How do you know it’s ADHD?
In 2009, the National Center for Health Statistics estimated 5 million children aged 3-17 were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). Usually apparent in children between ages 3 and 6; symptoms of ADHD can persist into adulthood. Boys are found to be more than twice as likely as girls to have the disorder (Bloom, Cohen, & Freeman, 2010). ADHD is characterized by persistent and pervasive levels of impulsivity, hyperactivity, and/or inattention resulting in impairment of functioning across multiple settings (American Psychiatric Association, 2000). Some children exhibit inattentive behaviors, while others present as impulsive and hyperactive; most children diagnosed with ADHD have a combination of both.
Attention is a multi-dimensional construct which can refer to problems with selective or focused attention, sustained attention, alertness, organization, distractibility, or forgetfulness (American Psychiatric Association, 2000). These difficulties can be observed in free play settings, however are seen more frequently in situations requiring sustained attention or with tasks considered to be boring and/or repetitive (Danforth, Barkley, & Stokes, 1991). Even when presented with intrinsically interesting stimuli, children with ADHD have difficulty attending to and comprehending events (Mash & Barkley, 2006).
Those diagnosed with ADHD may also display a deficiency in inhibiting or impulsive behavior, often coupled with difficulty in sustained attention. Like attention, impulsiveness is also a multi-dimensional construct (Nigg, 2001) and can refer to problems like sitting still, playing quietly, talking quietly, or waiting patiently (American Psychiatric Association, 2000). Taylor (1986) reported that it may be the pervasiveness of the hyperactivity/impulsiveness across multiple settings that separate ADHD from other diagnostic categories of children.
Various diagnoses are given to clinically referred children presenting with significant deficiencies in sustained attention, behavioral inhibition, resistance to distraction and the regulation of activity level. Therefore accurate diagnosis of children with ADHD remains difficult, especially as many forms of inattention and impulsivity are considered normal in early childhood. Because of the variety of signs and symptoms of ADHD and the different ways the disorder manifests, accurate diagnosis can be difficult and professionals must rule out other possible reasons for a child’s behavior. A diagnosis by a trained clinician should include a thorough examination of the child, as well as information from caregivers, teachers or family members who have observed the child.
Accurate diagnosis is imperative because the diagnosis a child receives will inform his or her ADHD treatment. ADHD medications, for example, will not be effective if a child’s inattention or impulsive behavior is caused by anxiety or trauma. Recent changes in the DSM-5 have helped to better define an ADHD diagnosis by specifying a child’s presentation of symptoms, including additional environmental settings and defining the term impairment.
Learn more on recent changes to ADHD criteria by attending our continuing education DSM-5 seminars.
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th edition, text revision). Washington, DC: American Psychiatric Association.
Bloom, B., Cohen, R. A., & Freeman, G. (2010) Summary health statistics for U.S. children: National health interview survey, 2009. National Center for Health Statistics. Vital Health Statistics, 10(247).
Danforth, J. S., Barkley, R. A., & Stokes, T. F. (1991). Observations of parent-child interactions with hyperactive children: Research and clinical implications. Clinical Psychology Review, 11, 703-727.
Mash, E. J. & Barkley, R. A. (2006) Treatment of Childhood Disorders (3rd ed.). New York: Guilford.
Nigg, J. T. (2001). Is ADHD an inhibitory disorder? Psychological Bulletin, 125, 571-596.
Taylor, E. A. (1986). Childhood hyperactivity. British Journal of Psychiatry, 149, 562-573.