Does My Child have ADHD?

As a mother and psychologist, one of the questions I get asked most is, "Does my child have ADHD?" Perhaps your 12 year old son’s grades have dropped, and his teachers report that he cannot seem to remain on task. He talks incessantly, and seems to switch frequently from topic to topic. He complains that he finds his schoolwork boring and cannot focus. He’s also notorious for losing his schoolwork or other important items.

The answer to whether he suffers from an attention disorder is quite complex. Attention-Deficit/Hyperactivity Disorder is a diagnosis reserved for individuals with a disorder of the parts of the brain controlling attention, impulse control, and activity. As many already know, this disorder is often over-diagnosed and the medications used to treat this disorder over-prescribed. The truth is, the diagnosis of Attention-Deficit/Hyperactivity Disorder requires a complete psychological evaluation, including the administration of psychometrically sound assessment instruments. Even adults can suffer from this disorder and benefit from treatment of its symptoms.

What are the Diagnostic Criteria for ADHD?

According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) (2000), the diagnostic criteria for Attention-Deficit/Hyperactivity Disorder are as follows. Please note that the DSM-IV-TR is not a collection of symptom checklists, but is rather a guideline for mental health professionals with specialized clinical training in assessment to use in diagnosing a mental disorder. It is not possible to self-diagnose any mental disorder.

A. Either (1) or (2):
(1) inattention: six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
(b) often has difficulty sustaining attention in tasks or play activities
(c) often does not seem to listen when spoken to directly
(d) often does not follow through on instructions and fails to finish school work, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
(e) often has difficulty organizing tasks and activities
(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
(g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
(h) is often easily distracted by extraneous stimuli
(i) is often forgetful in daily activities

(2) hyperactivity-impulsivity: six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Hyperactivity
(a) often fidgets with hands or feet or squirms in seat
(b) often leaves seat in classroom or in other situations in which remaining seated is expected
(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
(d) often has difficulty playing or engaging in leisure activities quietly
(e) is often "on the go" or often acts as if "driven by a motor"
(f) often talks excessively

Impulsivity
(g) often blurts out answers before questions have been completed
(h) often has difficulty awaiting turn
(i) often interrupts or intrudes on others (e.g., butts into conversations or games)

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorders, or a Personality Disorder).

Note that the “hyperactivity” component is not required for the diagnosis. Many individuals suffer from inattention without symptoms of hyperactivity.

The Importance of the “Rule-Out”

One of the most important steps in diagnosing ADHD is "ruling out" other disorders that can have some of the same features. Oppositional Defiant Disorder, for example, can look a lot like ADHD, as can Obsessive-Compulsive Disorder, anxiety disorders, impulse-control disorders, depressive disorders, learning disabilities, and Conduct Disorder. Even a gifted child can appear to suffer from inattention in the wrong academic environment. It is crucial to get the proper diagnosis to avoid treating the wrong problem and possibly worsening the symptoms. I have often evaluated a child or teen for ADHD on the parent's request and learned that the child actually has another disorder.

How is ADHD Treated?

Medication is not the only option for ADHD, although many people with this disorder report significant improvement in their symptoms with medication. There is some evidence that certain nutritional changes can alleviate the symptoms. Individual and family counseling is sometimes needed to help cope with the disorder. Relaxation techniques can also be helpful. Changes in the way the child approaches homework and studying can be of tremendous help, as individuals with ADHD often learn better in short study sessions. A meeting with teachers and other school personnel can be useful to negotiate classroom accommodations.

Where Do I Go to Get My Child Evaluated?

A sound evaluation with a psychologist experienced in this disorder is the first step with attention problems. A psychologist can help arrive at the proper diagnosis, aid in treatment planning, refer to a physician for any needed medications, and can serve as a liaison between the parents and the school.