Diagnosis of Attention Hyperactivity Deficit Disorder

n the most current assessment guidelines published by the American Psychiatric Association, Diagnostic and Statistical Manual for Mental Disorders IV (DSM4), the disorder is known as ADHD and has several types including: (1) predominantly inattentive; (2) predominantly impulsive or (3) combined. Individuals with this condition usually have many (but not all) of the following symptoms:

Inattention:

* often fails to finish what he starts
* doesn’t seem to listen
* easily distracted
* has difficulty concentration or paying attention
* doesn’t stick with a play activity

Impulsivity:

* often acts without thinking & later feels sorry
* shifts excessively from one activity to another
* has difficulty organizing work
* needs a lot of supervision
* speaks out loud in class
* doesn’t wait to take turns in games or groups

Hyperactivity:

* runs about or climbs on things excessively
* can’t sit still and is fidgety
* has difficulty staying in his seat and bothers classmates
* excessive activity during sleep
* always on the "go" and acts as if "driven"

Emotional Instability:

* angry outbursts
* social loner
* blames others for problems
* fights with others quickly
* very sensitive to criticism

The diagnosis is made by "ruling out" other medical or psychiatric causes for the symptoms and by then determining that the patient meets the DSM4 criteria for ADHD. Psychological testing can be useful to rule out learning disabilities and Continuous Performance Tests (Connor’s CPT, TOVA, IVA, Gordon Diagnostic) may help confirm the diagnosis and be helpful with titration of medication. At this time the use of imaging such as PET or SPECT is recommended for research purposes. Several professional organizations recommend against the use of these techniques due to unwarranted exposure to radiation and lack of sufficient data to enable accurate diagnosis.

This diagnosis may coexist with anxiety, depression, Tourette’s, bipolar disorder, conduct and learning disabilities.

True ADHD patients usually start showing symptoms by the time they start school. Some very impulsive children are diagnosed as early as 2 or 3 years old. Another group appears to develop more severe symptoms around the fourth grade. These children may have always had ADHD but were able to compensate for the condition. As school requires more work and more organization skills, these children may reach a point where they become unable to compensate and exhibit "full blown" ADHD symptoms. Some children may remain undiagnosed until they are in their teens. More recently adults have been diagnosed as having Attention Deficit Disorder. These individuals had the disorder as children but were not properly identified during their childhood