ADHDtheDiagnosis
A common triad HID or hyperactivity, impulsivity and distractibility will be used to demonstrate the principles of diagnosis using a simple screening tool to rule in and to rule out other biologically based mental health disorders.
This common symptom cluster of Hyperactivity-Impulsivity-Distractability or "HID" is often over diagnosed as classic ADHD with the wrong medication being used. This delays the early and adequate treatment of the primary disorder, with only non specific relief of symptoms without actually treating their cause, while the primary disorder worsens and may develop complications. Recognizing the other symptoms of the other common disorder will aid in their proper diagnosis, and proper choice of medication.
The Triad of Hyperactivity-Impulsivity-Distractibility [HID]:
a) Hyperactivity- more activity then expected for developmental age or situation, often fidgets, squirms, can’t sit still, runs/climbs excessively, talks excessively
b) Impulsivity- not thinking about consequences before doing, speaking, or further thinking, blurts out answers, has difficulty awaiting turn, interrupts or intrudes on others
c) Distractibility-poor concentration on boring things when left alone for 15 minutes, lacks attention to details, makes careless mistakes, is easily distracted, does not seem to listen, has problems organizing tasks, avoids complicated tasks, loses things
These symptoms must 1. cause distress or impairment, 2. be present for at least six months, 3. should be sustained and continuous, not occurring in episodes, and 4. not better accounted for by another disorder, a. general medical conditions like sleep apnea, thyroid, diabetes, lead intoxication, others, b. drugs like anti convulsants , for allergies, asthma, and other, c. substances of abuse ,street drugs and alcohol, d. environmental factors like learning problems or stresses like abuse , neglect, family violence verbal or physical, e. over stimulation by TV, computer use, other audio visual multimedia experience.
Use the following symptom list to screen for other disorders and causes: A more comphrensive screen is available at ProSymptomScreenExpanded
Read each item carefully, then 1. CHECK IF the Number APPLIES, THEN 2. CIRCLE the Specific Item to Clarify
1. [ ] Hyperactive, overly active, on the go, can’t sit still, and/or an inner sense of restlessness
2. [ ] Distractible, Sometimes? Mostly? Can’t concentrate, pay attention on boring stuff, for 15 minutes
3. [ ] Impulsive, doesn’t stop and think of consequences before talking or doing, or further thinking
4. [ ] Delay or improper use of language, play-pretend get stuck on one idea over, especially sexual, violent
5. [ ] Poor eye contact, doesn’t seem to get social things like greetings, jokes, sorrows, need to love, to grieve
6. [ ] Gets angry/fearful to change in routines ,sensitivities to, sound, touch, light, taste, smells, foods
7. [ ] Colicky as infant, presently unpleasant, irritable, nasty, mean, severe tantrums, bossy, the bully
8. [ ] Severe separation anxiety, frequent school absences, migraines, headaches, frequently ill, always sick
9. [ ] Short fuse, easily made angry, can’t calm self down within 20 min, severe temper, rage attacks
10. [ ] Mood swings, unpredictable, ups and downs of feelings, driven by moods, Dr Jekle & Mr.Hyde,
11. [ ] Can’t control anger, breaking things, self mutilating, dangerous to others, talks about killing others
12. [ ] Unaware of time, place, who you are, dazed, lost in time, confused, sleep like, or trance like states
13. [ ] Hurting self, cuts self, punches things, talk of suicide, being better off dead, dangerous to self
14. [ ] Sleep difficulties, sleeps too much/ too little, wakes up, dreams seem real, nightmares, wets bed,
15. [ ] Talks too much, too fast, not logical, difficult to follow, talks in circles, doesn’t always makes sense
16. [ ] Feeling sad, crying, saying negative things, not normal self, easily bored, things are less fun, isolates self
17. [ ] Excessive eating, especially in evening, waking up after asleep and eating, eats to calm down
18. [ ] Overly suspicious, holds grudges paranoid, thoughts seem like voices, odd, bizarre, strange, weird
19. [ ] Too worried, afraid to do things, go places, shy, stage fright, panic attacks, heart beats fast, sweats easily
20. [ ] Excessive eye blinking, facial movements, throat clearing, sniffing, snorting, coughing,
21. [ ] Does things over and over, rituals, touching, counting, hand washing, ordering, putting things in sequence
22. [ ] Over use or can’t stop TV, video games, computer time, food, exercise, using drugs, alcohol, tobacco
23. [ ] Trouble in reading, spelling, math, other learning problems, speech, stuttering, co ordination difficulties
24. [ ] Witnessed domestic violence, victim of neglect, physical and/or sexual abuse, natural catastrophe
25. [ ] Cruel to animals, cruel to people, nasty, mean, seems to lack conscience, no or little remorse, guilt, shame
Stimulant responsive uncomplicated ADHD : ADHD by definition should not be accompanied by any significant disturbance medically, environmentally or other psychiatric disturbance of thinking, relatedness, behavior including sever aggressive behavior, mood instability , depression, anxiety, or any movement –impulse disorder. If these are present as shown by doing a symptom-problem screen as above, or as determined by individual and family history, then either the primary diagnosis is not ADHD or it ADHD plus another disorder that should likely be treated first, for the ADHD triad of HID may respond. Then if needed the “core” HID of ADHD may be treated with a stimulant .
