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An Overview of ADHD Diagnosis

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ADHD is not a "new" mental health diagnosis, and it is not a disorder made up by the drug companies, psychiatrists, or by the main stream media to turn a profit. It is a very real behavioral and brain disorder that affects millions of people. According to the National Institute of Mental Health (NIMH), attention deficit hyperactive disorder is one of the most common disorders in children and teenagers. According to NIMH, the estimated number of children with the disorder is between 3% - 5%, and the estimate for adults is 4%.

It has taken quite a long time for us to accept attention deficit hyperactive disorder as a real problem, but in actuality, it is something that's been documented in medical literature for at least 200 years. As early as 1798, it was first described by Dr. Alexander Crichton, who called it "Mental Restlessness." "The Story of Fidgety Philip," who apparently suffered from ADHD, was written in 1845 by Dr. Heinrich Hoffman. In 1922, it was labeled as Post Encephalitic Behavior Disorder. It was discovered in 1937 that stimulants could help control hyperactivity in children. In 1957 methylphenidate (Ritalin), became commercially available as a pharmeceutical treatment hyperactive children.

In the early 1960s, attention defict hyperactive disorder was called "Minimal Brain Dysfunction." by 1968, it became known as "Hyperkinetic Reaction of Childhood." The emphasis was placed more on the hyperactivity than inattention symptoms. In 1980, the diagnosis was changed to Attention Deficit Disorder (ADD), with or without Hyperactivity," placing equal emphasis on hyperactivity and inattention. But by 1987, the disorder was labeled a medical disorder that resulted in behavioral problems, and renamed Attention Deficit Hyperactivity Disorder (ADHD) and divided into four categories.

1. Attention-Deficit Hyperactivity Disorder, Predominantly Inattentive Type (ADD) is noted by impaired attention and concentration.

2. Attention-Deficit Hyperactivity Disorder, Predominantly Hyperactive, Impulsive Type (ADHD) is noted by hyperactivity without inattentiveness.

3. Attention-Deficit Hyperactivity Disorder, Combined Type (the most common type) involves all the symptoms: inattention, hyperactivity, and impulsiveness.

4. Attention-Deficit Hyperactivity Disorder Not Otherwise Specified. This category is for disorders that include prominent symptoms of inattention or impulsiveness and hyperactivity, but do not meet the DSM IV-TR criteria for a foramal diagnosis.

To better understand ADHD and its four categories, it's helpful to illustrate hyperactivity, impulsiveness, and inattention with examples.

Typical hyperactive symptoms include:

  • Acting as if "driven by a motor" and often "on the go"
  • Feeling restless
  • Squirming, or nervously moving hands and feet
  • Frequently getting up to walk or run around
  • Running or climbing excessively, and when it's not appropriate
  • Difficulty playing quietly, or engaging in quiet activities
  • Talking excessively, or too talking fast
  • Often getting out of the seat, when remaining seated is expected
  • Can't be quietly involved in social activities

Typical symptoms of impulsiveness include:

  • Acting suddenly, without thinking first
  • Blurting out the answers, before the question is fully asked
  • Having difficulty waiting a turn
  • Often interrupting others' conversations or activities
  • Poor decisions or judgment in social situations, which result in not being accepted by the peer group.

Typical symptoms of inattention include:

  • Not paying attention to details and making careless mistakes
  • Having trouble staying focused, and being easily distracted
  • Appearing not to listen when spoken to
  • Forgetful in daily activities
  • Trouble staying organized, planning ahead, and finishing projects
  • Losing or misplacing books, homework, toys, tools or other items
  • Not seeming to listen when spoken to
  • Not following instructions, and failing to finish schoolwork, chores or duties on the job
  • Avoiding or disliking jobs that require mental effort or concentration

Of the four ADHD subcategories, Hyperactive Impulsive Type is the most recognizable, and the easiest to diagnose. The hyperactive and impulsive symptoms are behaviorally manifested at home, with friends, at school, at work, or during extracurricular or athletic activities. Because of the hyperactive and impulsive traits, people with this disorder naturally attract the attention (often negative) of everyone around them. Compared to those without ADHD, these individuals are more difficult to teach, coach, communicate with and work with. Additionally, they are prone to be reckless, accident prone, disruptive, socially underdeveloped, and seemingly oppositional.

Parents of such children often report anger, frustration, and emotional exhaustion, because of their child's impulsiveness, inattention and hyperactivity. By the time they seek professional help, many parents describe complicated feelings of anger, fear, desperation, and guilt. They feel their "failure" to get their children to pay attention, focus, and to follow through with responsibilities, directions, and assignments is the cause of their feeling of hopelessness and desperation. Parents often report feeling guilty over their loss of patience, resentment, and reactionary discipline.

The following statistics from Dr. Russel Barkley and Dr. Tim Willens shows the far reaching implications of attention deficit hyperactive disorder.

  • ADHD has a childhood rate of 6-8%, with the disorder continuing into adolescence for 75% of the sufferers, and with 50% of those persisting into adulthood.

