A. Either 1 or 2 should be present:
1. Should have 6 or more of the following symptoms of inattention, persisting for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
2. Should have 6 or more of the following symptoms of hyperactivity-impulsivity that lasts for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
Note: Patients with A1 symptoms are diagnosed with ADHD, predominantly inattentive type. Those with A2 are diagnosed with ADHD, predominantly hyperactive-impulsive type. Those with both A1 and A2 are diagnosed as ADHD, combined-type.
B. Onset of some symptoms before the age of 7. However, children with the inattentive subtype are not often diagnosed until they are above 7 years of age.
C. Symptoms occur in two or more settings. For example, at home and at school.
D. Clear evidence of significant impairment in social or academic functioning.
E. Not caused by a pervasive developmental disorder, schizophrenia, or any other psychotic disorder, and is not better accounted for by another mental disorder, including anxiety or depression.
Source: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th Ed. (Text Revision). Washington, DC: 2000.
Important factors for making a diagnosis of attention-deficit hyperactivity disorder (ADHD) include:
No laboratory or imaging tests exist to reliably diagnose ADHD. A diagnosis relies only on behavioral symptoms and ruling out other disorders. Many doctors believe that the disorder is both over- and underdiagnosed. Diagnosis is difficult for some of the following reasons:
Factors Leading to the Over-Diagnosis of ADHD:
Factors Leading to the Under-Diagnosis of ADHD:
The doctor will first require a detailed history of the child's behavior. Doctors will match this against a standardized checklist to define the disorder.
The parents should describe:
The health professional will want to know how the parents handle different situations, and may want to observe them interacting with the child.
The child should also be given a general physical examination to determine if any medical conditions are present. The child should be given a hearing test to rule out hearing abnormalities as a source of behavioral problems.
Various tests are available to test neurologic, intellectual, and emotional development problems. Most involve learning and problem solving tasks that help define the particular areas that are most disabling. Blood or other laboratory tests are currently recommended only if the doctor suspects lead toxicity or other medical problems.
Although some doctors use a trial of a psychostimulant (usually Ritalin) to facilitate diagnosis, most doctors strongly recommend against this method of diagnosis, because it is not always accurate. An improvement in symptoms is considered suggestive of ADHD, while in non-ADHD children the stimulant often increases agitation and hyperactivity. Many children and adults without the disorder have a similar response, and such a diagnostic trial may lead to unnecessary prescriptions of this drug.
ADHD in adults always occurs as a continuation of the childhood condition. Adult-onset symptoms are likely due to other factors. Diagnosing adult ADHD can be a difficult problem since hyperactivity typically wanes as children get older, while attention and organizational problems may develop in older people.
A rating scale using four factors may be useful in identifying adults with ADHD:
Doctors use adult reports of childhood behaviors and experiences when searching for clues for a diagnosis.
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