|
The symptoms of ADHD are clustered according to criteria set out in clinical diagnostic systems. Diagnostic criteria for ADHD The major clinical diagnostic systems for children's mental and emotional disorders are the International Classification of Diseases, 10th edition (ICD-10) Classification of Mental and Behavioural Disorders (WHO 1993) and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American Psychiatric Association 1994). Characteristics of the diagnostic systems The ICD-10 consists of a volume of clinical descriptions and diagnostic guidelines, and a separate volume containing diagnostic criteria for research. The DSM-IV uses operational criteria and does not separate clinical from research criteria. The ICD-10 is an exclusive categorical system that does not allow multiple diagnoses, while DSM-IV allows multiple diagnoses to be applied in order of importance at presentation. The DSM-IV (and the earlier DSM-III-R) were developed using field trials and testing items against clinician diagnoses (Hart, Lahey, Loeber et al 1995; Frick, Lahey and Applegate 1994; Spitzer, Davies and Barkley 1990), although expert committees made final category decisions. The DSM-IV criteria for ADHD are listed below. The ICD-10 clinical description and diagnostic criteria for research are listed in Appendix A. DSM-IV criteria ÷ attention deficit/hyperactivity disorder A. Either (1) or (2): (1) six (or more) of the following symptoms of inattention have persisted for at least six 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 school work, 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 school work, chores, or duties in the workplace (not due to oppositional behaviour or failure to understand instructions); (e) often has difficulty organising tasks and activities; (f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as school work or homework); (g) often loses things necessary for tasks or activities (eg 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 hyperactivity÷impulsivity have persisted for at least six 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 (eg Îbutts intoâ conversations or games). B. Some hyperactiveöimpulsive or inattentive symptoms that caused impairment were present before age seven years . C. Some impairment from the symptoms is present in two or more settings (eg 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 (eg mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The DSM-IV codes ADHD are as follows (ICD-10 research codes are almost identical): 314.01 Attention-deficit/hyperactivity disorder, combined type: if both criteria A1 and A2 are met for the past six months. 314.00 Attention-deficit/hyperactivity disorder, predominantly inattentive type: if criterion A1 is met but criterion A2 is not met for the past six months. 314.01 Attention-deficit/hyperactivity disorder, predominantly hyperactive-impulsive type: if criterion A2 is met but criterion A1 is not met for the past six months. The criteria for diagnosis of ADHD in DSM-IV and hyperkinetic disorder in ICD-10 are almost identical criteria related to inattention and hyperactivityöimpulsivity. While DSM-IV allows multiple diagnoses with co-morbid conditions such as Conduct Disorder, ICD-10 contains a separate category of the Hyperkinetic Conduct Disorder. This difference has important implications for prevalence studies. The DSM-IV and ICD-10 diagnostic criteria for research both require that symptoms should be observed in two out of three settings (home/school/clinic). This represents a change from DSM-III-R which allowed a diagnosis either at home or at school. Finally, the requirement for clinically significant impairment in social, academic or occupational functioning is an important addition to previous criteria.
|
