What is AD/HD?
Attention-Deficit/Hyperactivity Disorder (AD/HD) is a condition that can make it hard for a person to sit still, control behavior, and pay attention. These difficulties usually begin before the person is 7 years of age. However, these behaviors may not be noticed until the child is older when it begins to affect their level of school or personal success.
Doctors do not know just what causes AD/HD. However, researchers who study the brain are coming closer to understanding what may cause AD/HD. They believe that some people with AD/HD do not have enough of certain chemicals (called neurotransmitters) in their brain. These chemicals help the brain control behavior.
Parents and teachers do not cause AD/HD. Still, there are many things that both parents and teachers can do to help a child with AD/HD.
How Common is AD/HD?
As many as 5 out of every 100 children in school may have AD/HD. Boys are three times more likely than girls to have AD/HD.
It is a chronic disorder with 30 to 50 percent of those individuals diagnosed in childhood continuing to have symptoms into adulthood. Adolescents and adults with AD/HD tend to develop coping mechanisms to compensate for some or all of their impairments. AD/HD is the most commonly studied and diagnosed psychiatric disorder in children American adults live with AD/HD.
What Are the Signs of AD/HD?
There are three main signs, or symptoms, of AD/HD. These are:
- problems with paying attention,
- being very active (called hyperactivity), and
- acting before thinking (called impulsivity).
More information about these symptoms is listed in a book called the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association (2000). Based on these symptoms, three types of AD/HD have been found:
- inattentive type, where the person can’t seem to get focused or stay focused on a task or activity;
- hyperactive-impulsive type, where the person is very active and often acts without thinking; and
- combined type, where the person is inattentive, impulsive, and too active
Inattentive type. Many children with AD/HD have problems paying attention. Children with the inattentive type of AD/HD often:
- do not pay close attention to details;
- can’t stay focused on play or school work;
- don’t follow through on instructions or finish school work or chores
- can’t seem to organize tasks and activities;
- get distracted easily; and
- lose things such as toys, school work, and books. (APA, 2000, pp.85-86)
Hyperactive-impulsive type. Being too active is probably the most visible sign of AD/HD. The hyperactive child is “always on the go.” (As he or she gets older, the level of activity may go down.) These children also act before thinking (called impulsivity). For example, they may run across the road without looking or climb to the top of very tall trees. They may be surprised to find themselves in a dangerous situation. They may have no idea of how to get out of the situation.
Hyperactivity and impulsivity tend to go together. Children with the hyperactive-impulsive type of AD/HD often may:
- fidget and squirm;
- get out of their chairs when they’re not supposed to;
- run around or climb constantly;
- have trouble playing quietly;
- talk too much;
- blurt out answers before questions have been completed;
- have trouble waiting their turn;
- interrupt others when they’re talking; and
- butt in on the games others are playing. (APA, 2000, p. 86)
Combined type. Children with the combined type of AD/HD have symptoms of both of the types described above. They have problems with paying attention, with hyperactivity, and with controlling their impulses.
Of course, from time to time, all children are inattentive, impulsive, and too active. With children who have AD/HD, these behaviors are the rule, not the exception.
These behaviors can cause a child to have real problems at home, at school, and with friends. As a result, many children with AD/HD will feel anxious, unsure of themselves, and depressed. These feelings are not symptoms of AD/HD. They come from having problems again and again at home and in school.
How Do You Know if a Child Has AD/HD?
When a child shows signs of AD/HD, he or she needs to be evaluated by a trained professional. This person may work for the school system or may be a professional in private practice. A complete evaluation is the only way to know for sure if the child has AD/HD. It is also important to:
- rule out other reasons for the child’s behavior, and
- find out if the child has other disabilities along with AD/HD
What About Treatment?
There is no quick treatment for AD/HD. However, the symptoms of AD/HD can be managed. It’s important that the child’s family and teachers:
· Seek out a counselor or therapist who is a specialist in the diagnosis and treatment for AD/HD
· find out more about AD/HD;
· learn how to help the child manage his or her behavior;
· create an educational program that fits the child’s individual needs;
· and provide medication, if parents and the doctor feel that this would help the child.
Some common symptoms and problems of living with AD/HD include:
- Poor attention; excessive distractibility
- Physical restlessness or hyperactivity
- Excessive impulsivity; saying or doing things without thinking
- Excessive and chronic procrastination
- Difficulty getting started on tasks
- Difficulty completing tasks
- Frequently losing things
- Poor organization, planning, and time management skills
- Excessive forgetfulness
Not every person with AD/HD displays all of the symptoms, nor does every person with AD/HD experience the symptoms of AD/HD to the same level of severity or impairment. Some people have mild AD/HD, while others have severe AD/HD, resulting in significant impairments. AD/HD can cause problems in school, in jobs and careers, at home, in family and other relationships, and with tasks of daily living.
AD/HD is thought to be a biological condition, most often inherited, that affects certain types of brain functioning. There is no cure for AD/HD. When properly diagnosed and treated, AD/HD can be well managed, leading to increased satisfaction in life and significant improvements in daily functioning. Many individuals with AD/HD lead highly successful and happy lives. An accurate diagnosis is the first step in learning to effectively manage AD/HD.
How is ADHD diagnosed?
There is no single medical, physical, or genetic test for AD/HD. However, a diagnostic evaluation can be provided by a qualified mental health care professional or physician who gathers information from multiple sources. These include AD/HD symptom checklists, standardized behavior rating scales, a detailed history of past and current functioning, and information obtained from family members or significant others who know the person well. AD/HD cannot be diagnosed accurately just from brief office observations, or just by talking to the person. The person may not always exhibit the symptoms of AD/HD in the office, and the diagnostician needs to take a thorough history of the individual's life. A diagnosis of AD/HD must include consideration of the possible presence of co-occurring conditions.
