David Rabiner, Ph.D. Research
Professor, Duke University
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David Rabiner, Ph.D.
(Note: If you are looking for information on Attention Deficit Disorder (ADD) please be aware that much of what is discussed below should also be relevant. Technically, the term ADD is no longer used. Instead, children who have the inattentive symptoms of ADHD but who do not show hyperactive/impulsive symptoms are now diagnosed with ADHD, Predominantly Inattentive Type rather than with ADD. These terms mean pretty much the same thing but the latter is no longer technically correct.)
Diagnostic Criteria for Attention Deficit Disorder/ADHD
Note: The information below is intended to familiarize you with
the diagnostic criteria for ADHD/ADD. Making this diagnosis correctly requires
a comprehensive evaluation, however, and should only be made by a qualified
health care provider.
In the United States, ADHD is diagnosed according to criteria specified in the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV). ADHD symptoms are divided into two groups: symptoms of inattention and symptoms of hyperactivity/impulsivity. These groups of symptoms are shown below:
In the United States, Attention Deficit Hyperactivity Disorder/Attention Deficit Disorder is diagnosed according to criteria specified in the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV). ADHD/ADD symptoms are divided into two groups: symptoms of inattention and symptoms of hyperactivity/impulsivity. These groups of symptoms are shown below:
work, or other activities;
· often has difficulty sustaining attention in tasks or play activities;
· often does not seem to listen when spoken to directly;
· often does not follow through on instructions and fails
to finish school work, chores, or
· often has difficulty organizing tasks or activities;
· often avoids or is reluctant to engage in tasks that require sustained mental effort;
· often loses things necessary for tasks or activities;
· is often easily distracted by extraneous stimuli;
· is often forgetful in daily activities;
· often leaves seat in classroom or in other situations in which remaining seated is expected;
· often runs about or climbs excessively in which it is inappropriate
(in adolescents and adults, may be limited to subjective feelings
· often has difficulty playing or engaging in leisure activities quietly;
· is often "on the go" or often acts as if "driven by a motor"
· often talks excessively;
· often blurts out answers before questions have been completed;
· often has difficulty awaiting turn;
· often interrupts or intrudes on others (e.g. butts into conversations or games)
To avoid diagnosing individuals who show only isolated difficulties,
at least 6 inattentive symptoms and/or 6 hyperactive/impulsive symptoms must
be present to possibly qualify for an ADHD/ADD diagnosis. In addition, these
symptoms must have been present for at least 6 months to a degree that is
considered inappropriate for the individual's age.
"Does my child have to show both kinds of symptoms to be diagnosed with Attention Deficit Hyperactivity Disorder/Attention Deficit Disorder?"
If 6 or more inattentive symptoms are present the diagnosis of ADHD/ADD, Predominantly Inattentive Type may apply. This is what people mean when they refer to ADD. Technically, this term is no longer correct.
If 6 or more hyperactive/impulsive symptoms are the diagnosis of ADHD, Predominantly Hyperactive/Impulsive Type may apply;When 6 or more of both types of symptoms are present, the diagnosis of ADHD, Combined Type may apply.
"Is deciding whether these symptoms are present the only factor involved in making the diagnosis?"
SOME HYPERACTIVE-IMPULSIVE OR INATTENTIVE SYMPTOMS THAT CAUSED IMPAIRMENT NEED TO HAVE BEEN PRESENT BEFORE THE CHILD WAS 7.
For example, it is not uncommon for children with inattentive symptoms, but not the hyperactive/impulsive symptoms, to do okay in the early grades when the academic demands are not very rigorous. This is especially likely for a bright child who catches on despite not attending very well. In later grades, however, when the work becomes more demanding, the child's problems with attention may begin to create real problems. Thus, although it may appear that the child's problems with attention emerged "suddenly", a careful investigation often reveals the presence of attentional difficulties earlier on.
In cases where there truly is no indication of ADHD symptoms, even
at a reduced level, than ADHD would not be an appropriate diagnosis. Instead,
it is likely that some other type of problem such as a mood disorder or anxiety
disorder is responsible for the symptoms.
It is important to emphasize that the intensity of ADHD symptoms
can vary considerably across settings and it is not necessary that the degree
of impairment from symptoms be equivalent in different settings. For example,
it is not uncommon for a child's difficulties to be more prominent at school
than at home. When this occurs, it is often because the demands to sustain
attention and inhibit activity level are greater at school than at home.
Thus, in order to satisfy the dual setting criteria, there just needs to
be some indication that the problems are not exclusively confined to a single
THERE MUST BE CLEAR EVIDENCE OF CLINICALLY SIGNIFICANT IMPAIRMENT IN SOCIAL, ACADEMIC, OR OCCUPATIONAL FUNCTIONING.
THE SYMPTOMS DO NOT OCCUR EXCLUSIVELY DURING THE COURSE OF A PERVASIVE DEVELOPMENTAL DISORDER, SCHIZOPHRENIA, OR OTHER PSYCHOTIC DISORDER AND ARE NOT BETTER ACCOUNTED FOR BY ANOTHER MENTAL DISORDER (E.G. MOOD DISORDER, ANXIETY DISORDER, DISSOCIATIVE DISORDER, OR A PERSONALITY DISORDER).
In reality, the first 3 disorders listed (i.e. pervasive Developmental
Disorder, Schizophrenia, or some other Psychotic Disorder) are quite rare,
and impair an individual's functioning to such an extent that it should be
clear that something besides a simple case of ADHD is present. The remaining
disorders are most likely to be the cause of ADHD symptoms when the symptoms
emerged after age 7, and there was no indication of ADHD symptoms earlier
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