hyperactive or impulsive at one time or another. It's typical for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and teenagers, attention span often depends on the level of interest.
The same is true of hyperactivity. Young children are naturally energetic - they often are still full of energy long after they've worn their parents out. In addition, some children just naturally have a higher activity level than others do. Children should never be classified as having ADHD just because they're different from their friends or siblings.
Children who have problems in school but get along well at home or with friends are likely struggling with something other than ADHD. The same is true of children who are hyperactive or inattentive at home, but whose schoolwork and friendships remain unaffected.
When to see a doctor
If you're concerned that your child shows signs of ADHD, see your pediatrician or family doctor. Your doctor may refer you to a specialist, and it's important to have a medical evaluation first to check for other possible causes of your child's difficulties.
Your pediatrician may refer your child to a pediatric subspecialist or mental health clinician if there are concerns in one of the following areas:
•Intellectual disability (formerly called mental retardation)
•Developmental disorder such as speech problems, motor problems, or a learning disability
•Chronic illness being treated with a medication that may interfere with learning
•Trouble seeing and/or hearing
•History of abuse
•Major anxiety or major depression
•Severe aggression
•Possible seizure disorder
•Possible sleep disorder
How is ADHD diagnosed?
Healthcare providers use the guidelines in the American Psychiatric Association's Diagnostic and Statistical Manual, Fifth edition (DSM-5)1, to help diagnose ADHD. This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD. Using the same standard across communities can also help determine how many children have ADHD, and how public health is impacted by this condition.
DSM-5 Criteria for ADHD
People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development:
Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
•Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
•Often has trouble holding attention on tasks or play activities.
•Often does not seem to listen when spoken to directly.
•Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
•Often has trouble organizing tasks and activities.
•Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
•Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
•Is often easily distracted
•Is often forgetful in daily activities.
Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person's developmental level:
•Often fidgets with or taps hands or feet, or squirms in seat.
•Often leaves seat in situations when remaining seated is expected.
•Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
•Often unable to play or take part in leisure activities quietly.
•Is often "on the go" acting as if "driven by a motor".
•Often talks excessively.
•Often blurts out an answer before a question has been completed.
•Often has trouble waiting their turn.
•Often interrupts or intrudes on others (e.g., butts into conversations or games)
In addition, the following conditions must be met:
•Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
•Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities).
•There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
•The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.
•Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
•Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
•Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity, but not inattention, were present for the past six months.
Because symptoms can change over time, the presentation may change over time as well.