Making the Diagnosis with other Mental Health Disorders with HID: It is best to rule in or rule out the other disorders and causes before assuming the HID symptom cluster is stimulant responsive uncomplicated ADHD. This is done by taking a individual and family history and finding out if the symptoms fit that of the other disorders as presented below, and determining if the HID can be better explained by that primary disorder. Often multiple medication trials may be needed to confirm the diagnosis, and to adequately treat the primary Dx so the HID is effectively treated, and not just symptomatically “patched up” with a stimulant of other ADHD type medication.
Medication Choice: The Medication Of Choice [MOC] for the primary disorder should be used first. This will also treat the HID, if not two disorders may be present, in that case then a stimulant or other ADHD medication is added.
1) Unstable Atypical Mood-Bipolar Type of Mood Disorder: HID plus mood swings, irritability, anger outburst, rage attacks, sad to glad to mad, big unrealistic ideas, need to be the boss, the bully, need little sleep, fast talker, too many ideas, difficult to live with, walking on egg shells, Dr Jeckle & Mr. Hyde. [MOC]- mood stabilizers, neuroleptics, [Risperdal, Abilify, Seroquel, Geodon, Zyprexa, Thorazine, Haldol, Trilafon, Prolixin] anticonvulsants [Depakote, Tegretol, Lamictal], and Lithium. Unstable Mood Scales Historical Markers, Treatment Scale, Symptom Picutre ,Childhood Bipolar and Atypical Mood Disorders Q and A, Bipolar and Unstable Mood Disorders
2) Stable Unipolar Depressive Type Mood Disorder: HID plus sad, depressed stable mood, lack of pleasure, little to no interest in things, tired, fatigue, mind slow, hard to think, negative about self, past, present , and future, hopeless, better off dead. [MOC]- SSRI/NRI’s [Prozac, Zoloft, Paxil, Luvox, Celexa, Lexapro, Cymbalta, Effexor], tricylic antidepressants [ imipramine, amitryptilene].Depression which is it, Unipolar or the unstable Bipolar type, Q and A, Unipolar Stable Depressive Disorders Q and A, WarningAntiDepressants, AntiDepressantWorsenSymptoms
3) Generalized or Other Anxiety Disorder: HID plus worried too much about past , present , and future, tense, keyed up, easily fatigued, panic attacks, fears, phobias, shy, avoids things, afraid to sleep or be alone, trouble going and staying in places like school, rituals like hand washing, counting, sequencing, ordering, getting things just right. [MOC]- SSRI/NRI’s, benzodiazepines [ Valium, Xanax, Klonopin]
To help tell these three apart go to link that has a useful screen of Unstable Mood vs Unipolar or stable Mood-Depression vs Anxiety Disorders at MoodAnxietyScreen
4) Tourette’s or Other Tic Disorder: HID plus motor movements around eyes like blinking, twitches of nose, face, neck, shoulders, sounds like snorting , sniffing, throat clearing, coughing. [MOC]- is a neuroleptic. Check out this link: TouretteTicDisorders
5) Thinking- unusual “Relatedness” and Schizophreniform : HID plus, blunted, shallow, inappropriate emotions, loss of interest, drive, motivation & ambition, little or disorganized speech, odd, peculiar, strange, paranoid behavior, loaner, isolates self, in their own world, voices, visions. [MOC]- is neuroleptic.
6) The “Atypical Child-Person”: having history of uneven development, not fitting in any other group having features of more than one if not many, including with a presentation that could at first appear to be uncomplicated ADHD. “Atypical” people often have very atypical and unusual and sensitive, brain chemistry which requires very careful and multiple medication trials to confirm their biochemical sensitivities good and negative. The rule of starting low and going slow applies and often very low doses of multiple medications may be needed, sometimes continuously often episodically. This group and the younger person with an unstable mood disorder often show medication “resistance” and “tolerance” due to shifting and developmentally changing brain chemistry issues.The Atypical Child-Person a proposed special diagnositic entity.
7) Classic ADHD-Attention Deficit Hyperactivity Disorder: HID plus no mood swings & aggression, no depression or loss of interest, no worry & anxiety, no motor/vocal tic-sounds, no thinking or unusual relatedness , not an “Atypical Child”. Medication of Choice [MOC]-stimulant like Adderal, Dexedrine, Focalin, Ritalin, Metadate, Concerta, Daytrana, Vyvanse
If your relatively sure you may be dealing with Uncomplicated Classical ADHD go to, ADHD Fact Sheet, which also has a good overview on stimulant medication, ADHD and Meditation and for more diagnostic clarification between a common cluster of problems that all may be present simultaneously see ODD,ADHD or Mood