pediatrics
Attention Deficit Hyperactivity Disorder (ADD, ADHD)
Diagnosis of ADHD
Clinical criteria based on the DSM-5 Diagnosis of ADHD is clinical and is based on comprehensive medical, developmental, educational, and psychologic evaluations (see also the American Academy of Pediatrics'2019 clinical practice guidelinefor the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents). DSM-5 diagnostic criteria include 9 symptoms and signs of inattention and 9 of hyperactivity and impulsivity. Diagnosis using these criteria requires ≥ 6 symptoms and signs from one or each group. Also, the symptoms need to Be present often for ≥ 6 months Be more pronounced than expected for the child’s developmental level Occur in at least 2 situations (eg, home and school) Be present before age 12 (at least some symptoms) Interfere with functioning at home, school, or work Inattention symptoms: Does not pay attention to details or makes careless mistakes in schoolwork or with other activities Has difficulty sustaining attention on tasks at school or during play Does not seem to listen when spoken to directly Does not follow through on instructions or finish tasks Has difficulty organizing tasks and activities Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort over a long period of time Often loses things necessary for school tasks or activities Is easily distracted Is forgetful in daily activities Hyperactivity and impulsivity symptoms: Often fidgets with hands or feet or squirms Often leaves seat in classroom or elsewhere Often runs about or climbs excessively where such activity is inappropriate Has difficulty playing quietly Often on the go, acting as if driven by a motor Often talks excessively Often blurts out answers before questions are completed Often has difficulty awaiting turn Often interrupts or intrudes on others Diagnosis of the predominantly inattentive type requires ≥ 6 symptoms and signs of inattention. Diagnosis of the hyperactive/impulsive type requires ≥ 6 symptoms and signs of hyperactivity and impulsivity. Diagnosis of the combined type requires ≥ 6 symptoms and signs each of inattention and hyperactivity/impulsivity. Differentiating between ADHD and other conditions can be challenging. Overdiagnosis must be avoided, and other conditions must be accurately identified. Many ADHD signs expressed during the preschool years could also indicate communication problems that can occur in other neurodevelopmental disorders (eg, Autism Spectrum Disorders ) or in certain Clinicians should consider whether the child is distracted by external factors (ie, environmental input) or by internal factors (ie, thoughts, anxieties, worries). However, during later childhood, ADHD signs become more qualitatively distinct; children with the hyperactive/impulsive type or combined type often exhibit continuous movement of the lower extremities, motor impersistence (eg, purposeless movement, fidgeting of hands), impulsive talking, and a seeming lack of awareness of their environment. Children with the predominantly inattentive type may have no physical signs. Medical assessmentis focused on identifying potentially treatable conditions that may contribute to or worsen symptoms and signs. Assessment should include seeking a history of prenatal exposures (eg, drugs, alcohol, tobacco), perinatal complications or infections, central nervous system infections, traumatic brain injury, cardiac disease, sleep-disordered breathing, poor appetite and/or picky eating, and a family history of ADHD. Developmental assessmentis focused on determining the onset and course of symptoms and signs. The assessment includes checking developmental milestones, particularly language milestones, and the use of ADHD-specific rating scales (eg, theVanderbilt Assessment Scale, the Conners Comprehensive Behavior Rating Scale, the ADHD Rating Scale-V). Versions of these scales are available for both families and school staff, allowing assessment across different situations as required by DSM-5 criteria. Note that scales should not be used alone to make a diagnosis. Educational assessmentis focused on documenting core symptoms and signs; it may involve reviewing educational records and using rating scales or checklists. However, rating scales and checklists alone often cannot distinguish ADHD from other developmental disorders or from behavioral disorders. 