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The current debate around attention deficit hyperactivity disorder (ADHD) centres on whether it is a formal disorder or a cluster of symptoms. The number of behavioural and developmental disorders that affect young children with symptoms of ADHD is increasing. This means it is important to properly assess the causes of their symptoms. Their symptoms can include: Difficulty paying attention - Impulsivity
- Overactivity.
All young children have a limited attention span and sometimes do things without thinking. Only a few of these children have ADHD. There is no single test. A diagnosis can only be made after a range of information is collected, especially from the parents. A paediatrician, child psychologist or child psychiatrist can make the assessment or arrange a referral. Assessments must include a developmental history of the child's past behaviours. Issues related to early attachment to a parent or caregiver, which may contribute to the behaviour, are also assessed. The diagnosis of ADHD is made after a clinical assessment and supplemented by a variety of internationally recognised scales. Inattention criteria The following criteria for inattention are often used to diagnose the inattention 'component' of ADHD. Six or more of these symptoms of inattention must be present for at least six months to a degree that is a problem and inconsistent with developmental level. To meet these criteria the child must, on a regular basis: - Fail to give close attention to details or make careless mistakes in school work, work or other activities.
- Have difficulty sustaining attention in tasks or play activities.
- Not seem to listen when spoken to directly.
- Not follow through on instructions and fail to finish school work, chores or duties in the workplace (but not because they are being wilful or do not understand instructions).
- Have difficulty organising tasks and activities.
- Avoid, dislike or be reluctant to engage in tasks that require sustained mental effort (such as school work or homework).
- Lose things necessary for tasks or activities (for example: toys, school assignments, pencils, books or tools).
- Be easily distracted.
- Be forgetful in daily activities.
Hyperactivity-impulsivity criteria The following criteria are often used to diagnose the hyperactivity-impulsivity commonly associated with ADHD. Six or more of these symptoms must be present for at least six months to a degree that is a problem and inconsistent with the child's developmental level. Hyperactivity - Often fidgets with hands or feet or squirms in seat.
- Often leaves seat in classroom or in other situations in which remaining seated is expected.
- Often runs about or climbs excessively in situations in which it is inappropriate.
- Often has difficulty playing or engaging in leisure activities quietly.
- Is often 'on the go' or often acts as if 'driven by a motor'.
- Often talks excessively.
Impulsivity - Often blurts out answers before questions have been completed.
- Often has difficulty waiting in turn.
- Often interrupts or intrudes on others (for example, 'butts into' conversations or games).
Other criteria Other criteria may include: - Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before the age of seven years.
- Some impairment from the symptoms is present in two or more settings, such as at school and at home.
- There must be clear evidence of clinically significant impairment in social, academic or occupational functioning.
- The symptoms do not occur exclusively during the course of a developmental disorder, a mental illness like schizophrenia or other psychotic disorder, and are not better accounted for by another disorder (for example: mood disorder, anxiety disorder, dissociative disorder or a personality disorder).
Type of disorder Using the above criteria, the health professional can determine the type of disorder, including: - ADHD combined type - if both criteria for inattention and hyperactivity-impulsivity are met for the past six months.
- ADHD predominantly inattentive type - if criteria for inattention are met but the criteria for hyperactivity- impulsivity are not met in the past six months.
- ADHD predominantly hyperactive-impulsive type - if criteria for hyperactivity-impulsivity are met but the criteria for inattention are not met in the past six months.
Possible contributing factors The exact cause of ADHD is unknown, but suspected contributing factors may include: - Neurophysiology - including differences in brain anatomy, electrical activity and metabolism.
- Genetics - some research suggests possible gene mutations may be present.
- Drugs - drug use (nicotine and cocaine) by the mother during pregnancy may contribute.
- Lead - chronic exposure to low levels of lead may influence behaviour and brain chemistry.
- Lack of early attachment - if a baby does not bond with a parent or caregiver, or has traumatic experiences related to the attachment, it can contribute to inattention and hyperreactivity.
- Childhood post traumatic stress disorder - this may present with features of ADHD, yet require different treatment.
Where to get help Your doctor
Paediatrician
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