Clinical guidelines for diagnosis of AD/HD are provided in the American Psychiatric Association diagnostic manual commonly referred to as the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision). These established guidelines are widely used in research and clinical practice. During an evaluation, the clinician will try to determine the extent to which these symptoms apply to the individual now and since childhood. The DSM-IV-TR symptoms for AD/HD are listed below:
Symptoms of Inattention
- Often fails to give close attention to details or makes careless mistakes in schoolwork, 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 schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
- Often has difficulty organizing tasks and activities
- Often avoids, dislikes, 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
Symptoms of Hyperactivity
- Often fidgets with hands or feet or squirms in seat
- Often leaves seat in classroom or in other situations in which remaining seated is expected
- Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
- 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
Symptoms of Impulsivity
- 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)
A diagnosis of AD/HD is determined by the clinician based on the number and severity of symptoms, the duration of symptoms, and the degree to which these symptoms cause impairment in various life domains (e.g. school, work, and home). It is possible to meet diagnostic criteria for AD/HD without any symptoms of hyperactivity and impulsivity. The clinician must further determine if these symptoms are caused by other conditions, or are influenced by co-existing conditions.
It is important to note that the presence of significant impairment in at least two major settings of the person's life is central to the diagnosis of AD/HD. Impairment refers to how AD/HD interferes with an individual's life. Examples of impairment include losing a job because of AD/HD symptoms, experiencing excessive conflict and distress in a marriage, getting into financial trouble because of impulsive spending or failure to pay bills in a timely manner, or getting on academic probation in college due to failing grades. If the individual manifests a number of AD/HD symptoms but does not manifest significant impairment, s/he may not meet the criteria for AD/HD as a clinical disorder.
The DSM-IV TR specifies three major subtypes of AD/HD:
- Primarily Inattentive Subtype. The individual mainly has difficulties with attention, organization, and follow-through.
- Primarily Hyperactive/Impulsive. The individual mainly has difficulties with impulse control, restlessness, and self-control.
- Combined Subtype. The individual has symptoms of inattention, impulsivity, and restlessness.
Internet Self-Rating Scales
There are many Internet sites about AD/HD that offer various types of questionnaires and lists of symptoms. These questionnaires are not standardized or scientifically validated and should never be used to self-diagnose or to diagnose others with AD/HD. A valid diagnosis can only be provided by a qualified, licensed professional
The Diagnostic Interview: AD/HD Symptoms
The single most important part of a comprehensive AD/HD evaluation is a structured or semi-structured interview, which provides a detailed history of the individual. In a "structured" or "semi-structured" interview, the interviewer asks a pre-determined, standardized set of questions, in order to increase reliability and decrease the chances that a different interviewer would come up with different conclusions. This allows the clinician to cover a broad range of topics, discuss relevant issues in more detail, and ask follow up questions while ensuring coverage of the domains of interest. The examiner will review the diagnostic criteria for AD/HD and determine how many of them apply to the individual, both at the present time and since childhood. The interviewer will further determine the extent to which these AD/HD symptoms are interfering with the individual's life.
The Diagnostic Interview: Screening for Other Psychiatric Disorders
The examiner will also conduct a detailed review of other psychiatric disorders that may resemble AD/HD or commonly co-exist with AD/HD. AD/HD rarely occurs alone. In fact, research has shown that many people with AD/HD have one or more co-existing conditions. The most common include depression, anxiety disorders, learning disabilities, and substance use disorders. Many of these conditions mimic some AD/HD symptoms, and may, in fact, be mistaken for AD/HD. A comprehensive evaluation includes some interviewing to screen for co-existing conditions. When one or more co-existing conditions are present along with AD/HD, it is essential that all are diagnosed and treated. Failure to treat co-existing conditions often leads to failure in treating the AD/HD. And, crucially, when the AD/HD symptoms are a secondary consequence of depression, anxiety, or some other psychiatric disorder, failure to detect this will result in incorrectly treating the individual for AD/HD. Other times, treating the AD/HD will eliminate the other disorder and the need to treat it independently of AD/HD.
The examiner is also likely to ask questions about the person's health history, developmental history going back to early childhood, academic history, work history, family and marital history, and social history.
Participation of a Significant Other
It is also essential for the clinician to interview one or more independent sources, usually a significant other (spouse, family member, parent, and partner) who knows the person well. This procedure is not to question the person's honesty, but rather to gather additional information. Many adults with AD/HD have a spotty or poor memory of their past, particularly from childhood. They may recall specific details, but forget diagnoses they were given or problems they encountered. Thus, the clinician may request that the individual being evaluated have his or her parents fill out a retrospective AD/HD profile describing childhood behavior.
Many adults with AD/HD may also have a limited awareness of how AD/HD-related behaviors cause problems for them and have impact on others. In the case of married or cohabitating couples, it is to the couple's advantage for the clinician to interview them together when reviewing the AD/HD symptoms. This procedure helps the non-AD/HD spouse or partner develop an accurate understanding and an empathetic attitude concerning the impact of AD/HD symptoms on the relationship, setting the stage for improving the relationship after the diagnostic process has been completed.
Finally, it should be noted that many adults with AD/HD feel deeply frustrated and embarrassed by the ongoing problems caused by their AD/HD. It is very important that the person being evaluated discuss these problems openly and honestly, and not hold back information due to feelings of shame or fear of criticism. The quality of the evaluation, and the accuracy of the diagnosis and treatment recommendations, will be largely determined by the accuracy of the information provided to the examiner.