Up to 10% of school-age children now carry a diagnosis of attention deficit disorder (also known as ADHD or ADD), and are in active treatment for the concern. The most commonly prescribed treatment is a stimulant medication such as Ritalin. But some parents and mental health professionals are concerned that ADHD is over-diagnosed, and not enough care is given to the specific conditions that are required to make an accurate ADHD diagnosis.
What to Look For in ADHD
ADHD is characterized by meeting at least six of eighteen inattention or hyperactivity symptoms. Usually both parents and clinicians can readily identify the symptoms in their child, and many believe that is all that is needed in order to make an accurate diagnosis.
However, the DSM diagnostic criteria for ADHD also specify a number of important factors that also must be met.
These symptoms must be present for at least 6 months in two or more settings, e.g., school and at home; play and at school; etc. If the symptoms have not been present for at least 6 months or the child meets the criteria only in one setting (e.g., school only), then ADHD should not be diagnosed.
The criteria also specify that some symptoms should have been apparent before age 7. The ADHD symptoms also must not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
Making an ADHD Diagnosis
It is especially difficult to establish an ADHD diagnosis in children younger than age 4 or 5 years, because their characteristic behavior is much more variable than that of older children. and include features that are similar to symptoms of Attention Deficit Disorder. Furthermore, symptoms of inattention in toddlers or preschool children are often not readily observed because young children typically experience few demands for sustained attention. However, even the attention of toddlers can be held in a variety of situations (e.g., the average 2- or 3-year-old child can typically sit with an adult looking through picture books).
In contrast, young children with Attention Deficit Disorder move excessively and typically are difficult to contain. The mental health professional making the diagnosis should always inquire about a wide variety of behaviors in a young child to help ensure that a full clinical picture has been obtained. Beware clinicians or doctors who ask only basic or shallow questions about the child’s symptoms, without taking time out to delve into the specific situations the behaviors are observed.
As children mature, symptoms usually become less conspicuous. By late childhood and early adolescence, signs of excessive activity (e.g., excessive running and climbing, not remaining seated) are less common, and hyperactivity symptoms may be confined to fidgetiness or an inner feeling of jitteriness or restlessness.
In school-age children, symptoms of inattention affect classroom work and academic performance. Impulsive symptoms may also lead to the breaking of familial, interpersonal, and educational rules, especially in adolescence.
In adulthood, restlessness may lead to difficulty in participating in sedentary activities and to avoiding pastimes or occupations that provide limited opportunity for spontaneous movement (e.g., desk jobs).
ADHD is much more frequent in males than in females, with male-to-female ratios ranging from 4:1 to 9:1, depending on the setting (i.e., general population or clinics).
Getting it Right
Ensure your mental health professional takes the time to question both you and your child to get the most accurate diagnosis possible. While family physicians can help screen for a problem like attention deficit disorder, you should trust only a trained and experienced mental health professional to make an accurate diagnosis.
As a parent, you should also be aware that some professionals believe ADHD is diagnosed inaccurately, when a mood disorder — such as bipolar disorder — would be a more accurate diagnosis. Ask your mental health professional to be certain you have the right diagnosis, as it can affect your child’s treatment and care.