Counseling Points - Psychiatric 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. 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.These treatments can rapidly become cost-prohibitive for families and school districts required to provide numerous services. A child’s health insurance coverage frequently has limited behavioral/mental health benefits; thus, the costs of mental health counseling and behavioral training become the responsibility of the 5 child’s school system and parents. School distr icts, although responsible for providing the majority of academic and behavioral interventions, have few, if any, options for seeking reimbursement for these services and must support them out of the general school budget. Many school districts are frankly unsympathetic to families of children with ADHD, and parents can find themselves in an adversarial position while advocating for their child.15 Because of the all-encompassing nature of ADHD and the numerous issues faced by families, many parents of children with ADHD experience significant stress, as well as depression and marital discord.15,16 The societal burden is increased when children are not diagnosed in a timely manner and/or receive ineffective treatment. Such children are more likely to experience academic failure, difficulty in maintaining peer relationships, substance abuse, and mental health problems, all of which augur poorly for successful long-term interpersonal relationships and occupational success in adulthood.7,10,17,18 NOVEMBER 2008

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Counseling Points - Psychiatric Nurse 11/08

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