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Attention-deficit hyperactivity disorder: childhood diagnosis

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Attention-Deficit/Hyperactivity Disorder (ADHD) is a chronic condition that affects millions of children and often persists into adulthood. ADHD includes a combination of problems, such as difficulty sustaining attention, hyperactivity, and impulsive behavior. The CDC reports that approximately 11% of American children 4-17 years of age (6.4 million) have been diagnosed with ADHD as of 2011. On average, ADHD was diagnosed at age 7. However, children who were reported by their parents as having more severe symptoms of ADHD were diagnosed earlier.

ADHD can be diagnosed by private mental health professionals such as psychiatrists, psychologists, and licensed educational psychologists (LEPs). Most private mental health professionals will use observations, interviews, rating scales, standardized assessments, and the American Psychiatric Association's Diagnostic and Statistical Manual, Fifth Edition (DSM-5) to diagnose ADHD.

According to the DSM-5, individuals can demonstrate three different types of ADHD: predominantly inattentive type, predominantly hyperactive-impulsive type, and combined type. In each case, a student must demonstrate at least 5 symptoms (6 if the student is under 17). The symptoms must be present for at least 6 months and inappropriate for the student's developmental level.

In addition to these criteria, several symptoms must be present before the age of 12, and symptoms must be present in more than one setting, such as in the classroom, at home, during recess, when shopping, or other settings. Furthermore, there must be clear evidence that the symptoms interfere with a person’s functioning at school or work, or impact a child’s ability to socialize with others. The symptoms cannot be explained by another condition, such as autism, learning disability, or anxiety disorder.

The DSM-5 states that a child may have an inattentive symptom of ADHD if he or she often:

• Is easily distracted
• Is forgetful, even in daily activities
• Fails to give close attention to details in school, work or other activities, including making careless mistakes
• Has trouble keeping attention on tasks or activities
• Ignores a speaker, even when spoken to directly
• Does not follow instructions, fails to finish schoolwork or chores, and loses focus or is easily side-tracked
• Has trouble with organization
• Dislikes and avoids tasks that require long periods of mental effort, such as homework
• Loses vital things needed for tasks and activities, such as books, keys, wallet, phones, etc.

The DSM-5 states a child or adult may have a hyperactive or impulsive symptom of ADHD if he or she often:

• Appears to be “driven by a motor” and always “on the go”
• Excessively talks
• Has trouble waiting his or her turn
• Squirms in seat, taps hands or feet, or fidgets
• Gets up from a seat when remaining seated is expected
• Runs around or climbs in inappropriate situations
• Is unable to quietly play or take part in leisure activities
• Blurts out an answer before a question has been finished
• Intrudes on and interrupts others

Although it is not part of the criteria as defined by the DSM-5, individuals with ADHD can often focus on preferred activities they excel at, such as video games. While some parents and teachers can perceive this as evidence that the student simply lacks motivation or is "lazy," in reality the attentional demands of a video game are significantly different from the attentional demands of a social activity such as eating a family dinner.

When playing a video game, the expectations, rewards, and all attentional demands are contained within the TV or computer screen, and success is dependent on the individual's intellectual skills (which are generally good in individuals with ADHD).

When eating a family dinner, on the other hand, individuals are expected to attend to social cues, participate in conversation, access their long term memories regarding both table manners and conversational topics, attend to their gross motor (such as sitting upright in their seat, not standing, etc.) and fine motor (such as eating with their mouth closed, holding a utensil appropriately) body movements. This is all required while dealing with a vast amount of sensory input competing for attention, including but not limited to the taste of the food, the sounds of each family member, the temperature in the room, and the smells of the cooking.

Although most people without ADHD and many adults with ADHD accept and deal with attentional demands fairly seamlessly in multiple environments, it can be particularly difficult for children with ADHD to behave and attend appropriately in environments with higher attentional demands, such as family gatherings, the classroom, or recess.

There are many treatment options available to support children with ADHD, and early intervention is key in attaining academic, social, and behavioral success. For many individuals, symptoms of ADHD in childhood can improve as the individual grows older and learns coping skills and strategies to manage the disorder.

If you suspect your child has ADHD, it is best to start by talking with your pediatrician about your concerns. Never try to diagnose any condition yourself, as children with concerning symptoms may have one or more of any number of disorders that can seem similar, and misdiagnosis can lead to treatment that is ineffective or even dangerous.

You can find more information about ADHD here.

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