Attention Deficit and Hyperactivity disorder is a well-known and well researched disorder that some children and adults face. It is a common developmental problem which results in poor concentration and/or poor control of impulses. It can affect children’s education, social skills and family functioning. If not diagnosed and treated, the child may face additional problems in future including academic difficulties, relationship issues, substance abuse and mental health disorders in adulthood.
Hyperactivity and impulsivity are easier to identify than inattention. This concentration difficulty can perhaps be more disabling than other features as it can often go undetected. It is not that these children can’t concentrate, it is just that they find it harder than their peers. They may be able to concentrate on things that interest them or when the classroom is very quiet. Children with ADHD find it difficult to filter out the most important thing to focus on e.g. the teacher’s instructions have equal value to the conversation that is going on behind the child and therefore their attention shifts between them.
ADHD Symptoms and Diagnosis
The primary characteristic of attention deficit hyperactivity disorder (ADHD) is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or a child’s development.
The problems usually occur in two or more areas of a person’s life: home, work, school, and social relationships. ADHD is also referred to as attention deficit disorder (ADD) when hyperactivity and/or impulsivity are not present.
Attention deficit disorder begins in childhood. The symptoms of inattention and hyperactivity need to show themselves in a manner and degree which is inconsistent with the child’s current developmental level. That is, the child’s behaviour is significantly more inattentive or hyperactive than that of his or her peers of a similar age.
Several symptoms must be present before age 12 (which is why ADHD is classified as a neurodevelopmental disorder, even if not diagnosed until adulthood). In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), symptoms were required before age 7. Now the age of 12 is seen as an acceptable criterion because it is often difficult for adults to look retrospectively and establish a precise age of onset for a child. Indeed, adult recall of childhood symptoms tends to be unreliable. Thus, the DSM-5 has added some leeway to the age cut-off.
Diagnostic Criteria
A: A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterised by (1) and/or (2):
- Inattention: six (or more) of the following symptoms have persisted for at least months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. NOTE: The symptoms are not solely the manifestation of oppositional behaviours, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least 5 symptoms are required.
- Often fails to give cloase attention to details or makes careless errors in schoolwork, at work or during other activities. –
- Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
- Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
- Often does not follow through on instructions and fails to finish school work, chores, or duties in the work place (e.g., starts tasks but quickly loses focus and is easily sidetracked).
- Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).
- Often avoids or is reluctant to engage in tasks that require sustained mental effort (e.g. schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).
- Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
- Is often easily distracted by extraneous stimuli (e.g., for older adolescents and adults may include unrelated thoughts).
- Is often forgetful in daily activities (e.g., doing chores, running errands; for olderadolescents and adults, returning calls, paying bills, keeping appointments).
- Hyperactivity and impulsivity: six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. NOTE: The symptoms are not solely the manifestation of oppositional behaviours, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least 5 symptoms are required.
- Often fidgets with or taps hands or squirms in seat.
- Often leaves seat in situations when remaining seated is expected (e.g., leaves his orher place in the classroom, in the office or other workplace, or in other situations that require remaining in place).
- Often runs about or climbs in situations where it is inappropriate (e.g., in adolescents or adults, may be limited to feeling restless).
- Often unable to play or engage in leisure activities quietly;
- Is often “on the go” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).
- Often talks excessively;
- Often blurts out answers before questions have been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).
- Often has difficulty awaiting turn (e.g., while waiting in line).
- Often interrupts or intrudes on others (e.g. butts into conversations,games, or activities. may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).
B: Several inattentive or hyperactive-impulsive symptoms are present prior to the age of 12.
C: Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g. home, school, work, with friends or relatives, other activities).
D: There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.
E: The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g. mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).
The Different Types of ADHD:
- Predominantly Inattentive presentation: This type shows six or more symptoms from the inattention category and fewer than six symptoms from the hyperactive-impulsive (but individuals can exhibit some of these symptoms).
- Predominantly Hyperactive-Impulsive presentation: These individuals show six or more symptoms from the hyperactive-impulsive category and fewer than six symptoms from the inattention type (but some of these symptoms can be present).
- Combined presentation: Common in children, this type exhibits six or more symptoms of the inattentive type along with six or more symptoms from the hyperactive-impulsive type.
