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DSM-IV Criteria for ADHD
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
1) ADHD, Combined Type: if both criteria 1A and 1B are met for the past 6 months
2) ADHD, Predominantly Inattentive Type: if criterion 1A is met but criterion 1B is not met for the past six months
3) ADHD, Predominantly Hyperactive-Impulsive Type: if Criterion 1B is met but Criterion 1A is not met for the past six months.
Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:
1) Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2) Often has trouble keeping attention on tasks or play activities.
3) Often does not seem to listen when spoken to directly.
4) Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5) Often has trouble organizing activities.
6) Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7) Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8) Is often easily distracted.
9) Is often forgetful in daily activities.
Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:
1) Often fidgets with hands or feet or squirms in seat.
2) Often gets up from seat when remaining in seat is expected.
3) Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4) Often has trouble playing or enjoying leisure activities quietly.
5) Is often "on the go" or often acts as if "driven by a motor".
6) Often talks excessively.
Impulsivity
7) Often blurts out answers before questions have been finished.
8) Often has trouble waiting one’s turn.
9) Often interrupts or intrudes on others (e.g., butts into conversations or games)
1. Some symptoms that cause impairment were present before age 7 years see discussion below on incidence and under diagnosis.
2. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
3. There must be clear evidence of significant impairment in social, school, or work functioning.
4. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
· Not a blood test, psychological test, computer test nor brain imaging test that can make the diagnosis – See Note 1 NIH Studies
· Significant impairment – ability to function in daily life
o Severity. The behavior in question must occur more frequently in the child than in other children at the same developmental stage.
o Early onset. At least some of the symptoms must have been present prior to age 7.
o Duration. The symptoms must also have been present for at least 6 months prior to the evaluation.
o Impact. The symptoms must have a negative impact on the child’s academic or social life.
o Settings. The symptoms must be present in multiple settings.
· Even with the diagnosis, there may be some activities that individuals can concentrate and focus on when interested, such as playing video games or sports
· NOT, however, a will power problem, laziness or lack of motivation
Name Change--- some confusion -ADD recognized for 100 years -1994 Name changed to Attention Deficit/Hyperactivity Disorder,….(with a comma –for subtype
· ADHD, Predominantly Inattentive:
· Recognition that there are children with problems paying attention but not hyperactivity/impulsive symptoms
· Not diagnosed as early AD/HD with hyperactivity (which is more disruptive).
· May appear withdrawn.
· Display "internalizing" problems, such as depression and anxiety
· Often noticed when academic workload increases in middle and high school.
Incidence- (National Resource Center on AD/HD)
One girl for every three boys in childhood
In adults – 1: 1 ratio
Suggests girls have not been as recognized – disruption, calling attention, gender stereotypes
In Understanding Girls with AD/HD By Kathleen Nadeau, Ph.D., Ellen Littman, Ph.D., & Patricia Quinn, M.D. they suggest as many as 50% to 75% of girls with the disorder are missed.
ADHD, Predominantly Inattentive Type: --most common
In the article “Prevalence, Recognition, and Treatment of Attention-Deficit/Hyperactivity Disorder in a National Sample of US Children,” which appeared in the September 2007 edition of Archives of Pediatrics & Adolescent Medicine.
* Total Sample - 3082
* AD/HD all types - 222
* Inattentive subtype – 95
* Combined type - 72
* Hyperactive-Impulsive type - 55
4.5 million children ages 3 to 17 (7%) with AD/HD
Children in poor health status are nearly 3 times more likely to have AD/HD (7% vs. 19%).
AD/HD diagnoses increased an average of 3% annually between 1997 and 2006.
