Sometimes people discuss ADD as opposed to ADHD, which simply reflects the development of the disorder over time. The DSM-III (Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, 1980) first identified the diagnosis Attention Deficit Disorder (ADD). Prior to 1980, the DSM-II (1968) first termed ADHD symptoms as “Hyperkinetic Reaction of Childhood,” though “mental restlessness” was first recognized as early as 1798 by Alexander Crichton. In 1987, the revised edition of the DSM (DSM-III-R) arrived with the diagnosis of ADHD as we know it now and we continue to use the diagnosis in the current DSM (DSM-IV-TR, APA, 2000).
ADHD Criteria According to the DSM-IV-TR
In order to meet the criteria for ADHD, a person must have exhibited at least six symptoms of inattention or hyperactivity/impulsivity as defined below.
· Often fails to give close attention to details or makes careless
mistakes in homework, work, or other activities
· Often has difficulties sustaining attention in tasks or play
· Often does not seem to listen when spoken to directly
· Often does not follow through instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to
oppositional behavior or failure to understand instructions)
· Often has difficulties organizing tasks and activities
· Often avoids, dislikes, or is reluctant to engage in tasks that
require sustained mental efforts
· Often loses things necessary for tasks or activities (e.g. toys,
school assignments, pencils, books)
· Is often easily distracted by extraneous stimuli
· Is often forgetful in daily activities
· Often fidgets with hands or feet or squirms in seat
· Often leaves seat in classroom or in other situations in which
remaining seated is unexpected
· Often runs about or climbs excessively in situations in which it is
inappropriate (in adolescents or adults, may be limited to
subjective feelings of restlessness)
· Often has difficulty playing or engaging in leisure activities quietly
· Is often “on the go” or often acts as if “driven by a motor”
· Often talks excessively
· Often blurts out answers before questions have been completed
· Often has difficulty awaiting turn
· Often interrupts or intrudes on others (e.g. butts into
conversations or games)
The above symptoms of inattention, hyperactivity, or impulsivity must persist for at least 6 months to a degree that is maladaptive and inconsistent with the person’s developmental level. There are technically four types of ADHD: (a) combined type, (b) predominantly inattentive type, (c) predominantly hyperactive, impulsive type, and (d) not otherwise specified.
More than Just a List of Symptoms
In order to receive a diagnosis of ADHD, other factors must be taken into consideration. At least some symptoms must have been present before the age of 7 years old and must have caused impairment. The impairment from the symptoms must be present in two or more settings. There must be clear evidence of clinically significant impairment in school, academic, or occupational functioning. These symptoms cannot occur during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. Lastly, the symptoms cannot be accounted for by another mental health or medical disorder (i.e., anxiety, depression, etc.).
People express interest in determining whether they qualify for a diagnosis of ADHD. Examples for possible reasons a person may want an ADHD assessment include (but are not limited to):
· Medication referral
· Determining appropriate treatment
· Accommodations for testing situations and/or academic settings
· Specific recommendations for improving ADHD-type symptoms
· Personal interest
The extent of assessment varies depending on the reason for referral, whether the referring institution has specific requirements to determine an ADHD diagnosis, and the examiner’s opinion of appropriate measures to include in the test battery. Some individuals may just require a clinical interview with a psychiatrist or psychologist, whereas others may want/need to integrate subjective and objective measures of functioning into the assessment. The most accurate diagnosis usually involves a clinical interview as well as number of tests that measure intellectual, cognitive, and psychological functioning.
It is important to note that when conducting an assessment of ADHD, the assessor cannot only evaluate symptoms of inattention, hyperactivity, or impulsivity. As stated above there are additional criteria that must be met to warrant a diagnosis of ADHD. Consequently, the person conducting the assessment may need information about childhood history to determine if symptoms started before the age of seven.
In addition, an adequate assessment of ADHD requires an understanding of the client’s functioning in multiple settings. For children, that might mean interviewing teachers, parents, babysitters, coaches, etc. Instead of interviewing, asking these individuals to complete a questionnaire might be more appropriate and more comfortable. For adults, in order to determine whether symptoms of ADHD exist across multiple settings co-workers, employers, professors, friends, roommates, etc. may be asked to complete questionnaires in order to provide a comprehensive assessment. If someone is assessing you for ADHD and inquires about consulting or providing questionnaires to others about your symptoms, it is a normal part of a comprehensive ADHD assessment. If you are not comfortable with the examiner getting information from other settings, it may limit the quality of the assessment but efforts can be made to accommodate your request.
The requirement that ADHD symptoms are not accounted for by another mental health or medical disorder is also very important. Difficulties concentrating can be a symptom of depression, anxiety, posttraumatic stress disorder, boredom, low or high intellectual functioning, brain injury, language development problems, a learning disorder, etc. Consequently, evaluators often include questionnaires or tests that rule out other explanations for inattentions, hyperactivity, or impulsivity. If comorbid problems exist (i.e., a person has both anxiety and depression), the assessor will use test results as well as clinical judgment to determine an accurate diagnosis.
Lastly, socio-cultural issues can often cause people to overlook symptoms of a disorder or inaccurately diagnosis a disorder when it is not present. Consequently, socio-cultural issues must always be taken into consideration when assessing any mental health issue.
Overall, this blog entry was written in attempt to help people better understand ADHD and how it is diagnosed. If you have additional questions or would like to peruse further resources, please consider the following sites:
· Attention Deficit Disorder Association
· National Institute of Mental Health: ADHD/ADD
· Children and Adults with ADHD
· National Resource Center of ADHD
Lastly, if you are interested in a comprehensive ADHD evaluation for any reason, contact us for more information.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed. text revision). Washington, DC: Author.