By Dr Ananya Mandal, MD
All children are different and Attention Deficit Hyperactivity Disorder (ADHD) is often difficult to diagnose among children.
Many normal preschoolers may display many common symptoms of ADHD like over activity, high energy, fidgetiness, impulsivity, inattention or low attention spans and easy distractions.
Diagnosis of ADHD thus needs to follow set guidelines and standardized criteria. There are however, no single tests to diagnose the condition.
History of child’s behaviour
The clinician often needs to take a detailed history of the child’s behavior at various settings like home, school etc. to arrive at a conclusive diagnosis.
The diagnosis of ADHD is often made between ages 3 and 6 in a child. The clinician may need to talk to other care givers like babysitters, coaches etc. to study the child’s behavioural problems in detail. (1, 2)
Parents may help by writing down in detail the nature and extent of the problem in the form of a diary. They can note the major changes in the child’s immediate environment and life to be shown to the clinician.
They can also prepare a list of medications and vitamin supplements that the child is taking.
Common questions put to caregivers include duration of behavioral problems, if the problems are more with respect to peers and the number of settings like school, playground or home where the problems are manifested.
The doctor may also ask if anything worsens or improves the child’s behavior, and ask about caffeine intake of the child, sleep patterns of the child, current and earlier academic performance records, and preferred discipline method used at home.
He or she may ask the parent or caregiver to describe a typical day’s routine in the child’s life. (1, 2)
Ruling out other conditions
The paediatrician who is consulted first, as well as the mental health specialist who is called in for referral, will initially rule out other conditions that may lead to symptoms of hyperactivity, impulsiveness or inattention.
There may be undetected seizures. Commonly “absence seizures” result in blanking out that may be mistaken for inattention.
There may be undetected middle ear infections leading to hearing problems or undetected vision problems that may lead to inattention.
Medical problems that lead to altered thinking and behavior maybe mistaken for ADHD as can anxiety disorders, depression and other metal ailments.
Learning disabilities, psychological trauma due to sudden change like death, parental divorce or parental loss of job may also give rise to behavioral problems.
Once detailed analysis is made and the child fulfils all criteria the child is diagnosed with ADHD. (2, 3)
According to the American Psychiatric Association’s Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV-TR) criteria for ADHD, ADHD can be diagnosed based on number of symptoms of hyperactivity-impulsiveness and inattention. (4)
- Predominantly inattentive – Six or more symptoms of inattention present over six months at a point that is “inappropriate for developmental level”.
- Lack of close attention
- Lack of attention to tasks and play activities
- Does not listen when spoken to
- Does not follow instructions
- Cannot organize activities
- Lack of interest in activities that require mental effort
- Losing things needed for activities and tasks
- Easily distracted
- Predominantly hyperactive-impulsive – Six or more symptoms of hyperactive-impulsivity present over six months at a point that is “disruptive inappropriate for developmental level”.
- Hyperactive –
- Fidgets or squirms
- Often gets up when asked to sit
- Excessive running, climbing and movements
- Trouble with play and leisurely activities
- Often “on the go” as if “driven by a motor”
- Excessive talking
- Impulsive -
- Blurting out comments and answers before question is finished
- Trouble waiting for one’s turn
- Habit of interrupting conversation
- Symptoms (some of them) present before age of 7 years
- Symptoms present in more than one environment (e.g. school, playground and home).
- Symptoms affecting social, work and school performance.
- No other psychiatric or psychological ailments like Pervasive Developmental Disorder, Anxiety disorder, Dissociative disorder, Personality disorder or Schizophrenia can explain the symptoms.
Based on these symptoms over six months –
- ADHD Combined type is diagnosed if there is presence of both criteria A and B
- ADHD Predominantly Inattentive type if A is fulfilled but B is not.
- ADHD Predominantly hyperactive impulsive type if criteria B is met but A is not.
Edited By April Cashin-Garbutt, BA Hons (Cantab)
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