ATTENTION DEFICIT HYPERACTIVITY DISORDER

DIAGNOSING ADHD

ADHD is characterized by either inattention and/or hyperactivity-impulsivity. There is a veritable "Chinese menu" for determining whether a particular patient meets the diagnostic criteria for ADHD, and if so, for which subtype.

In the United States, mental health professionals use the DSM-IV diagnostic criteria while in Europe, mental health professional generally use the ICD-10 diagnostic criteria.

Note that in the American criteria, a child need not have both hyperactivity-impulsivity and inattention. It is possible to be diagnosed if inattention is the primary or sole problem. Although many children and teenagers will meet criteria for both inattention and hyperactivity-impulsivity (i.e., they will meet diagnostic criteria for the "combined" subtype), keeping the different subtypes (primarily inattentive, primarily hyperactive-impulsive, or combined) is helpful.

DIFFERENTIAL DIAGNOSIS: ADHD OR SOMETHING ELSE?

Because there are many other possible explanations for inattentive or hyperactive-impulsive behavior, and as part of the diagnostic examination, the professional needs to collect information from multiple sources of information. Some of the other conditions that produce behavior patterns or symptoms that might at first blush appear to be ADHD include:

• A learning disability that leads to poor performance in school, frustration, and a behavior pattern where the child seems to stop paying attention or "gives up" listening to the teacher;
• Attention lapses caused by petit mal seizures;
• Attention lapses caused by obsessive thoughts or silent compulsive rituals;
• A middle ear infection causing an intermittent hearing problem that interferes with the child's ability to respond to orally presented requests or material;
• Disruptive or unresponsive behavior due to anxiety, depression, or bipolar disorder (manic phase).

ADHD OR EXECUTIVE DYSFUNCTION OR...?

In another article, we discuss a condition that is known as Executive Dysfunction. If you've already read about it, you may have noted that many of the symptoms described sound remarkably like the inattentive criteria in the DSM-IV criteria for ADHD. Specifically, the following signs or symptoms of "inattention" may also indicate executive dysfunction:

1. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities;
2. Often has difficulty sustaining attention in tasks or play activities;
3. 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);
4. Often has difficulty organizing tasks and activities;
5. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework);
6. Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools);
7. Is often easily distracted by extraneous stimuli;

In order to clarify diagnostic issues, a neuropsychological assessment may be helpful or necessary.