Attention Deficit/Hyperactivity Disorder Diagnosis

  • Diagnosis

    Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder that begins in childhood, and is characterized by a persistent pattern of inattention, impulsivity, and hyperactivity. ADHD is one of the most commonly diagnosed psychiatric disorders in children and adolescents. ADHD is thought to affect about 9.2% of boys and 2.9% of girls who are of school age. While it is estimated that about 2% of adults also suffer from ADHD, the condition often goes unrecognized in adults.

    People with ADHD have many symptoms, including extreme inattentiveness and/or impulsiveness and hyperactivity. Many people with ADHD continue to have symptoms throughout life.

    ADHD runs in families, and seems to have a strong genetic component.

    Scientists are not sure what happens in the brain to cause ADHD. One study found that children with ADHD have symptoms similar to those seen in adults with damage to the part of the brain largely responsible for emotions and personality (frontal lobes). Therefore, it is thought that the frontal lobes or related structures may be involved with ADHD Figure 01. Other studies evaluating blood flow or energy use in the brain have also found evidence of brain dysfunction among people with ADHD.

    Click to enlarge: Frontal lobes of the brain

    Figure 01. Frontal lobes of the brain

    ADHD is characterized by inattentive, hyperactive, or impulsive behavior that begins during childhood. ADHD is characteristically diagnosed in children under the age of seven, although the disorder can be present in adolescents and adults as well. Individuals with ADHD often seem to be disorganized or preoccupied. They may be poor listeners, and frequently change the subject or become distracted by unimportant interruptions. Individuals with ADHD may appear to be impatient, interrupting others frequently, or blurting out tactless comments. Some impulsive people engage in high-risk sports or other activities. While similar symptoms can occur in normal children and adults, people with ADHD show a persistent pattern that is more frequent and more severe than that of others in the same age group.

    Some people with ADHD have mostly inattentive symptoms, while others exhibit mostly hyperactive and impulsive behavior. Most people with ADHD have features of both subtypes Table 01. Inattention may manifest itself as carelessness at work or at home, or difficulty completing projects. Individuals with ADHD often seem to be disorganized or preoccupied.

    Hyperactivity can manifest as fidgetiness or an inability to engage in tasks or leisure activities that require a person to sit still. People with these symptoms often seem to be “on the go.” Hyperactive people sometimes describe having accelerated or multiple thoughts at the same time.

    Table 1.  Symptoms of ADHD by Subtype

    Inattentive Hyperactive/impulsive
    Fails to pay close attention to details or makes careless mistakes Fidgets with hands or feet or squirms in seat
    Has difficulty sustaining attention Leaves seat in situations where remaining seated is expected
    Does not seem to listen Runs about or climbs excessively (in adults, may be limited to feelings of restlessness)
    Does not follow through on instructions and fails to finish tasks Has difficulty paying attention or engaging in leisure activities quietly
    Has difficulty organizing tasks and activities ?On the go? or acts as if ?driven by a motor?
    Avoids or dislikes tasks that require sustained mental effort Talks excessively
    Loses things necessary for tasks or activities Blurts out answers before questions completed (impulsivity)
    Easily distracted by extraneous stimuli Has problems waiting turns (impulsivity)
    Forgetful in daily activities Interrupts or intrudes on others (impulsivity)

    Other troubling features are commonly seen in individuals with ADHD Table 02. Possibly as a result of frequently being “in trouble” or regarded as lazy, many people with ADHD have low self-esteem. They may have a low tolerance for frustration, and have frequent temper outbursts and mood changes. Some very impulsive people become “class clowns.” More troubling consequences of ADHD include possible drug abuse and conduct disorder, often involving anti-social behavior and skirmishes with the law.

    Table 2.  Learning/Behavior Problems In Children or Adolescents with ADHD

    Possible problems identified by parents/family members Possible problems identified by school personnel Possible problems identified by patients
    Noncompliance Fidgety, restless behavior Dislike of school
    Aggression Hyperactivity Lack of close or long-term friendships
    Anger management problems Fidgety, restless behavior Frustration with certain teachers or subjects
    Impulsivity Inattention, off-task behavior, distractibility Excessive conflict with parents
    Engaging in physically dangerous activity Social interaction problems (impulsivity, intrusiveness) Low self-esteem
    Task completion difficulty Underachievement, school failure ?
    Disorganized, messy Disruptive classroom behavior
    Appearing ?spaced out? or ?zoned out? Excessive talking, blurting out answers
    Changeable moods Poor listening
    Absent-mindedness Incomplete, missing homework
    Social/emotional ?immaturity? Messy, disorganized work
    ?Hyper,? ?in constant motion?

    ADHD is more common in boys than in girls.

    ADHD tends to run in families

    A doctor will ask the patient and family members or teachers about noticeable symptoms of ADHD, including information about trouble at work or school. As children or teenagers with ADHD often fail to report their symptoms completely or accurately, it is important for the doctor to gather information from family members and teachers as well. The doctor will ask about personal relationships both inside and outside the home, and work or study habits.

    Adults often lack insight about their own symptoms, and should also bring along their spouse, significant other, or other family members to provide additional information.

    To be diagnosed as such, ADHD must be severe enough to adversely affect the person in at least two settings, such as at school, at home, in social groups, or in the workplace.

    Because psychiatrists define ADHD as a disorder that must have been present since before the age of seven, it is difficult for doctors to diagnose ADHD in adults.

    A diagnosis in adults is based on a recollection of symptoms from childhood and current symptoms. Old school records and reports from other family members may help confirm the childhood diagnosis.

  • Prevention and Screening

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