Attention Deficit Hyperactivity Disorder
The diagnosis of attention deficit hyperactivity disorder (ADHD) is marked by inattention, hyperactivity, and impulsivity. Since these and other symptoms are behaviors, blood tests and imaging equipment cannot be used to diagnose ADHD. Rather, behaviors have to be observed, assessed, and interpreted. Interpretation of the symptoms of ADHD, as with other psychiatric conditions, can certainly vary among professionals. Complicating matters even further, diagnostic criteria has changed, and will continue to change, in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). Still, as understanding of the disorder increases, diagnoses of ADHD can be made more precisely and reliably.
Diagnosing ADHD in Children
How is ADHD diagnosed in children? Children being evaluated for a possible diagnosis of ADHD receive a complete physical exam. The child’s medical history is considered, as well as other conditions that may impact a child’s behavior. Circumstances and medical conditions that could cause similar symptoms to ADHD include sudden life changes (divorce, a relative’s death, or moving), thyroid disorders, insomnia, undetected seizures, depression, or lead toxicity.
Many individuals and professionals are involved in a childhood diagnosis of ADHD, which is considered after symptoms have been displayed on a regular basis for more than six months. Pediatricians and child psychologists diagnose the condition with the help of guidelines as outlined in the DSM-IV. Professionals will evaluate how a child’s behavior compares to the behavior of children the same age. In making the diagnosis, information is also gathered from parents, caregivers, and teachers.
According to the DSM-IV, children will display six or more of the following symptoms of inattention:
- Does not pay attention to details or makes careless mistakes on school assignments
- Has difficulty sustaining attention in school and in play
- Does not seem to listen
- Fails to follow through on instructions and does not complete schoolwork
- Has difficulties with organizing tasks and activities
- Avoids or is reluctant to work on tasks that require sustained concentration
- Loses school supplies or other items required for activities
- Often becomes distracted
- Displays forgetfulness in daily activities.
Children with ADHD will show six or more of the following symptoms of hyperactivity or impulsivity:
- Fidgets with hands or feet and squirms in seat
- Gets up from seat when expected to remain seated
- Runs or climbs excessively at inappropriate times
- Has difficulty playing or doing other activities quietly
- Often talks constantly
- Blurts out answers before hearing the end of questions
- Has difficulty waiting for a turn
- Interrupts or intrudes
Diagnosing ADHD in Adults
Just a few years ago, mental health professionals believed children with ADHD would grow out of the disorder. While some will experience symptom improvement as they reach adulthood, many others will not. In fact, approximately 60% of children with ADHD will continue to experience difficulties into adulthood. An adult with ADHD is difficult to diagnose. Adults will sometimes recognize the symptoms of the condition in themselves when a son or daughter receives a diagnosis. Many adults will often seek mental health treatment for depression, anxiety, or other symptoms and learn that what they are experiencing results from their ADHD.
Although the DSM-IV criteria for ADHD are the same for all individuals, symptoms will manifest themselves differently in adults than they do in children. Adults with ADHD will typically experience the following symptoms:
- Poor organizational skills
- Continually starting new tasks before finishing old ones
- Carelessness and lack of attention to detail
- Difficulties with focusing or prioritizing
- Chronic lateness
- Continually losing or misplacing things
- Forgetfulness, restlessness, and edginess
- Poor social timing when speaking to others
- Mood swings and irritability
- Inability to deal with stress
- Taking risks in activities without regard to personal safety or the safety of others
To be diagnosed with ADHD, an adult must have experienced symptoms in childhood and currently have persistent symptoms. For an accurate diagnosis, an adult should have a thorough physical exam. Psychological testing is the next step in diagnosis, with assessments typically using a rating scale to determine the degree of symptomology. Then, a history of the adult’s behavior as a child is taken. A mental health professional may also interview the individual’s life partner, parent, or a close friend.
If ADHD in adults is left undiagnosed and unmanaged, the condition can cause emotional, social, occupational and academic problems. Adults who do not receive treatment typically experience low self-esteem and anxiety. Drug abuse, alcohol problems, and smoking-related disorders are extremely common among adults with untreated ADHD. Traffic accidents and intentional risky behaviors also increase among this population, as do convictions and incarcerations because of extreme and violent behavior. Relationship difficulties and problems related to employment and education tend to persist as well.
National Institute of Mental Health, www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/how-is-adhd-diagnosed.shtml.
Chandler, Chris. The Science of ADHD: A Guide for Parents and Professionals. Wiley-Blackwell, 2010.
Centers for Disease Control and Prevention, www.cdc.gov/ncbddd/adhd/diagnosis.html.