Counseling Services of Barbara Reade, L.C.P.C.
Bel Air, Maryland 21014
Phone: 410-803-1510
Email: reade.lcpc@yahoo.com
ADHD
Recognizing ADHD
When properly diagnosed, the symptoms of ADHD can be treated and managed. Managing ADHD begins with knowing the signs that characterize it.
CHILDHOOD ADHD
According to the National Institutes of Health, ADHD is the most commonly diagnosed behavioral disorder of childhood. In fact, ADHD is estimated to affect up to 5% of school-age children. But sometimes it can be hard to know if a child's over-activity or inattention is normal for his or her age, especially because children with ADHD do the same things that other children do. An evaluation by a doctor can help clarify the causes, appropriate diagnosis and correct treatment for your child.
Diagnosing Childhood ADHD
Diagnosing ADHD can be difficult, and requires information from a number of sources, including parents, doctors and teachers. A proper diagnosis depends on the report of behavior characteristic to this disorder, input from the child, and a doctor's evaluation.
A positive diagnosis of ADHD, especially in children, requires:
- Symptoms of inattention and/or hyperactivity-impulsivity have been observed for at least six months. With ADHD, these symptoms will be more frequent and severe than typically seen in individuals at a comparable level of development.
- Some symptoms have been present before age seven.
- Symptoms have been present in at least two settings - for instance, at school and at home.
The symptoms have affected social or academic functioning. This means above all, the symptoms must be interfering with a child's daily functioning.
Diagnostic Criteria for ADHD
The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), lists the following symptoms for inattention and hyperactivity-impulsivity:
Symptoms of Inattention
1. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has difficulty sustaining attention in tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow through on instructions and fails to complete schoolwork, chores, or duties (not due to oppositional behavior or failure to understand instructions).
5. Often has difficulty organizing tasks and activities.
6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework).
7. Often loses things necessary for tasks or activities (toys, school assignments, pencils, books, or tools).
8. Is often easily distracted by extraneous stimuli
9. Is often forgetful in daily activities.
Symptoms of Hyperactivity/Impulsivity
1. Often fidgets with hands or feet or squirms in seat.
2. Often leaves seat in classroom or in other situations in which the child is expected to remain seated.
3. Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents and adults, may be limited to subjective feelings of restlessness).
4. Often has difficulty playing or engaging in leisure activities quietly.
5. Is often 'on the go' or often acts as if 'driven by a motor.'
6. Often talks excessively.
7. Often blurts out answers before questions have been completed.
8. Often has difficulty awaiting turn.
9. Often interrupts or intrudes on others (butts into conversations or games).
The first step in getting help for ADHD is making a correct diagnosis.
The information on this page is intended to help you identify behaviors and signs that may be consistent with ADHD. Talk to a doctor or psychotherapist, if you recognize any of these symptoms. He or she can help assess these symptoms more accurately and help guide you to correct treatment.
Diagnosis Subtypes
While most people with ADHD experience a combination of inattention and hyperactivity-impulsivity, in most cases, one symptom pattern may stand out. To make the distinction between symptoms, doctors classify ADHD diagnosis into three subtypes.
Predominantly Hyperactive-Impulsive
A person may be diagnosed 'Predominantly Hyperactive-Impulsive' if he or she has:
- Six (or more) symptoms of hyperactivity-impulsivity.
- Fewer than six signs of inattention, that have lasted at least six months. However, it is important to note that inattention may still be a significant feature.
Predominantly Inattentive
A person may be diagnosed as 'Predominantly Inattentive' if he or she has:
- Six (or more) symptoms of inattention.
- Fewer than six signs of hyperactivity-impulsivity, that have lasted at least six months.
Combined Type
A person may be diagnosed as the 'Combined Type' if he or she has:
- Six (or more) symptoms of hyperactivity-impulsivity.
- Six (or more) signs of inattention, that have lasted at least 6 months.
Most children and adolescents with ADHD are diagnosed as the 'Combined Type.'
Four Signs
Medical help may be needed if inattention or hyperactivity is causing significant problems at home, in school, and with relationships. Talk to your doctor if you have observed these behaviors. He or she can evaluate your child and determine the right course of treatment. In identifying ADHD, doctors often look for four major signs. William Sears, M.D., and Lynda Thompson, Ph.D. describe the four signs as follows:
- Selective Inattention - Instead of maintaining a relatively even attention span, children with ADHD fluctuate between inattention and hyperfocusing - showing extended concentration on things like video games, TV, or something that is of particular interest to them.
