attention%20deficit_hyperactivity%20disorder
ATTENTION DEFICIT/HYPERACTIVITY DISORDER
Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by the presence of impairing levels of inattention, disorganization and/or hyperactivity-impulsivity.
Symptoms that suggest ADHD include hyperactivity, acting without thinking, inattention/daydreaming, fidgety, restless, excessive talking, aggressive behavior, academic underachievement, disorganized and has difficulty in completing tasks.

Diagnosis

  • Based on DSM-5, criteria to diagnose ADHD are the following:
    • Presence of continuous and constant pattern of either inattention and/or hyperactivity-impulsivity that causes significant interference or impairment in development and social, academic, or occupational functioning
    • Presence of inattentiveness or hyperactive-impulsive symptoms before the age of 12 years
    • Presence of inattentiveness or hyperactive-impulsive symptoms in 2 or more situations eg school, work or home
    • Disturbance does not occur exclusively during the course of schizophrenia or other psychotic disorder and not better explained by any other mental disorder or substance intoxication or withdrawal
    • Presence of at least 5 inattention and/or hyperactivity-impulsivity symptoms in patients ≥17 years old OR ≥6 symptoms in patients <17 years old that persisted for at least 6 months
      • Inattention symptoms include:
        • Often having inattention to details or makes careless mistakes in schoolwork, work or other activities
        • Often having problems sustaining attention in doing tasks or play activities
        • Often does not seem to listen when spoken to directly, even without obvious distraction
        • Often fails to carry out instructions to completion and fails to finish schoolwork, tasks or duties at work
        • Often having problems organizing tasks and activities
        • Often avoids or strongly dislikes doing tasks that would require sustained mental effort
        • Often loses things needed to perform tasks or activities
        • Often easily distracted by extraneous stimuli
        • Often forgets daily activities
      • Hyperactivity-impulsivity symptoms include:
        • Fidgeting or tapping of hands/feet; or squirming in seat is often observed
        • Often leaves seat in the classroom or any situation that requires to be remained seated
        • Inappropriately runs about or climbs excessively
        • Often have inability to be quiet while playing or engaging in leisure activities
        • Often uncomfortable or having difficulty being still for extended periods of time that others may perceive as being always “on the go” or acts like “driven by a motor”
        • Excessively talking
        • Often blurting out answers to questions before questions have been completed
        • Often having problems waiting in line or waiting for his or her turn
        • Always interrupting or intruding on others; in adults or adolescents, it is evident with intruding or taking over what others are doing
  •  According to DSM-5 criteria, ADHD can be classified to subclasses:
    • Predominantly inattentive where hyperactivity symptoms are not present in the past 6 months
    • Predominantly hyperactive/impulsive where inattentive symptoms are not present in the past 6 month
    • Combined where both hyperactivity/impulsivity and inattentive symptoms are present in the past 6 months
  • It can also be specified by severity based on the effect in occupational or social function:
    • In partial remission where few symptoms in the criteria recur for the past 6 months after previously meeting the full diagnostic criteria
    • Mild for minor impairment
    • Moderate if impairment is between mild and severe symptoms and functions
    • Severe if the symptoms are in excess of those necessary to meet diagnosis or there is marked impairment

Assessment

  • Increased prevalence of ADHD may be seen in those born preterm; with epilepsy, acquired brain injury, history of substance misuse, or family history of ADHD; individuals who are looked after  
  • Female patients are more likely to be underdiagnosed or misdiagnosed with a different mental health or neurodevelopmental disorder
  • Other components of evaluation include:
    • Parent/caregiver interview (eg medical history including obstetric and perinatal history, developmental history, family history, co-existing conditions, current drug therapy, parent/caregiver’s mental health)
    • Patient interview
    • Questionnaires
    • Psychoeducational assessment
    • Clinical exam [eg physical (height and weight)/medical exam, vision and hearing test]
    • Ancillary evaluation (psychiatric, psychological), when necessary
  • ADHD-specific scales or narrow-band scales may be used to establish the diagnosis of ADHD
    • Focus directly on the symptoms
    • Preschool children may be assessed using Conner comprehensive behavior rating scales and the ADHD rating scale
  • Broad-band rating scales may be used to identify associated behavioral conditions and evaluate psychological functioning
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