Attention Deficit Hyperactivity Disorder (ADHD) is a spectrum disorder. The symptoms run the length of the continuum, and are more intense or occur more frequently in some individuals than others. Fifty percent of the children who are diagnosed with ADHD will not go into remission, but remain as an adult, who has ADHD. This spectrum disorder is based on DSM-IV criteria (American Psychiatric Association Diagnostic Manual); therefore, more restrictive than other sources which may be used to diagnose this problem.
Per the DSM-IV, three criteria must be met to diagnose ADHD:
• Inattention
a) Distractibility
b) Difficulty paying attention
c) Difficulty in listening, daydreaming
d) Losing things
e) Unreliable in completing an assigned task, or no follow-through of own ideas.
• Hyperactivity
a) Talking excessively
b) Inability to sit still, internal feelings of restlessness
c) Fidgeting behavior (e.g. Bouncing leg while sitting, biting fingernails)
d) Complaints of feeling overwhelmed, and sometimes overwhelming others via their behavior.
• Impulsivity
a) Frequent job changes
b) Relationship problems (eg. More frequent sexual partners, more sexually transmitted disease, more divorce, no lasting friendships)
c) Difficulty waiting turn (e.g. waiting turn in supermarket line, or in congested traffic)
d) Blurting out answers, or intruding on another’s talk.
e) Impulsive, no thought of consequences of actions.
f) Increased irritability, and inability to control anger.
g) Excessive spending or shopping.
In diagnosing ADHD, one of the determinants for adult ADHD is a history of ADHD in childhood. So, a clinical interview is always necessary to elicit the appropriate responses.
As the frontal sub-cortical area of the brain is involved, an evaluation for Executive Dysfunction is always done.
• Inhibition.
• Working memory
• Set-shifting
• Planning
• Attention.
Neuro-Psych Testing is not specific or sensitive enough to determine a diagnosis, although it may help identify some patterns.
Rating scales are available which also may identify some behaviors. The most helpful on line scale is the ASRS (Adult ADHD Self Report Scale).
Increasing the confusion of the diagnostic process is that ¾ of adult ADHD have co-morbidities (additional mental diagnosis). Mood disorders, Anxiety, Bi-Polar Spectrum Disorders, and Substance Abuse are the major co-morbid condition. The co-morbid condition must also be identified. Treatment is prioritized by what is causing the individual the most impairment.
Other conditions which must be considered are the following:
• Thyroid function (either hypo or hyper)
• Central Nervous System Disease or Head Injury
• Sleep Disorders
• Lead toxicity
Psychiatric and Mental Health Congress, 2006
Http://viss.cmellc.com/psychcongress/
del.icio.us
Digg this
