Attention Deficit Hyperactivity Disorder

Types

Four types of ADHD are included in the DSM-IV-TR, including the Predominantly Inattentive Type, the Predominantly Hyperactive-Impulsive Type, the Combined Type, and ADHD Not Otherwise Specified. The Predominantly Inattentive Type includes symptoms related largely to inattention, such as the inability to maintain attention, avoiding tasks that require mental effort, losing things and being forgetful, failing to pay close attention to details, and lacking in organizational skills. The Predominantly Hyperactive-Impulsive Type includes symptoms related to hyperactivity and/or impulsivity, including being unable to sit still, being restless, talking excessively, fidgeting, and interrupting others. To be diagnosed with either of these types of ADHD, six or more symptoms of either inattention or hyper-activity/impulsivity, as outlined in the DSM-IV-TR, must be present for at least 6 months in two or more settings (e.g., school, home). The onset of most of the symptoms must occur before the age of 7. Further, the symptoms must be maladaptive and must be inconsistent with the child's developmental level. The Combined Type includes symptoms of both inattention and hyperactivity/impulsivity, and ADHD Not Otherwise Specified includes behaviors that are symptomatic of either inattention or hyperactivity/impulsivity, but do not meet the diagnostic criteria outlined in the DSM-IV-TR.

Diagnosis

The most common method for identifying ADHD is the use of rating scales, which are norm-referenced [Page 73]instruments that list a variety of behaviors (e.g., “Is impulsive”) and ask the rater to gauge the degree to which a child exhibits the behavior. Common rating scales include Conners' Parent and Teacher Rating Scales–Revised, the Child Behavior Checklist, and the Behavior Assessment System for Children. The diagnosis of ADHD, however, should ideally be based on multiple sources and multiple types of information across different settings. For example, in addition to using rating scales, diagnosticians could employ clinical interviews, laboratory measures, and direct behavioral observations. Clinical interviews should explore such topics as the child's family history, current family situation (i.e., to check for family conflict or other issues that might be causing symptoms), medical history, academic performance, behavior problems, and peer relationships. Laboratory measures are designed to measure core symptoms of ADHD, such as attention span, impulsivity, and motor activity. Common laboratory measures include the Continuous Performance Test (CPT), the Matching Familiar Figures Test (MFFT), and the Test of Variables of Attention (TOVA). Direct behavioral observations provide diagnosticians with an opportunity to compare a child's behavior across an array of settings, including school, home, and during leisure time. Multiple behavioral checklists have been created to assist teachers, parents, and others in observing a child's behavior, including several mentioned above.

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