Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood issue that is treatable.

ADHDAt our clinic, we provide comprehensive assessment and treatment services to help your child and family develop strategies to effectively manage the symptoms and promote healthy and happy relationships at home, school, and with peers.

Your child may present with symptoms of ADHD that include inattention, hyperactivity, and/or impulsivity. It is important to utilize the expertise of a psychologist to obtain a clear picture of how the ADHD affects your child.  Some children and adolescents have inattention and a level of activity and impulsivity that is typical for their age.  However, a comprehensive assessment can help identify if the challenges exceed what is typical for your child’s developmental level.

The American Psychiatric Association defines ADHD as a constellation of symptoms that tend to co-occur together and become apparent in early childhood. These symptoms are outlined in the American Psychiatric Association’s comprehensive diagnostic manual called the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition – Text Revision (DSM-V-TR). In the DSM-V-TR, the diagnostic criteria for ADHD are:

A. Either (1) or (2):

(1)  six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Inattention

(a)   often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities

(b)   often has difficulty sustaining attention in tasks or play activities

(c)    often does not seem to listen when spoken to directly

(d)   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)

(e)   often has difficulty organizing tasks and activities

(f)     often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)

(g)    often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)

(h)   is often easily distracted by extraneous stimuli

(i)     is often forgetful in daily activities

(2)   six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Hyperactivity

(a)   often fidgets with hands or feet or squirms in seat

(b)   often leaves seat in classroom or in other situations in which remaining seated is expected

(c)    often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be related to subjective feelings of restlessness)

(d)   often has difficulty playing or engaging in leisure activities quietly

(e)   is often “on the go” or acts as if “driven by a motor”

(f)     often talks excessively

Impulsivity

(a)   often blurts out answers before questions have been completed

(b)   often has difficulty awaiting turn

(c)    often interrupts or intrudes on others (e.g., butts into conversations or games)

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder, and are not better accounted by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

According to the DSM-V-TR, it is possible for some children with ADHD to be primarily inattentive. It is also possible for some children with ADHD to be primarily hyperactive. Finally, some children display both hyperactivity and inattentiveness and have what is called ADHD-Combined Type.

How common is ADHD?

The prevalence of ADHD varies depending on the population that is measured (for example, preschoolers versus adolescents) and on how it is measured (for example, with formal diagnostic criteria such as those listed in the previous section completed by trained mental health professionals versus teacher surveys of perceptions of hyperactive behavior). The best estimates on the prevalence of ADHD are that the disorder affects somewhere between 3-5% of all children. This means that there is approximately one child with ADHD in almost every classroom.

How can you tell if your child has ADHD?

When somebody suspects that a child has ADHD, it is important NOT to jump to conclusions too early. To protect your child from receiving an inaccurate diagnosis and being treated for a condition that he or she may not actually have, or to avoid having your child be overlooked for a problem that may be causing him or her significant problems, the diagnosis of ADHD (and any other mental health difficulty for that matter) should only be made by a qualified mental health practitioner. These professionals include family physicians, pediatricians, psychiatrists, or clinical psychologists.

What is involved in the assessment/diagnosis of ADHD?

There is no single test that is diagnostic of ADHD. Instead, a diagnosis of ADHD can only be made on the basis of an overall pattern of data that is collected on your child. The assessment of ADHD is often driven by issues involved in each individual case. To this end, assessment procedures will vary from child to child. There are some procedures, however, that have been recommended as “best practices” by experts on ADHD.  At our clinic, every psychologist is trained to provide the best assessment and to work very closely with other professionals involved in your child’s care and his or her school team in efforts to provide a comprehensive and accurate assessment.

Dr. Pure endorses the following references to help you understand ADHD:

  1. A Mind at a Time, The Myth of Laziness and Ready or Not, Here Life Comes – a series of book by Mel Levine
  2. Attention Deficit Disorder: the Unfocused Mind in Children and Adults. Thomas Brown
  3. Taking Charge of ADHD: the Complete, Authoritative Guide for Parents. Russell Barkley
  4. Attention Deficit Disorder and Learning Disabilities: Realities, Myths and Controversial Treatments. Barbara Ingersoll & Sam Goldstein
  5. Smart But Scattered  by Terri Mauro
  6. Disconnected Kids: the Groundbreaking Brain Balance Program for Children with Autism, ADHD, Dyslexia and Other Neurological Disorders. Robert Melillo
  7. The Everything Parent’s Guide to ADHD in Children. Carole Jacobs & Isadore Wendel
  8. Executive Skills in Children and Adolescents: A practical guide to assessment and intervention (Second Edition).  Peg Dawson and Richard Guare.