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DSM-IV ADHD Diagnosis


Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder are diagnosed by psychiatrists and psychologists with the DSM-IV criteria, which are descriptions of behaviour patterns. There is nothing in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision) linked to a physiological or neurological criteria. The manual states this clearly:


"There are no laboratory tests, neurological assessments, or attentional assessments that have been established as diagnostic in the clinical assessment of Attention-Deficit/Hyperactivity Disorder."

(DSM-IV-TR page 88)


Unfortunately most psychiatrists, psychologists and doctors have not read this section in the DSM-IV. It is this idea that a set of symptoms is a disorder that has caused most of the confusion surrounding ADHD. The DSM-IV lists symptoms and if these are used as a guide to find the solution for each individual, then the DSM-IV is very useful. There are over 100 causes for ADHD like behavior. For a discussion on the use of the word “disorder,” please go to the page onADHD solutions.


DSM-IV ADD/ADHD Diagnostic Criteria


Diagnostic criteria according to the DSM-IV for Attention-Deficit Hyperactivity Disorder are as follows:


A. Either (1) o r (2):

(1) At least six 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 stimuli unrelated to the subject or activity being dealt with.

(i) Is often forgetful in daily activities.

(2) At least six of the following symptoms of hyperactivity-Impulsivity 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, office meetings 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 were present before age 7 years.


C. Some impairment from the symptoms is present in two or more settings (e.g. at school [or work] and at home).


D. There must be dear 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, or a Personality Disorder).


Attention Deficit Types


Attention-Deficit/Hyperactivity Disorder, Combined Type: if both Criteria A1 and A2 are met for the past 6 months.


Attention Deficit/Hyperactivity Disorder. Predominantly Inattentive Type: if Criterion A1 is met but Criterion A2 is not met for the past 6 months.


Attention Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type: if Criterion A2 is met but Criterion A1 is not met for the past 6 months.


Attention-Deficit/Hyperactivity Disorder Not Otherwise Specified (NOS):This category is for disorders with prominent symptoms of inattention or hyperactivity-impulsivity that do not meet criteria for Attention-Deficit/ Hyperactivity Disorder.


Examples of Not Otherwise Specified include:


1. Individuals whose symptoms and impairment meet the criteria for Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type but whose age at onset is 7 years or after.


2. Individuals with clinically significant impairment who present with inattention and whose symptom pattern does not meet the full criteria for the disorder, but have a behavioral pattern marked by sluggishness, daydreaming, and hypoactivity.





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