· 2.05 million children between the ages of 5 to 11 have AD/HD (7.4%)
· 2.4 million children between the ages of 12 to 17 have AD/HD (9.7%)
· * White: 3.6 million children have AD/HD (7.6%)
· * Black or African American: 705,000 children have AD/HD (7.4%)
· * Hispanic or Latino: 602,000 children have AD/HD (5.1%)
By Family Structure:
· Mother and father: 2.5 Million children have AD/HD (5.9 %)
· Mother, no father: 1.6 Million children have AD/HD (11.1 %)
· Father, no mother: 226,000 children have AD/HD (8.6 %
· Neither mother nor father: 219,000 children have AD/HD (10.7 %)
Causes
· Neurological basis
· ADHD is not a disorder of attention “function of developmental failure in the brain circuitry that monitors inhibition and self-control. This loss of self-regulation impairs other important brain functions crucial for maintaining attention, including the ability to defer immediate rewards for later gain. (Barkley, 1998a)
· Heredity most important factor
· difficulties during pregnancy, prenatal exposure to alcohol and tobacco, premature delivery, significantly low birth weight, excessively high body lead levels, and postnatal injury to the prefrontal regions of the brain
(CHADD - Children and Adults with Attention-Deficit/Hyperactivity Disorder)
· Early identification important
· Consequences: school failure, depression, conduct disorder, failed relationships, and substance abuse
· Previously thought that children could outgrow AD/HD. Now realized that hyper activity may decrease but other symptoms persist.
· Problems at work
· Relationships
· Anxiety and depression
(CHADD - Children and Adults with Attention-Deficit/Hyperactivity Disorder)
Co Morbidity (July 2008 edition of Child and Adolescent Psychiatry and Mental Health)
Predominantly Inattentive subtype:
* 20.8% had Minor Depression/Dysthymia (MDDD)
* 20.8% Oppositional Defiance Disorder (ODD
* 18.6% Generalized Anxiety Disorder
Note: 2 – see hyperactive-impulsive subtype --
In predominantly hyperactive-impulsive subtype: 41.9% had ODD
RESOURCES
CHADD The nation's leading non-profit organization with 22,000 members. Serving the needs of individuals with AD/HD, CHADD provides research-based, evidence-based information about AD/HD to parents, educators, professionals, the media and the general public. www.chadd.org
The National Resource Center on AD/HD: A Program of CHADD has been established with funding from the U.S. Centers for Disease Control and Prevention (CDC) to be a national clearinghouse of information and resources concerning this important public health concern.
(2007 Centers for Disease Control and Prevention) Centers for Disease Control and Prevention (CDC) publication Vital and Health Statistics (PDF; September 2007)http://www.help4adhd.org/en/about/statistics?format=print
http://www.cdc.gov/nchs/data/series/sr_10/sr10_234.pdf
Barkley, R. A. (1990a). Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. New York: Guilford Press.
Barkley, R. A. (1990b). Comprehensive evaluation of attention deficit disorder with and without hyperactivity as defined by research criteria. Journal of Consulting and Clinical Psychology, 58, 775-789.
Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological Bulletin, 121:1, 65-94.
Barkley, R. A. (September, 1998a). Attention-deficit hyperactivity disorder. Scientific American, 279: 3.
Barkley, R. A. (1998b). Handbook of Attention Deficit Hyperactivity Disorder (2nd ed.). New York: Guilford Press.
“Attention Deficit Disorder Without Hyperactivity: ADHD, Predominantly Inattentive Type” Jennifer Wheeler, M.A., and Caryn L. Carlson, Ph.D. The University of Texas at Austin. Published by Learning Disabilities Association of California http://www.kidsource.com/LDA-CA/index.html
Understanding Girls with AD/HD By Kathleen Nadeau, Ph.D., Ellen Littman, Ph.D., & Patricia Quinn, M.D.)
http://www.addvance.com/index.html
The National Center for Girls and Women with AD/HD, 3268 Arcadia Place, NW Washington, DC 20015
A 1996 study conducted at the National Institutes for Mental Health (NIMH) found that the right prefrontal cortex (part of the cerebellum) and at least two of the clusters of nerve cells known collectively as the basal ganglia are significantly smaller in children with ADHD (as cited in Barkley, 1998a). It appears that these areas of the brain relate to the regulation of attention. Why these areas of the brain are smaller for some children is yet unknown, but researchers have suggested mutations in several genes that are active in the prefrontal cortex and basal ganglia may play a significant role (Barkley, 1998a quoted from Identifying and Treating Attention Deficit disorder: A resource for School and Home: Ideas that Work, U.S. Office of Special Education Programs) 2003.
Breakdown of co-occurring conditions by AD/HD subtype (Chadd)
In predominantly hyperactive-impulsive subtype:
* 41.9% had ODD.
* 22.2% GAD.
* 19.4% MDDD.
In combined subtype:
* 50.7% had ODD.
* 22.7% MDDD.
* 12.4% GAD.