- Distractibility - A child quickly jumps from one idea or activity to the next, often without completing the thought or task. The child may also 'daydream' when you are talking to him or her.
- Impulsivity - A child with ADHD often acts without thinking, says things repeatedly, or makes careless errors on schoolwork.
- Hyperactivity - Not everyone who has ADHD is hyperactive, but identifying this trait may make the diagnosis easier.
From Child to Adolescent: Changes
During adolescence, some symptoms become less noticeable, including hyperactivity, attention span, and impulse control. As a result, many teens who were diagnosed with the Combined Type of ADHD no longer meet the criteria. However, impulsivity is still ofte, a major problem for many ADHD teens. It can cause difficulties with school, work, family, and social relationships. For ADHD teens, independence and responsibilities increase, but so do driving accidents, low self-esteem, drug and alcohol abuse or encounters with the law. Issues associated with identity, peer-group acceptance, and physical changes add to adolescent stress. Adolescents frequently deny symptoms and refuse to take medication at school because they do not want to be 'different.' Learning how to set goals and make good decisions will help give ADHD teens the direction they need to stay on course. It is important for the ADHD teen to learn that managing symptoms is a key part of developing life skills and handling everyday situations.
Evaluation and Diagnosis
The diagnosis of ADHD should only be made after symptoms have persisted over an extended period of time, and interfere with a teen's ability to function. At that point, a thorough evaluation by a doctor experienced in ADHD diagnosis and treatment may be necessary. Also, a psycho-educational evaluation can rule out associated learning disabilities and other illnesses and identify areas of strength and weakness.
A Note About ADHD in Teenage Girls
For girls and women, ADHD can be a hidden disorder, ignored or misdiagnosed by the educational and medical communities, which may cause these girls and women to suffer in silence. In view of the serious consequences of ADHD in adolescence and adulthood, there is an urgent need for increased awareness of the prevalence of this disorder in teenagers. Adolescent girls, often are not identified until school underachievement has become chronic. To prevent this from happening, earlier diagnosis and management are essential.
Getting Help
In the case of adolescents with ADHD, parent interaction and response is affected by ADHD symptoms. Parents should be guided toward reasonable expectations and accurate interpretation of their teens' behavior.'
Teenagers who have difficulties in school, with friends, or have ongoing negative thoughts about themselves may benefit from treatment, including counseling and/or medication, may help address difficulties with concentration and attention span. Counseling can also help address emotional and social issues, including:
- Problems with friends, family, and teachers.
A few things that may point to having ADHD:
1. General untidiness, in school and at home.
2. Consistently late with assignments.
3. Constantly losing things such as homework.
4. Easily distracted with a brief attention span.
5. Regularly running late for school.
6. Everything with a deadline is done at the very last minute.
7. An unusual sense of fairness.
8. Many excuses for things not getting done.
9. People think you are not listening when they are speaking to you.
The Diagnostic and Statistical Manual for Primary Care, Child and Adolescent Version has formulated a behavioral description that differentiates normal developmental variations from behavioral problems and true disorders (ADHD). View the table below.
Understanding Behavioral Differences
The table below differentiates normal developmental variations and presentations in teens from behavioral problems and true disorders. Excessive activity and impulsivity are detected only by observations of the child in multiple settings over time. The attention span of children normally increases with age, so that inattention must be evaluated in the context of the child's age and developmental stage.
Is it normal behavior, problem behavior, or ADHD?
Hyperactivity / Impulsivity in adolescence
Developmental Variations
During school years and adolescence, activity may be high in play situations and impulsive behaviors may normally occur, especially in peer pressure situations. High levels of hyperactive/impulsive behavior do not indicate a problem or disorder if the behavior does not impair function.
Behavior Problems
Hyperactive and impulsive behaviors are more intense and annoy others or cause difficulties in and out of the classroom.
ADHD
Restless, motoric, and impulsive behavior is seen during most activities; the adolescent shows problems in social situations
Adolescent gets into trouble frequently. Hyperactive symptons decrease or are replaced with a sense of restlessness.
Inattention in adolescence
Developmental Variations
Adolescent is easily distracted from tasks that are not interesting or require close attention. At times, misses instructions and explanations.
Inattention Problems
Some difficulties are seen with following instructions, completing tasks, completing games with other children or grownups.
Does not pickup subtle social cues from others.
Some difficulties with academic and social events begin to surface
ADHD
Adolescent has symptoms of inattention and distractibility that significantly impair social and academic performance
Adapted from American Academy of Pediatrics: The Classification of Child and Adolescent Mental Diagnosis in Primary Care, Elk Grove Village, IL, 1996
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