Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is a childhood-onset psychiatric disorder whose cardinal symptoms are inattention, hyperactivity and impulsivity1. Diagnostic criteria for ADHD are based on extensive empirical research and appropriately lead to the diagnosis of a syndrome with higher interrater reliability, high predictability of course and medication responsiveness. The criteria of what constitutes children have broadened and there is growing appreciation of the persistence of ADHD into adulthood2. Diagnostic Features: ADHD often referred to erroneously as ADD is presented in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSMIV) (American Psychological Association [APA], 1994, pp. 78-85) as a disorder usually first diagnosed in infancy, childhood or adolescence. The diagnostic criteria are enumerated as follows; either (1) or (2): 1. Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Inattention a. Often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities b. Often has difficulty in sustaining attention in tasks or playing activities c. Often does not seem to listen when spoken to directly d. 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) e. Often has difficulty in organizing tasks and activities f. Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) g. Often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books or tools) h. Is often easily distracted by extraneous stimuli i. Is often forgetful in daily activities 2. Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Hyperactivity a. Often fidgets with hands or feet or squirms in seat b. Often leaves seat in classroom or in other situations in which remaining seated is expected c. 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) d. Often has difficulty in playing or engaging in leisure activities quietly e. Is often "on the go" or often acts as if "driven by a motor" f. Often talks excessively Impulsivity a. Often blurts out answers before questions have been completed b. Often has difficulty in awaiting turn c. Often interrupts or intrudes on others (e.g. butts into conversations or games) d. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years e. Some impairment from the symptoms is present in two or more settings (e.g. at school [or work] and at home) f. There must be clear evidence of clinically significant impairment in social, academic or occupational functioning g. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder or a Personality Disorder) The DSM-IV also defines four diagnostic categories of ADHD based upon the impairments present. If Criteria A1 and A2 are met (inattention and hyperactivity-impulsivity), ADHD Combined Type is appropriate. If Criteria A1 is met (inattention), ADHD Predominately Inattentive Type is appropriate. And if Criteria A2 is met (hyperactivity-impulsivity), ADHD Predominately Hyperactive-Impulsive Type is appropriate. The fourth category is defined as ADHD Not Otherwise Specified (NOS) and is utilized for those who have "disorders with prominent symptoms of inattention or hyperactivity-impulsivity that do not meet the criteria for Attention Deficit/Hyperactivity