04/07/2022
Neurodevelopmental Disorders III
Attention Deficit Hyperactivity Disorder(ADHD)
Children with attention-deficit/hyperactivity disorder (ADHD) have great difficulty attending to tasks or behave over actively and impulsively, or both. About half of the children with ADHD also have learning or communication problems; many perform poorly in school; a number have difficulty interacting with other children, and about 80 percent misbehave, often quite seriously. The children may also have great difficulty controlling their emotions, and some have anxiety or mood problems
There are two features of ADHD:
1. Inattention and Disorganization Entail:
Inability to stay on task, seemingly not to listen
Losing materials
At levels that are inconsistent with age or developmental level
2. Hyperactivity-Impulsivity Entails:
Over-activity
Fidgeting,
Inability to stay seated, particularly in a structured environment
Intruding into other people's activities
Inability to wait
Symptoms that are excessive for age
If all the symptoms interfere with functioning or development, as characterized by Inattention and/or 6 (or more) symptoms for at least 6 months, the individual will be diagnosed with ADHD. ADHD is a difficult disorder to assess properly. Ideally, the child’s behavior should be observed in several environments (school, home, with friends) because the symptoms of hyperactivity and inattentiveness must be present across multiple settings for ADHD to be diagnosed.
It negatively impacts directly on social and occupational functioning and academic functioning of the child.
Diagnostic Criteria:
Following is the diagnostic criteria of Attention Deficit Hyperactivity Disorder (ADHD):A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):
Diagnostic Criteria: (In continuation to the prev
Inattention:
Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
Note:
The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required.
Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).
Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).
Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlinesOften avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).
Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).
Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills,
Hyperactivity and impulsivity:
Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:
Note:
The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required.
Often fidgets with or taps hands or feet or squirms in seat.
Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).
Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.)
Often unable to play or engage in leisure activities quietly.
Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).
Often talks excessively.
Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).
Often has difficulty waiting his or her turn (e.g., while waiting in line).
Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).
Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.
C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).
D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).
Other than the previously discussed symptoms i.e. inattention and hyperactivity, duration and age of onset, the following must also be looked upon:
We need to specify if:
The child is with combined presentation i.e. both attention deficit and hyperactivity
The child is with predominantly inattentive presentation
The child is with predominantly hyperactive/impulsive presentation
It also needs to be specified if the condition/disorder is in partial remission. When full criteria were previously met, fewer than the full criteria have been met for the past 6 months, and the symptoms still result in impairment insocial, academic, or occupational functioning.
Severity:
Along with all previously discussed elements, the severity of the problems also needs to be specified as per followings:
Mild: Few, if any, symptoms are there
Moderate: Symptoms between “mild” and “severe” are present
Severe: Many symptoms are present