Attention deficit hyperactivity disorder (ADHD or AD/HD or ADD) is said to be a neurobehavioral developmental disorder.
It is also said to be primarily characterized by ‘inattention’, ‘hyperactivity’, and ‘impulsivity’ with symptoms starting before seven years of age.
AD/HD and its diagnosis and treatment have been considered controversial since the 1970s. Indeed, some countries disallow Big Pharma to market ‘ADHD drugs’ because no one can actually show a cause for the ‘disorder diagnosis’!
AD/HD is said to have three subtypes:
* Predominantly hyperactive-impulsive (ADHD)
* Predominantly inattentive (ADD)
* Combined hyperactive-impulsive and inattentive
o Most children with AD/HD are said to have the combined type.
The symptoms of AD/HD are especially difficult to define because it is hard to draw the line at where normal levels of inattention, hyperactivity, and impulsivity end and clinically significant levels requiring intervention begin.
To be diagnosed with AD/HD, symptoms must be observed in two different settings for six months or more and to a degree that is greater than other children of the same age.
The DSM-IV (short for the Diagnostic and Statistical Manual of Mental Disorders) has this listing:
IA. Six or more of the following signs of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:
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 on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow 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 a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (such as toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Often forgetful in daily activities.
IB. Six or more of the following signs of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:
1. Often fidgets with hands or feet or squirms in seat.
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 enjoying leisure activities quietly.
5. Is often “on the go” or often acts as if “driven by a motor”.
6. Often talks excessively.
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 (example: 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 (such as at school/work and at home).
IV. There must be clear evidence of significant impairment in social, school, or work functioning.
The American Academy of Pediatrics Clinical Practice Guideline for children with AD/HD emphasizes that a reliable diagnosis is dependent upon the fulfillment of three criteria:
* The use of explicit criteria for the diagnosis using the DSM-IV-TR.
* The importance of obtaining information about the child’s signs in more than one setting.
* The search for coexisting conditions that may make the diagnosis more difficult or complicate treatment planning.
All three criteria are determined using the patient’s history given by the parents, teachers and/or the patient.
The American Academy of Child Adolescent Psychiatry (AACAP) considers it necessary that the following be present before attaching the label of AD/HD to a child:
* The behaviors must appear before age 7.
* They must continue for at least six months.
* The symptoms must also create a real handicap in at least two of the following areas of the child’s life:
o in the classroom,
o on the playground,
o at home,
o in the community, or
o in social settings.
If a child seems too active on the playground but not elsewhere, the problem might not be AD/HD. It might also not be AD/HD if the behaviors occur in the classroom but nowhere else. A child who shows some symptoms would not be diagnosed with AD/HD if his or her schoolwork or friendships are not impaired by the behaviors.
To make the diagnosis of AD/HD, a number of other possible medical and psychological conditions must be excluded, such as hypothyroidism, anemia, lead poisoning, chronic illness, hearing or vision impairment, substance abuse, medication side effects, sleep impairment and child abuse, and cluttering (tachyphemia) among others.
Consideration should also be given to Diet. For example, anecdotal evidence from parents has shown that FD&A Red dye no. 3 has caused hyperactivity in some children who were sensitive to it.
Here is a less clinical description with examples:
At present, the AD/HD diagnosis applies to children and adults who consistently display certain characteristic behaviors over a period of time. As mentioned previously, the most common behaviors fall into three categories: inattention, hyperactivity, and impulsivity.
Inattention. People who are inattentive have a hard time keeping their mind on any one thing and may get bored with a task after only a few minutes. They may give effortless, automatic attention to activities and things they enjoy. But focusing deliberate, conscious attention to organizing and completing a task or learning something new is difficult.
For example, Lisa found it agonizing to do homework. Often, she forgot to plan ahead by writing down the assignment or bringing home the right books. And when trying to work, every few minutes she found her mind drifting to something else. As a result, she rarely finished and her work was full of errors.
Hyperactivity. People who are hyperactive always seem to be in motion. They can’t sit still. Like Mark, they may dash around or talk incessantly. Sitting still through a lesson can be an impossible task. Hyperactive children squirm in their seat or roam around the room. Or they might wiggle their feet, touch everything, or noisily tap their pencil. Hyperactive teens and adults may feel intensely restless. They may be fidgety or, like Henry, they may try to do several things at once, bouncing around from one activity to the next.
Impulsivity. People who are overly impulsive seem unable to curb their immediate reactions or think before they act. As a result, like Lisa, they may blurt out inappropriate comments. Or like Mark, they may run into the street without looking. Their impulsivity may make it hard for them to wait for things they want or to take their turn in games. They may grab a toy from another child or hit when they’re upset.
Not everyone who is overly hyperactive, inattentive, or impulsive has an attention disorder. Since most people sometimes blurt out things they didn’t mean to say, bounce from one task to another, or become disorganized and forgetful, how can specialists tell if the problem is AD/HD?
To assess whether a person has AD/HD, specialists consider several critical questions: Are these behaviors excessive, long-term, and pervasive? That is, do they occur more often than in other people the same age? Are they a continuous problem, not just a response to a temporary situation? Do the behaviors occur in several settings or only in one specific place like the playground or the office? The person’s pattern of behavior is compared against a set of criteria and characteristics of the disorder. These criteria appear in a diagnostic reference book called the DSM (short for the Diagnostic and Statistical Manual of Mental Disorders).
According to the diagnostic manual, there are three patterns of behavior that indicate ADHD. People with ADHD may show several signs of being consistently inattentive. They may have a pattern of being hyperactive and impulsive. Or they may show all three types of behavior.
Thing is, there are a few misconceptions in all the above. Maybe we’ll talk about that in another post. 🙂