Attention-deficit/hyperactivity disorder (ADHD)
A syndrome, usually diagnosed in childhood, characterized by a persistent pattern of impulsiveness, a short attention span, and often hyperactivity, and interfering especially with academic, occupational, and social performance. Children with these problems have difficulty completing their school work and are often in trouble with parents and teachers.
There are many different causes and explanations for the symptoms of ADHD including diet, allergies, food intolerances, low muscle tone, anxiety, depression, family problems, poor discipline and even some forms of illness.
Symptoms of ADHD include inability to sit still; short attention span; extreme distractibility; procrastination; forgetfulness; easily excited; difficulty organizing or finishing tasks; problems adapting to new situations; impatience; emotional instability; lack of goals; temper tantrums; talking too much; lack of concentration; disruptive in the classroom or at work; disorganized thoughts; trouble making and keeping friends; and a tendency to disturb others.
Diagnosing ADHD in children
Assessing a child for ADHD usually begins with complete medical, school and family histories, and a medical exam to exclude other causes of your child's symptoms. A number of medical conditions may cause signs and symptoms similar to those of ADHD, including learning disabilities, mood disturbances, hyperthyroidism, seizure disorders, fetal alcohol syndrome, vision or hearing problems, and Tourette's syndrome — a neurological disorder characterized by compulsive body movements and vocalizations.
An evaluation for ADHD should also include checking for learning or language problems, depression, anxiety and sleep disorders. These and other coexisting conditions are found in as many as one in three children with ADHD.
Because ADHD symptoms may not be obvious in a medical office, your doctor is likely to use questionnaires and interviews to learn more about your child's behavior. You, your child's teachers and other people who know your child well, such as babysitters and coaches, may be interviewed, and your doctor may also use ADHD-specific rating scales, such as the Vanderbilt questionnaire, the Connors' Rating Scales or the Achenbach Child Behavior Checklist (CBCL), to help collect and evaluate information about your child.
It's important to determine not just how your child behaves but whether the behavior is long-standing or temporary and when it occurs. Children diagnosed with ADHD exhibit symptoms over a long period of time and have particular trouble in stressful, demanding situations or in those that require sustained attention such as reading, doing math problems or playing board games.
Gathering as much information about your child as possible is the best way to ensure an accurate diagnosis. Brain scans aren't a reliable way to diagnose the disorder, nor is a child's response to a psychostimulant medication.
Diagnosing ADHD in adults
It can be even more challenging to identify ADHD in adults than it is in children. The signs and symptoms in adults are often especially subtle and subjective, and no single test can confirm the diagnosis, including self-report tools such as the Copeland Symptoms Checklist for Adult ADHD or the Brown Adult Attention Deficit Disorder Scales.
What's more, adults may have a hard time remembering whether their problems date back to childhood. And yet a persistent pattern of signs and symptoms, beginning no later than age 7, is essential for a diagnosis of adult ADHD. For that reason, your doctor is likely to ask for your old school records and to gather information from teachers, parents and anyone else who knew you when you were young. If your difficulties are recent or only occurred occasionally in the past, you're not considered to have adult ADHD. In addition, your doctor will carefully assess the impact of your core symptoms on your current life — your performance at work or in school and your relationships with friends and family.
As with children, your evaluation should include a thorough physical exam to rule out other reasons for your symptoms. This means ruling out not only medical conditions that can mimic ADHD, such as hyperthyroidism and hearing loss, but also psychological problems such as bipolar disorder, which are much more common in adults than ADHD is. Substance abuse, for instance, can cause mood swings and affect memory and concentration. Severe depression can also affect attention and memory and can make it difficult to concentrate or complete tasks.
To help arrive at a diagnosis, some specialists use tests that objectively measure your cognitive ability, your short-term memory, your concentration and your problem-solving skills. Even so, many factors can affect your performance on these tests, and by themselves, they're not necessarily good indicators of the presence of adult ADHD. Combined with extensive medical and behavioral histories and school and job records, however, they can help provide a fuller and more accurate picture of how you function in the world.
Getting an accurate diagnosis
Most experts agree that ADHD is both under- and overdiagnosed in the United States. In some areas of the country, an exceptionally high percentage of children are being treated for ADHD. These children are typically white, male and from affluent families. This has led to concern among some public health officials that ADHD has become a fad diagnosis in certain communities. On the other hand, ADHD may be underdiagnosed in black and Asian-American children or in children living in poor and rural areas, either because their families lack insurance coverage for medical evaluations or because of geographic, gender or racial biases.
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