Hi - it’s Dr. Kenny Handelman here with the next edition of your ADHD Audio Newsletter.
This is one of our members’ questions “How do you know if you have it”? This is an excellent question and a great place to begin.

Essentially to get the diagnosis of ADHD you really need to see a professional who has expertise in assessing and diagnosing ADHD. It may be helpful to listen to (or read) educational products like this or go to web sites or get other information but to really get the diagnosis you’re going to have to see a professional and have a thorough assessment.

But let’s help you to understand the diagnosis of ADHD and how it is done by the professional. We’ll start with the diagnostic criteria. In North America we use the DSM-IV TR. This is a publication by the American Psychiatric Association that stands for the Diagnostic and Statistic Manual Fourth Edition Text Revision. This is a manual which summarizes psychiatric research and knowledge, into the diagnostic criteria for all psychiatric conditions.

The DSM first editions came out many years ago and over time it’s gradually revised. In 1994 the DSM-IV came out and in 2004 they did a text revision which basically added more evidence based information to the diagnoses and the diagnostic criteria, though most criteria were not changed.

The American Psychiatric Association publishes that the purpose of the DSM-IV is to provide clear descriptions of the diagnostic categories in order to enable clinicians and investigators to diagnose, communicate about, study and treat people with various mental disorders.

There are other diagnostic classification systems. The World Health Organization has developed the ICD, which is the International Classification of Diseases. The ICD is on version 10. They have different diagnoses, and the equivalent diagnosis for ADHD in the ICD is hyperkinetic disorder (HKD). HKD refers to a more limited view of ADHD symptoms than the DSM diagnosis.

Now let’s go through the diagnostic criteria for ADHD. There are two main categories for the diagnosis: Inattention and Hyperactivity/Impulsivity.

For the inattentive criteria: there are nine symptoms (criteria) for inattention. To meet the diagnosis an individual has to have six or more of these symptoms. The symptoms have to be present for at least six months to a degree that is maladaptive and inconsistent with their developmental level.

Here are the DSM-IV criteria are for Inattention:

1. fails to give close attention to details and makes careless mistakes in school, work or other activities
2. often has difficulties sustaining attention in tasks or play activities
3. often does not seem to listen when spoken to directly
4. often does not follow through on instructions and fails to finish school work, chores or other duties in the work place (and this is not due to oppositional behaviour or failure to understand instructions)
5. often has difficulty organizing tasks and activities
6. often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort like schoolwork or homework
7. often loses things necessary for tasks or activities like toys, school assignments, pencils, books or tools
8. is often easily distracted by extraneous stimuli
9. is often forgetful in daily activities

Now of course if you went into any grade two class and asked how many kids have any of these symptoms there would be a large number who had one symptom, a large number who had two, some who had three etc. but when your getting to six of nine it’s getting to the relevant range insofar as a disorder.

The next major group are nine criteria for hyperactivity impulsivity. Similarly, one needs to have six or more present for six months to a degree that is maladaptive and inconsistent with a developmental level.

Here are the DSM-IV criteria for Hyperactivity/Impulsivity:

1. often fidgets with hand or with feet or squirms in ones seat
2. often leaves seat in classroom or in other situations which remaining seated is expected i.e. church or family meals etc.
3. often runs about or climbs excessively in situations in which it is inappropriate. In adolescents or adults may be limited to subjective feelings of restlessness, so they may not be so overtly hyperactive.
4. often has difficulty playing or engaging in leisure activities quietly
5. is often on the go or acts as if driven by a motor
6. often talks excessively
7. often blurts out answers before questions have been completed
8. often has difficulty awaiting one’s turn
9. often interrupts or intrudes on others - like butting into conversations or games

So those are the core criteria for inattention and hyperactivity impulsivity. Now there are further criteria. The DSM further states that there have to be some symptoms that caused impairment before the age of seven years old. This is to help eliminate the concern that at the age of 27 because of other factors an individual finds they’re having trouble with concentration and that may be related to depression or anxiety or something else and not ADHD.

Other criteria include some impairment from the symptoms as present in two or more settings. It is important to see symptoms present in home and school, for example. Because if the symptoms are only present in one setting - then there is a problem with that one setting, and not necessarily a diagnosis of ADHD.

There must be clear evidence of clinically significant impairment in social, academic or occupational functioning. Now this is very important. Impairment makes this a disorder. If there is no impairment there is no disorder. If you have six of nine criteria and no impairment then you don’t have ADHD. In other words it is a problem, it is a disorder because it interferes and impairs with the functioning. The normal developmental tasks for the individual are not working properly.

The last criterion in the diagnosis of ADHD is that the symptoms do not occur during the course of another disorder such as schizophrenia, psychotic disorder, PDD or autism, mood disorder etc.

There are three possible diagnoses with ADHD. They include:

• ADHD Combined Type
• ADHD Predominantly Inattentive Type
• ADHD Predominantly Hyperactive Impulsive Type

ADHD Predominantly Inattentive Type: This diagnosis used to be called ‘ADD’, or attention deficit disorder (i.e. without hyperactivity). This term is no longer officially used, though you can find it in many settings. This diagnosis includes people who have trouble paying attention, but do not have hyperactivity, or impulsivity.

ADHD Predominantly Hyperactive Impulsive Type: This diagnosis refers to individuals who are quite hyperactive, fidgety, restless, and impulsive. However, they do not have significant trouble paying attention. This subgroup is the least commonly seen of the diagnoses of ADHD, and researchers suggest that by adolescence or adult life, most people with this diagnosis end up with the combined type.

ADHD Combined Type: This diagnosis refers to those individuals who have significant inattention as well as hyperactivity and impulsivity.

What are some of the criticisms of the DSM-IV ADHD Diagnostic Criteria?

1) Field trials were done on children with ADHD to help to establish the criteria and the cut off levels. However, the field trials were predominantly done in boys aged six to 12 years old. This means that these diagnostic criteria are not great for diagnosing girls with ADHD, as well as adults with ADHD. Expert clinicians will have to adjust the criteria to suit girls and adults.

2) This is the only disorder in the DSM that has an onset age where you have to have symptoms before the age of seven. When reviewing this with experts in the field I’ve learned that the scientists are challenging this. Now if somebody shows up at the age of 30 and never had trouble with inattention previously they wouldn’t get the diagnosis of ADHD. There would have to be something else going on. The reason for this criterion is that ADHD is a developmental disorder - i.e. it starts in childhood. However, the age of 7 is somewhat arbitrary, and it may be changed in the future editions of the DSM to ‘pre-puberty’.

So we started off with a question: How do you know if you have ADHD?

In summary, it is a clinical assessment - which means that you meet a professional with expertise in the field and you answer questions. There are no lab tests, xrays or brain scans which can diagnose ADHD.

This article served to review the DSM criteria and I will cover more of the diagnostic issues in our next newsletter.

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Written by Dr. Kenny Handelman - The ADHD Doctor


To find get a FREE special report on ADD/ADHD Medication, visit: Medication Mastery

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