According to the National Survey of Children's Health, the percentage of children diagnosed with ADHD in the United States increased from 7.8% in 2003 to 11% in 2011.
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that is usually diagnosed in the childhood. However, it can persist into adolescence and adulthood. In light of the growing incidence of ADHD in young children and teenagers, some changes were made in the definition and the diagnostic criteria of ADHD in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association. While DSM-IV required that the symptoms should be documented before the age of 7 years, DSM-V (updated in 2013) raised this age to 12 years.
The logic behind the change in the onset of the symptoms was that certain behavioral symptoms surface with the increasing social demands during adolescence. This disorder is characterized by behavioral patterns that can be observed in different settings such as home or school. The diagnostic criteria in DSM-IV-TR suggested three subtypes wherein the affected child might be predominantly inattentive, predominantly hyperactive-impulsive, and combined inattentive and hyperactive-impulsive. The DSM-V edition uses the term 'presentations' in place of subtypes. According to DSM-V, the presentations can change during one's lifetime. This has broadened the scope of diagnosis.
The hallmark characteristics of ADHD are inattentiveness, impulsiveness, or hyperactivity. These traits could be present in isolation or combination. There's no single ADHD diagnostic test. This disorder can be diagnosed with the help of the following:
- Questionnaires for family members and teachers
- Rating scales
- Medical examination to rule out other conditions
- Examination by a child psychologist
As per the DSM-V, the child with an inattentive presentation:
- Fails to give close attention to details or makes careless mistakes
- Has difficulty sustaining attention
- Does not appear to listen
- Struggles to follow through on instructions
- Has difficulty with organization
- Avoids or dislikes tasks requiring a lot of thinking
- Loses things
- Is easily distracted
- Is forgetful in daily activities
The child with a hyperactive-impulsive presentation:
- Fidgets with hands or feet or squirms in chair
- Has difficulty remaining seated
- Runs about or climbs excessively (in children); extreme restlessness in adults
- Difficulty engaging in activities quietly
- Acts as if driven by a motor; adults will often feel inside like they were driven by a motor
- Talks excessively
- Blurts out answers before questions have been completed
- Difficulty waiting or taking turns
- Interrupts or intrudes upon others
In case of a combined inattentive and hyperactive-impulsive presentation, the symptoms of both inattentive and hyperactive-impulsive presentation can be observed.
It is the task of the psychologist to closely study the behavior of the child, and determine if the severity is mild, moderate, or severe. It is determined by the effect the symptoms would have, on ability of the child to carry out routine activities in 2 or more settings.
- In mild and moderate presentation, there are a few additional symptoms besides the number of symptoms needed to make a diagnosis, and these bring about minor or moderate impairment in settings such as home or school.
- Severe ADHD presentation is characterized by the presence of several symptoms, in addition to the symptoms that are required for making a diagnosis. These symptoms cause significant impairment in multiple settings.
Screening for Co-existing Conditions
In order to have a clear diagnosis of ADHD, it is essential to rule out other conditions that might cause behavioral changes. Due to the excess nervous energy that most children have, it becomes essential to make a thorough assessment.
- Learning disability
- Pediatric bipolar disorder
- Tourette syndrome
- Disruptive behavior disorders
In general, three criteria must be met in order to make a diagnosis of ADHD:
- DSM-V criteria must be met
- The information about the child's behavior must be gathered from more than one setting
- Other co-existing medical conditions must be diagnosed and considered while confirming the diagnosis and deciding treatment
It is extremely essential to find an experienced child psychologist/psychiatrist who has been treating children affected by this disorder, and is trained to identify the symptoms of this neurodevelopmental disorder. Several screening tests, questionnaires, and checklists are widely used for making an assessment of the child's behavior. Some of the questionnaires need to be filled by the parents or the teachers to give the clinician an idea about the degree of impairment in two settings. These include:
- Vanderbilt Assessment Scale
- Behavior Assessment System for Children
- Child Behavior Checklist
- Teacher Report Form of the Child Behavior Checklist
- Connors' Rating Scale
- The SNAP-IV Teacher and Parent Rating Scale
- ADD-H: Comprehensive Teacher Rating Scale (ACTeRS)
- Barkley Home Situations Questionnaire (HSQ)
- Barkley School Situations Questionnaire (SSQ)
On a concluding note, a child psychologist should be consulted, if a child often has difficulty in paying or sustaining attention, sitting still, organizing tasks, finishing tasks that require sustained mental effort, etc. Though there is no single neurological or attentional test that can help a clinician make a diagnosis of ADHD, medical examinations, combination of several neurological/attentional tests, and interviews can help the psychologist gather information that can help him/her identify or rule out ADHD as the underlying cause of behavioral patterns. It must be noted that this condition can persist into adulthood, which is why early diagnosis is important. The treatment has to be decided according to the unique needs of the child, keeping in mind the type and severity of ADHD. A multimodal approach is followed for the treatment to manage the symptoms. It combines cognitive behavioral therapy, drug therapy, education, proper diet, and support at home and school.
Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.