Diagnosing ADHD

What is ADHD?

ADHD stands for attention deficit hyperactivity disorder.

There are three core symptoms of ADHD:

1. Inattention

2. Impulsivity

3. Hyperactivity

Inattention

Inattention can present itself in many ways. Some of the most common complaints that I hear about are daydreaming, forgetting assignments and inability to complete a short list of chores at home.

Often children who mostly have inattention do not become recognized until they are older because they are not the ones causing all kinds of problems in the kindergarten classroom. They will skirt by making OK grades and not getting in trouble until they get a little older and the requirements to sit still and complete assignments on their own increase.

Impulsivity

Do you know that split second where you think about telling someone off but you stop yourself? Or you think about driving 100 mph because you’re running late but don’t because you realize it will be dangerous? That split second is another thing that children with ADHD are lacking. They push right through that pause and act before thinking about the consequences of their action.

The best summary for this problem is that they lack the ability to determine if the upcoming action is: safe or appropriate for time and place.

Hyperactivity

The hyperactive symptoms are the ones that most people (even strangers) will notice about children with ADHD. They are not even necessarily bad kids, it’s simply that they have a significant struggle with staying seated, staying still when seated and not talking out of turn. These symptoms are usually noticed by 4 years of age and progressively worsen until about 7 years.

Learn more about hyperactivity and ADHD here.

ADHD subtypes

There are three major types of ADHD and they are characterized by which of the core symptoms your child demonstrates: mostly inattentive, mostly hyperactive-impulsive and combined.

Diagnosis

The diagnosis of ADHD can be made by multiple practitioners: pediatricians, psychologist, psychiatrists and some counselors are trained to diagnose ADHD. I prefer to make my own diagnosis in my clinic unless the case is particularly challenging or there is something complex about the presentation.

There are many different modalities that can be used to diagnose ADHD but it is mostly made by parental history, teacher’s reports and screening scales. I prefer to use the Vanderbilt scale but there are many other scales out there that can be used.

Diagnostic criteria

Diagnostic criteria for ADHD start at age 4 so younger children are generally not diagnosed with ADHD. This is due in part to the complexity of trying to decide what is normal and what is hyperactive or inattentive for a child younger than 3.

The following criteria are used:

1. Be present in more than one environment (home and school) - this is important because children who have issues only at home or only at school are usually having more of a problem with the structure at one place than actually having a tendency towards ADHD

2.  Be present for more than 6 months

3. Be present before age 7 - this is becoming more of a problem as adolescents and adults are becoming more aware of the problem but demonstrating that there were symptoms prior to age 7 can be difficult

4. The symptoms must impair function-see below

5.  Be excessive for the developmental level of the child - An active 2 year old is not hyperactive but normal.

Does it impair function?

My main point when I am discussing a child’s ADHD with the family is focused upon this aspect of the diagnosis and treatment. For most children, impairment of function means that they are not progressing through school appropriately, are in trouble at school regularly for hyperactive or impulsive behaviors or have difficulty performing regular function at the house because of their ADHD.