ADHD symptoms and behavior vary widely from child to child, making a firm ADHD diagnosis difficult. Symptoms of ADHD can range from hyperactivity and impulsive behavior to daydreaming and inattentiveness. An ADHD diagnosis may also be complicated by other mental disorders, learning disorders and dyslexia, as all can mimic symptoms of ADHD.
No diagnostic test for ADHD exists: An ADHD diagnosis is based on the presence of symptoms and the symptoms’ severity. Depending on whether symptoms of hyperactivity or inattentiveness are present, ADHD is classified into four categories:
- ADHD, Predominately Inattentive Type
- ADHD, Predominately Hyperactive-Impulsive Type
- ADHD Combined Type
- ADHD Not Otherwise Specified.
Symptoms of ADHD: Inattentive Type
According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), a diagnosis of ADHD, Predominately Inattentive Type, requires the presence of very specific behavior. At least six of the following symptoms and behavior problems must be present to warrant a diagnosis of inattentive ADHD. Symptoms must be present for at least six months, and include:
- avoiding or disliking mental effort (such as schoolwork or homework)
- being easily distracted
- being forgetful
- having difficulty following instructions and often failing to finish tasks
- having difficulty organizing tasks
- having difficulty staying focused on tasks
- making careless mistakes in schoolwork or other activities
- not paying attention to details
- not seeming to listen to people
- often losing things.
Symptoms of ADHD: Hyperactive-Impulsive Type
As with ADHD, Inattentive Type, specific behavior must be present to warrant a diagnosis of this type of ADHD. At least six of the following ADHD symptoms must be present for at least six months for a diagnosis:
- blurting out answers before questions are completed
- having difficulty playing quietly
- hyperactive behavior
- often fidgeting, squirming in seat or pacing
- often having difficulty with taking turns
- often interrupting people
- often leaving seat in situations where sitting is expected
- running or climbing in inappropriate places
- talking excessively.
ADHD Diagnosis: Other Types of ADHD
There are two other categories of ADHD:
- ADHD, Combined Type describes cases in which the child meets the diagnostic criteria for both hyperactivity and inattentive ADHD types.
- ADHD NOS (not otherwise specified) describes children with significant symptoms of ADHD whose behavior falls short of the other three categories of ADHD diagnosis.
ADHD Diagnosis: Symptoms Aren’t Enough
A child with the behavior and symptom requirements of ADHD does not automatically receive an ADHD diagnosis. In addition to symptoms of ADHD, the child must also:
- display some symptoms of ADHD that cause impairment prior to age seven
- experience impairment due to ADHD symptoms in at least two settings (school, home, etc.)
- lack symptoms that can be explained by an anxiety disorder, childhood schizophrenia, dissociative disorder, mood disorder, personality disorder, pervasive developmental disorder or psychotic disorder.
The keyword in the first two items is impairment. A child may fulfill the requirements of hyperactivity, impulsivity or inattentiveness, but unless these symptoms cause serious impairment in daily life, an ADHD diagnosis and ADHD treatment are neither called for nor necessary.
ADHD Behavior: Over-Diagnosed?
Some controversy has arisen concerning ADHD diagnoses: Critics maintain that teachers, parents and doctors are too quick to believe a child’s hyperactivity or inattentiveness is due to ADHD. They’re concerned that many doctors are unqualified to make an ADHD diagnosis, and that some parents prefer a socially acceptable ADHD diagnosis over mental disorders with a social stigma, such as clinical depression. At the extreme end of ADHD diagnosis criticism are groups that contend ADHD doesn’t exist.
It’s possible that ADHD is over-diagnosed, so ADHD diagnoses are best left to qualified psychiatrists, psychologists, pediatricians and neurologists. Family doctors and clinical social workers trained to identify symptoms of ADHD may also make an ADHD diagnosis, although generally an ADHD diagnosis is best left to specialists.
Care must be taken to rule out conditions that mimic hyperactivity and other ADHD symptoms. Possible ADHD “mimics” include:
- anxiety disorders
- learning disorders such as dyslexia
- middle ear infections (causing inconsistent hearing problems)
- traumatic events (a family death or divorce, for example).
American Academy of Family Physicians (2003). ADHD. Retrieved August 2, 2007, from the AAFP Web site: http://search.aafp.org/search?q=adhd