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Unraveling ADD/ADHD


I personally never heard of ADD or ADHD until my firstborn son attended kindergarten. I knew that he was different, but how different and what caused that difference was still an unknown. I can’t even remember how I knew what to ask the pediatrician for, but I do remember making the appointment with a developmental psychologist to have him tested. Finally, I had something: a name, a diagnosis, a starting point in which I could get to work and help my son.


What is ADD/ADHD


ADHD is a “persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development” according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 is the authoritative source of what is defined as a mental/behavioral disorder or not. This group of experts around the world compile and analyze all data on mental disorders in order to standardize diagnoses, treatments, and all research protocols.


How is a Person Determined to have ADHD


A person is determined to have ADHD through a screening process consisting of an objective questionnaire. This is filled out by a parent, a child’s teachers, and/or even a spouse if this is an adult seeking a diagnosis. A word of advice: In order to decrease the chance of misdiagnosis, the evaluation should to be conducted by a well-educated healthcare professional who is either a psychologist, psychiatrist, or a primary care provider such as a pediatrician who has taken another step in their education called a fellowship. You should ask for all of their credentials before allowing them to diagnosis and or even treat your loved with medications. Failure to use a professional who has pursued a fellowship in this subject matter may lead to some inaccuracies in diagnosis and could potentially lead to missing other learning issues that may further complicate the symptoms of ADHD such as, other processing disorders like dyslexia and dysgraphia or even other behavioral issues such as anxiety, depression, or oppositional defiant disorder just to name a few.


The following are the DSM-5 determination for ADHD


1. Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:

o Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.

o Often has trouble holding attention on tasks or play activities.

o Often does not seem to listen when spoken to directly.

o Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).

o Often has trouble organizing tasks and activities.

o Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).

o Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

o Is often easily distracted

o Is often forgetful in daily activities.


2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:

o Often fidgets with or taps hands or feet, or squirms in seat.

o Often leaves seat in situations when remaining seated is expected.

o Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).

o Often unable to play or take part in leisure activities quietly.

o Is often “on the go” acting as if “driven by a motor”.

o Often talks excessively.

o Often blurts out an answer before a question has been completed.

o Often has trouble waiting his/her turn.

o Often interrupts or intrudes on others (e.g., butts into conversations or games)


In addition, the following conditions must be met:

· Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.

· Several symptoms are present in two or more setting, (such as at home, school or work; with friends or relatives; in other activities).

· There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.

· The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.


Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

· Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months

· Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months

· Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity, but not inattention, were present for the past six months.

As you can see a solid diagnosis is the key to helping a person design the best plan for success. It would be easy if ADHD could be determined with a common blood test, a CT, or even an MRI, but currently there has not been any laboratory markers identified nor has any diagnostic test been conclusive enough to be used. Therefore, a highly-educated healthcare professional who is knowledgeable of the DSM-5 criteria should only be considered. In other blog entries, I will discuss whether to medicate or not as well as my take on all the other topics that are common in the mainstream today.


References:


DSM-5

https://www.psychiatry.org/psychiatrists/practice/dsm

American Academy of Pediatric

https://www.aap.org/en-us/Pages/Default.aspx

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