Counseling Points - Family/Pediatric Nurse 11/08 - (Page 5)

Table 1. DSM IV-TR Diagnostic Criteria for ADHD5 A. Either (1) or (2): (1) Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Inattention a. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities b. Often has difficulty sustaining attention in tasks or play activities c. Often does not seem to listen when spoken to directly d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) e. Often has difficulty organizing tasks and activities f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) g. Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools) h. Is often easily distracted by extraneous stimuli i. Is often forgetful in daily activities ((2) Six (or more) of the following symptoms of hyperactivityimpulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Hyperactivity a. Often fidgets with hands or feet or squirms in seat b. Often leaves seat in classroom or in other situations in which remaining seated is expected c. 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) d. Often has difficulty playing or engaging in leisure activities quietly e. Is often “on the go” or often acts “as if driven by a motor” f. Often talks excessively Impulsivity g. Often blurts out answers before questions have been completed h. Often has difficulty awaiting turn i. Often interrupts or intrudes on others (e.g., butts into conversations or games) B. Some hyperactive-impulsive or inattentive symptoms that caused impairment present before age 7 years. C. Some impairment from the symptoms present in two or more settings (e.g., at school [or work] and at home). D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning. E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, Personality Disorder). ADHD=attention deficit hyperactivity disorder; DSM IV-TR= Diagnostic and Statistical Manual of Mental Disorders IV-TR. Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders IV-TR. Washington; DC: American Psychiatric Association. 2000, pp 92-93. rates for preschool children are estimated at 2%-6%.10 The majority of adolescents diagnosed with ADHD earlier in life continue to meet the diagnostic criteria for an ADHD diagnosis. The prevalence of ADHD is higher in males than females. Boys are diagnosed more frequently than girls at a ratio of 2-4:1, probably because boys are more likely to exhibit hyperactivity and impulsivity and have their symptoms noticed. 9,11 Girls, who are more likely to have ADHD-I, tend to have symptoms that are less noticeable, which often leads to later or under-diagnosis. Children from low socioeconomic backgrounds and differing cultures may be diagnosed less frequently. Different diagnostic standards used by practitioners and the availability of community services affect prevalence rates, with under-, over-, and misdiagnosis of ADHD still being common problems. Estimated prevalence rates for adults are between 3.4% and 4.4%.9,12,13 5 Socioeconomic Burden Because ADHD can lead to impairments in virtually every aspect of a child’s life, it has a considerable impact on the child, family, and community. Approximately 30% of students with ADHD repeat a grade, up to 33% fail to complete high school, and only 5%-10% complete college.14 Approximately 50% of adolescents, and especially those with co-existing mental health conditions, engage in antisocial activities.14 Children with ADHD are also at increased risk for unintentional injuries compared with children without ADHD.10 Children diagnosed with ADHD are more frequent users of medical, mental health, and educational services than their nonaffected peers. The intensity and long-term nature of recommended multi-modal treatment approaches (academic interventions, social- and behavioral-skills training, and pharmacologic approaches) are expensive. NOVEMBER 2008

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Counseling Points - Family/Pediatric Nurse 11/08

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