According to the National institute of mental health the definition for ADHD or Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity).
There have been a number of studies on ADHD and the results from several international studies of twins show that ADHD often runs in families. Researchers are looking at several genes that may make people more likely to develop the disorder. Knowing the genes involved may one day help researchers prevent the disorder before symptoms develop. Children with ADHD who carry a particular version of a certain gene have thinner brain tissue in the areas of the brain associated with attention. However, this research also showed that the difference was not permanent, and as children with this gene grew up, the brain developed to a normal level of thickness. The result: their ADHD symptoms also improved.
ADHD affects about 4.1% of American adults age 18 years and older in a given year. The disorder affects 9.0% of American children age 13 to 18 years. Boys are four times more at risk than girls. Studies show that the number of children being diagnosed with ADHD is increasing, but it is unclear why.
ADHD has three subtypes:
- Predominantly hyperactive-impulsive
- Predominantly inattentive
- Combined hyperactive-impulsive and inattentive
Only a doctor or other trained health care professional can diagnose ADHD. Because no single test can diagnose a child as having ADHD, a licensed health professional needs to gather information about the child, and his or her behavior and environment. A family may want to first talk with the child’s pediatrician. Some pediatricians can assess the child themselves, but many will refer the family to a mental health specialist with experience in childhood mental disorders such as ADHD. The pediatrician or mental health specialist will first try to rule out other possibilities for the symptoms. For example, certain situations, events, or health conditions may cause temporary behaviors in a child that seem like ADHD.
Between them, the referring pediatrician and specialist will determine if a child:
- Is experiencing undetected seizures that could be associated with other medical conditions
- Has a middle ear infection that is causing hearing problems
- Has any undetected hearing or vision problems
- Has any medical problems that affect thinking and behavior
- Has any learning disabilities
- Has anxiety or depression, or other psychiatric problems that might cause ADHD-like symptoms
- Has been affected by a significant and sudden change, such as the death of a family member, a divorce, or parent’s job loss.
A specialist will also check school and medical records for clues, to see if the child’s home or school settings appear unusually stressful or disrupted, and gather information from the child’s parents and teachers. Coaches, babysitters, and other adults who know the child well also may be consulted.
If you think your child have ADHD, or a teacher raises concerns, you may be able to request that the school conduct an evaluation to determine whether he or she qualifies for special education services. Start by speaking with your child’s teacher, school counselor, or the school’s student support team, to begin an evaluation.
Diagnostic Criteria for ADHD
The first step in correctly diagnosing and treating ADHD is understanding the definition. ADHD is classified within the Neurodevelopmental Disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Depending on the subtype, the diagnosis of ADHD involves a persistent pattern of inattention, hyperactivity, and/or impulsivity, more than would be expected for a typical person at the same level of development.
Typically, several symptoms must be present before the age of 12 years. Also, there must also be clear evidence that the symptoms cause distress or interfere with functioning. These criteria are currently used for both children and adults, although the number of criteria varies.
According to the DSM-5 criteria for ADHD, one of the following groups of symptoms must be present:
- Inattention: At least six (or five for persons 17 years of age and older) of the following symptoms of inattention have persisted for at least six months to a degree that is inconsistent with developmental level and that negatively impacts social and academic/occupational activities:
- Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
- Often has difficulty sustaining attention in 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 (not due to oppositional behavior or failure to understand instructions)
- Often has difficulty organizing tasks and activities– Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork, homework)
- Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, tools)
- Is often easily distracted by extraneous stimuli
- Is often forgetful in daily activities
- Hyperactivity/Impulsivity: At least six (or five for persons 17 years of age and older) of the following symptoms of hyperactivity/impulsivity have persisted for at least six months to a degree that is inconsistent with developmental level and that negatively impacts social and academic/occupational 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 expected
- 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 unable to play or engage in leisure activities quietly
- Is often “on the go” or often acts as if “driven by a motor”
- Often talks excessively
- Often blurts out an answer before question has been completed
- Often has difficulty awaiting turn
- Often interrupts or intrudes on others (e.g., butts into conversations or games)
Impairment from the symptoms must be present in two or more settings (e.g., at school [or work] and at home). There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
For a diagnosis of ADHD, the symptoms may not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder or be better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or personality disorder).
For individuals (especially adolescents and adults) who have symptoms that no longer meet full criteria, “in partial remission” should be specified. The category unspecified ADHD is for disorders with prominent symptoms of inattention or hyperactivity-impulsivity that do not meet the full criteria for ADHD.
Patients with ADHD often have features that are not part of the diagnosis but are consequences of functional impairment. Examples include low frustration tolerance, temper outbursts, stubbornness, poor self-esteem, and devaluation of academic achievement. People may have the impression that children with ADHD are lazy, irresponsible, oppositional, or willful.
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