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Attention%20deficit_hyperactivity%20disorder Diagnosis
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
- Inattention symptoms include:
- 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 or with low birth weight; 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 provide additional supportive evidence in establishing the diagnosis of ADHD as well as to monitor symptom progress
- 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
