ADHD-What is it?

9 Apr

There has been lots of news this week about ADHD…reports and studies have shown increasing rates in children and teenagers as well as news about how many cases of ADHD persist into adulthood.

So, what is ADHD?

ADHD stands for attention deficit hyperactivity disorder.

There are 3 core symptoms of ADHD:

1) Inattention

2) Impulsivity

3) Hyperactivity

Inattention

Inattention can present itself in many ways.  Some of the most common complaints that I hear about are daydreaming, forgetting assignments and inability to complete a short list of chores at home.

Often children who mostly have inattention do not become recognized until they are older because they are not the ones causing all kinds of problems in the kindergarten classroom.  They will often skirt by making OK grades and not getting in trouble until they get a little older and the requirements to sit still and complete assignments on their own increase in the 2nd-3rd grade.

Impulsivity

Do you know that split second where you think about telling someone off but you stop yourself?  Or you think about driving 100 mph because you’re running late but don’t because you realize it will be dangerous?  That split second is another thing that children with ADHD are lacking.  They push right through that pause and act before thinking about the consequences of their action.

The best summary for this problem is that they lack the ability to determine if the upcoming action is: safe or appropriate for time and place.

Hyperactivity

The hyperactive symptoms are the ones that most people (even strangers) will notice about children with ADHD.  They are not even necessarily bad kids, it’s simply that they have a significant struggle with staying seated, staying still when seated and not talking out of turn.  These symptoms are usually noticed by 4 years of age and progressively worsen until about 7 years.

ADHD Subtypes

There are 3 major types of ADHD and they are characterized by which of the core symptoms your child demonstrates: predominately inattentive, predominately hyperactive-impulsive and combined.

Diagnosis

The diagnosis of ADHD can be made by multiple practitioners: pediatricians, psychologist, psychiatrists and some counselors are trained to diagnose ADHD.  I prefer to make my own diagnosis in my clinic unless the case is particularly challenging or there is something complex about the presentation.

There are many different modalities that can be used to diagnose ADHD but it is mostly made by parental history, teachers reports and screening scales.  I prefer to use the Vanderbilt scale but there are many other scales out there that can be used.

Diagnostic Criteria

Diagnostic criteria for ADHD start at age 4 so younger children are generally not diagnosed with ADHD.  This is due in part to the complexity of trying to decide what is normal and what is hyperactive or inattentive for a child younger than 3.

The following criteria are used:

1) Be present in more than 1 environment (home and school)-this is important because children who have issues only at home or only at school are usually having more of a problem with the structure at one place than actually having a tendency towards ADHD

2) Be present for more than 6 months

3) Be present before age 7-this is becoming more of a problem as adolescents and adults are becoming more aware of the problem but demonstrating that there were symptoms prior to age 7 can be difficult

4) Impair function-see below

5) Be excessive for the developmental level of the child

Impair Function

My main point when I am discussing a child’s ADHD with the family is focused upon this aspect of the diagnosis and treatment.  For most children, impairment of function means that they are not progressing through school appropriately, are in trouble at school regularly for hyperactive or impulsive behaviors or have difficulty performing regular function at the house because of their ADHD.

As I work on treatment, I also discuss regularly how the child is functioning in home and school.  I am not aiming for perfection and this should never be the goal.  Improving function to a tolerable level for the parties involved (child, parents, teachers) while avoiding any side effects from treatment is the goal.

Here is the full table of contents for the ADHD Series:

ADHD-What is it?

ADHD Behavioral Treatment-8 Tips

ADHD-Medical Management Concepts

ADHD-Medication Types and My Thoughts

Preschool Child with ADHD Symptoms

Why Is ADHD On The Rise?-My Opinions

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One Response to “ADHD-What is it?”

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  1. ADHD Behavioral Treatment-8 Tips | DoctorJSmith - April 11, 2013

    […] ADHD-What is it? […]

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