Attention-Deficit/Hyperactivity Disorder (ADHD), previously called Attention-Deficit Disorder (ADD), is a widely known disorder diagnosed primarily in childhood. It’s most recognized characteristic in pop culture is hyperactivity. While hyperactivity can be a symptom of ADHD, the disorder is much more complex than this one symptom. In order for a child to be diagnosed with ADHD, there are a cluster of symptoms, some very different than hyperactivity, that must be present.
Types of ADHD
There are three types of ADHD:
1. ADHD-Predominantly Inattentive Type
Some of the common symptoms of the Predominantly Inattentive Type ADHD include the following:
At least six of the following symptoms have been persistent for at least 6 months:
- Makes careless mistakes or doesn’t give enough attention to details in schoolwork or other activities
- Has problems maintaining attention on assignments or play activities
- Doesn’t seem to listen when being spoken to directly
- Doesn’t seem to follow through on instructions and fails to finish tasks (not due to oppositional behavior or misunderstanding the instructions)
- Has difficulty organizing activities
- Often loses things needed for activities (bookbag, books, pencils, assignments, worksheets, etc;)
- Easily distracted
- Forgetful in day-to-day activities
2. ADHD-Predominantly Hyperactive Type
Some of the common symptoms of the Predominantly Hyperactive Type ADHD include the following:
At least six of the following symptoms have been persistent for at least 6 months:
- (Hyperactive symptoms)
- Fidgety with hands and feet; has difficulty sitting still
- Will leave seat in a classroom or in other situations in which remaining seated is expected
- Runs or climbs in inappropriate situations
- Problems playing quietly
- Seems like child is constantly “on the go” or being “driven by a motor”
- (Impulsive symptoms)
- Will shout out answers before question has been completed
- Has difficulty waiting to take a turn
- Will interrupt or intrude on others
3. ADHD-Combined Type
Symptoms of the combined type include at least six of the inattentive symptoms AND six of the hyperactive/impulsive symptoms persistently for six months.
Common Mistakes in Diagnosing ADHD
Many times children are first identified as having ADHD symptoms when they enter a structured environment, such as preschool or even Sunday school classes. It is important to note that ADHD should not be diagnosed before a child turns four or five years old. This is because children before five years of age developmentally are more likely to test limits, not know how to behave in structured environments, not follow rules well, and be more boisterous and active. Until they reach pre-school age, they are not able to, nor should they be expected to follow the rules of the structured environment required in a classroom. In order for a child to be diagnosed with ADHD some symptoms must be present before seven years of age.
Diagnosing should never be done by people without at least a master’s degree in the mental health field. Many teachers will label a child as ADHD due to classroom behavior. (This is not a slam on teachers-they are under-resourced, under-supported, and under-paid and are expected to juggle many different issues in the classroom for which they are not appropriately trained or prepared.) This is why in order to be diagnosed with ADHD a child must have symptoms present in more than one setting (at home, at school, at church, or at work, etc;). If a child is only showing symptoms of hyperactivity in the classroom, he/she cannot be given the diagnosis of ADHD and other causes to the issues must be explored.
As with any other disorder, the symptoms being displayed must be causing significant trouble in the various settings. There are many times when symptoms may be present, but not causing substantial distress. Children will go through phases when they are bored with their schoolwork and may exhibit inattentive symptoms. If the child’s grades do not fall and their behavior is not causing trouble in the various settings, the child should not be diagnosed with ADHD. There are also times when children may exhibit hyperactive/impulsive behaviors. They may simply be testing the limits or bored as well, and should not be diagnosed as ADHD unless there is significant impairment and/or disruption across the various settings.
When diagnosing ADHD, the symptoms should be cross checked with other common disorders. Some of the symptoms listed above may also be seen in children with mental retardation, oppositional behavior, pervasive developmental disorder, or a psychotic disorder.
Causes of ADHD
There are quite a few debates in the research on the causes of ADHD and an exact cause is unknown. Some studies show there may be a biological component, with ADHD being more common in first-degree biological relatives of children with ADHD. [i] Other studies show that a mother’s behavior when she is pregnant (cigarette smoking, alcohol and drug use) may increase the child’s risk for developing ADHD. A child’s brain structure (areas that function differently or develop more slowly) and brain chemistry (dopamine and norepinephrine activity) have also been shown to be involved in cases of children with ADHD.
There are also debates in both research and pop culture regarding whether or not ADHD is over-diagnosed. There are a few reasons why we may be hearing more about this disorder. Science has gotten better at early detection. We have more media outlets that educate us on these disorders (thousands of internet websites, numerous daily TV news programs, etc;). These types of issues are the reasons you should contact a trained professional if you suspect someone you know has enough symptoms for a diagnosis of ADHD.
If you’re struggling with your children who have already been diagnosed with ADHD or would like to get an accurate assessment of your child, Lotus Group provides family counseling services and will be able to assist you as you take care of your family’s needs and challenges. In our next articles we’ll share the treatment options available for childhood ADHD.
[i] Majority of the information presented to this point has been taken from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV), (1994).