  • Boys are diagnosed with ADHD 3 times more often than girls.

  • Emotional development in children with ADHD is 30% slower than in normal children.

  • 65% of children with ADHD show problems with authority figures and defiancesuch as verbal hostility and temper tantrums.

  • Teenagers with ADHD have nearly four times as many traffic accidents as nonADHD drivers, and are seven times more likely to have a second accident.

  • 21% of teenagers with ADHD skip school on a regularly, and 35% drop out before finishing high school.

  • 45% of children with ADHD have been suspended from school at least once.

  • 30% of children with ADHD have had to repeat a school year.

  • 75% of kids in the juvenile justice system have undiagnosed learning disabilities, including ADHD.

Research funded by the National Institute of Medical Health (NIMH) and the U.S. Public Health Service (PHS) shows clear evidence that attention deficit hyperactive disorder runs in families, and is genetic. According to recent research, more than 25% of first degree relatives of families with ADHD children, also have ADHD. Research also indicates that 80% of adults with ADHD have at least one child with ADHD, and 52% have two or more children with the disorder. Matters can get complicated when parents with undiagnosed ADHD have problems with their ADHD child; it is crucial to evaluate a family history, when assessing ADHD in youth.

Diagnosis of Attention Deficit Disorder Inattentive Type is no easy task; more harm than good can be done when a person is incorrectly diagnosed, which may lead to unnecessary treatment, such as a prescription for serious medication. Unnecessary medication can cause serious side effects. Of course, when a person is correctly diagnosed and receives the right treatment, the potential for life is limitless.

A medical doctor, preferably a psychiatrist, can diagnose ADHD, and prescribe medication. Nurse practitioners, and physician assistants under the supervision of a physician, can also diagnose, and get a prescription written. But, psychiatrists, because of their expertise in mental disorders, are the best qualified to prescribe medication.

While the ADHD Hyperactive Type are easily noticed, those with ADHD Inattentive Type are prone to be misdiagnosed or do not get noticed at all. Kids with ADHD Inattentive Type are often mislabeled, misunderstood, and blamed for something over which they have no control. Because ADHD Inattentive Type manifests more internally and less with outward behavior, these kids are not as frequently noticed as having a problem, and do not receive potentially life changing treatment, they "fall between the cracks" of the mental health, juvenile justice, social service, and educational systems.

Kids with untreated ADHD may grow up into adults with a poor self image, low self esteem, and the associated emotional, educational, and employment problems. According to statistics, adults with untreated attention defict hyperactive disorder are more prone to alcohol and drug problems. It's common for adolescents and adults with ADHD to "self medicate" by using addictive substances such as alcohol, marijuana, narcotics, tranquilizers, nicotine, cocaine and amphetamines.

Approximately 60% who had ADHD as a child continue to have it as adults. Thanks to increased public awareness, more adults are seeking help for ADHD. But, many adults who were not treated as children have "scars"; emotional, educational, personal, and occupational. As children, they did not feel as smart, successful or likable as their normal kids. With no one to explain why they struggled at home, with friends, and in school, they turned inward to explain their problems, and eventually they internalize the negative about themselves, creating fewer opportunities for success as adults.

Adults with ADHD have serious problems with concentration and paying attention, or are hyperactive in one or more areas of their lives. Some of the most common problems include:

  • Problems with jobs and careers; losing or quitting jobs frequently
  • Problems doing well at work or in school
  • Problems with everyday tasks, such as doing chores, paying bills, and organizing things
  • Problems with relationships because you forget important dates, don't follow through, or get upset over little things
  • Stress and worry because you don't meet goals and responsibilities
  • Strong feelings of frustration, guilt and blame

While there is no consensus as to the cause, there is general agreement within the medical and mental health professions that ADHD is biological in nature. Some common explanations are: chemical imbalances in the brain, early head trauma or brain injury, nutritional deficiencies, or impairments to normal brain development, or brain dysfunction or neurological impairment.

Too often, a person is mistakenly diagnosed with ADHD, not because of attention deficit issues, but because of their unique learning style, emotional make up, personality, energy levels, and other factors that better explain their problem behaviors. A misdiagnosis could also be related to other mental or emotional problems, unemployment, divorce, family dysfunction, or medical conditions.

Because other disorders share similar symptoms with ADHD, it is necessary to consider the possibility that another disorder could possibly account for the symptoms. Generalized Anxiety Disorder and Major Depression share the symptoms of lack of concentration, disorganization, and work completion issues. Typical disorders to be ruled out include: Major Depression, Generalized Anxiety, Post Traumatic Stress Disorder, and Substance Abuse Disorders. Additionally, medical explanations should be ruled out, such as sleep disorders, nutritional deficiencies, and hearing problems.

In conclusion, ADHD is a mental and medical disorder, that has become increasingly more accepted, treated more effectively. A solid foundation of information creates the potential for positive outcomes in the treatment of ADHD.