Diagnosis of Attention-Deficit Hyperactivity Disorder (ADHD)

by Joseph M. Carver, Ph.D.

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The essential features of Attention-Deficit Hyperactivity Disorder (ADHD), as described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (1994), is the presence of developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity. Individuals with the disorder generally display some disturbance in each of these areas, but to varying degrees.

The following is a list of symptoms commonly associated with Attention-Deficit Hyperactivity Disorder (ADHD) based on the 1994 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV):

These symptoms are related to inattention...

Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities. ADHD Children/Adults children are famous for skipped math problems, milk cartons on the kitchen table, etc.

Often has difficulty sustaining attention in tasks or play activities. A two-minute timed task is often interrupted by glancing about the room.

Often does not seem to listen when spoken to directly. As described, ADHD Children/Adults are often considered to have hearing problems or difficulties in auditory processing due to their inability to hear or respond to comments.

Often does not follow through on instructions and fails to finish schoolwork, chores, or duties. ADHD Children/Adults quit games half-way through, half-clean their room, or wander off in the middle of projects. Homework is often partially finished or even if finished, the ADHD student forgets to turn it in.

Often has difficulty organizing tasks and activities. Many tasks/activities require planning and organization. An adult might gather four tools for a project in one trip. The ADHD individual must retrieve one tool at a time, failing to see the big picture and the equipment that might be needed.

Often avoids, dislikes, or is reluctant to engage in tasks that require sustained effort. Homework and schoolwork are often an ordeal for the ADHD Child and his/her parents. What should normally take 30 minutes requires three hours and after the ordeal, both student and parent are exhausted and traumatized.

Often loses things necessary for tasks or activities. ADHD Children misplace pencils, notebooks, and other needed equipment. They forget lunch money or inform you 20 minutes before bedtime that they need a large poster board for a project the next day.

If often easily distracted by extraneous stimuli. Noises, conversation, flying birds, movements by others - almost anything can draw the attention of ADHD Children from their task at hand.

If often forgetful in daily activities.

These symptoms are related to hyperactivity...

Often fidgets with hands or feet or squirms in seat. ADHD Children look much like a running motor with a rough idle. If we imagine a video recording of the ADHD Children, their body is almost constantly in movement, importantly, purposeless movement.

Often leaves seat in classroom or in other situations in which remaining seated is expected. Depending upon the severity of the hyperactivity, ADHD Children have difficulty remaining seated in school, church, family gatherings, etc. In school, ADHD Children are known to "pop up" from their seat, as though gravity was suddenly canceled in their area.

Often runs about or climbs excessively in situations in which it is inappropriate. Younger ADHD children are climbers, runners, bouncers, tumblers, and jumpers. As the ADHD Child matures, he/she may report an internal sensation of a "running motor" or restlessness. Hyperactivity in ADHD adolescents can also take the form of finger drumming, restless legs, excessive humming/singing/whistling, and even object-drumming. ADHD teens often turn kitchen canisters and tables into drum sets.

Often has difficulty playing or engaging in leisure activities quietly. As the excitement builds in an ADHD Child, so increases the voice and physical activity. When playing video games, ADHD Children often shout, yell, and physically act their participation.

Often "On the go" or acts as if "driven by a motor".

Often talks excessively. ADHD Children and Adults talk and question excessively. Questions are often totally unrelated to the task at hand. ADHD in adults often produces the "fast talker" we find in certain occupations.

These symptoms are related to impulsivity...

Often blurts out answers before questions have been completed. Labeled "disruptive" in the classroom setting, ADHD Children fail to raise their hand or await proper acknowledgment before speaking in group situations.

Often has difficulty awaiting turn. If we study the actual location where ADHD Children have difficulty, it's often when they are waiting - the cafeteria line, riding on the bus, in line before recess, etc. During such times, ADHD Children can't control their urge to physically touch/poke or irritate others.

Often interrupts or intrudes on others. ADHD Children butt into conversations, interrupt adults, interrupt games, and demand responses to questions when the parent/teacher is already engaged. ADHD Children have few "social graces" for this reason.

Neurology and ADHD

The ADD Medical Treatment Center of Santa Clara Valley list absolute indications and suggestive indications of the underlying neurological basis for Attention-Deficit Hyperactivity Disorder (ADHD).

Absolute Indicators of ADHD Neurology

Hyperactivity/Fidgetiness
Impulsivity (hyperactivity of the mind)
Unexplained inattention for "boring" activities
Primary nocturnal enuresis (bed-wetting)
(48% of ADHD children have bed-wetting)
Episodic Explosiveness or Emotional Outbursts

Strongly Suggestive Indicators of ADHD Neurology

Waking slowly, not snapping awake, or being
excessively grouchy (91% of ADHD cases)
Difficulty falling asleep at night (73%)
Unexplained irritability and rapid frustration
Unexplained negativity with or without depression
Verbal and/or spatial dyslexia (number, letter,
and often word reversals)

Manifestations of the disorder usually appear in most situations, including at home, in school, at work, and in social situations, but to varying degrees. Some people, however, show signs of the disorder in only one setting, such as at home or at school. Symptoms typically worsen in situations requiring sustained attention, such as listening to a teacher in a classroom, attending meetings, or doing class assignments or chores at home. Signs of the disorder may be minimal or absent when the person is receiving frequent reinforcement or very strict control, or is in a novel setting or a one-to-one situation (e.g., being examined in the clinician's office, or interacting with a videogame).

Attention-Deficit Hyperactivity Disorder (ADHD) in younger children is often readily identified by the presence of hyperkinesis or "hyperactivity". Rapid, purposeless, and nonstop movements are often found. These youngsters can seldom watch a thirty-minute television/VCR program due to their short attention span and hyperactivity.

In older children, above the age of twelve, the rapid body movements become less obvious although they can still be observed. Rather than running around the room or class, the older ADHD child exhibits leg shaking, drumming fingers, squirming, glancing about the room, and poor impulse control. The older ADHD child remains inattentive and will have difficulty with harder classes and frequently forgets homework.

Attention-Deficit Hyperactivity Disorder (ADHD) can persist into adulthood. The adult version of Attention-Deficit Hyperactivity Disorder (ADHD) contains rapid speech, poor judgment, poor impulse control, quick temper, and poor sustained effort. The adult "fast talker" frequently wears out friends with their hyperactive pace and talkativeness.

About the Author

www.drjoecarver.com
This handout was written by Joseph M. Carver, Ph.D., a Clinical Psychologist. Dr. Carver is in private practice in Southern Ohio.