How is ADHD Diagnosed?

October 6, 2013 at 11:39 pm

The current diagnosis criteria for Attention Deficit Hyperactivity Disorder (ADHD) is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), currently in it’s fifth edition.  The consensus in the scientific literature is that ADHD affects somewhere in the region of 3-5% of Adults, and up to 7% of children. Given how disruptive the condition can be, I think everyone should take five minutes to familiarise themselves with what ADHD is and how to spot it in others.

 

According to the DSM-V, ADHD comes in three main forms:

ADHD – Predominantly Inattentive (without the Hyperactivity)
ADHD – Predominantly Hyperactive (without the Inattention)
ADHD – Combined Type (Inattention and Hyperactivity)

I have the Predominantly inattentive type, which is why I refer to it as Attention Deficit Disorder (ADD). Whilst I do have some symptoms of hyperactivity, I don’t have enough to fulfil the criteria set out in the DSM-V for having the combined type of the disorder.

It is important to note therefore that not everyone with Attention Deficit  Hyperactivity Disorder (ADHD) is hyperactive. In fact according to Dr Russell Barkley at the Medical University of South Carolina,

“It is not hyperactivity that distinguishes adults with ADHD from normal adults or those having other disorders but distractibility, impulsive decision making and poor executive function (inattention)”.

To complicate matters, ADHD also significantly increases the chances of having other Psychological disorders such as depression, dysthymia, generalised anxiety disorder, alcohol and cannabis dependence and abuse disorders, a childhood history of Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). It is however not associated  with any higher risk for OCD or for Bipolar Disorder. Current research has shown that around 24-35% of adults with ADHD will have ODD and 17-25% will have CD, either currently or over the course of their earlier development. Hence the association most people have with ADHD simply being a disruptive childhood disorder.

 

How do I know if I have ADHD?

Well firstly, a diagnosis of ADHD can only be made in the UK by a Consultant Psychiatrist. GP’s in the NHS have varying degrees of awareness of ADHD, some are even reluctant to prescribe medication or even make referrals for the disorder. It can also take a while to get diagnosed. Although thankfully there are some NICE ADHD guidelines which require them to do so. Other websites have far more detailed information about getting a referral so I won’t bore you with the details. Instead for the purposes of this article I shall focus more on the symptoms of ADHD. Normally a Consultant would get you to complete various questionnaires and have at least a 2 hour consultation before reaching a diagnosis. The main criteria however is that you meet the requirements of the DSM-V.  A copy of these requirements can be found here, but according to Dr Barkley there is a better method for diagnosing adults with Attention Deficit Disorder than the current DSM-V guidelines…

I shall present Dr Barkley’s recommendations  over the DSM-V guidelines, because I would agree that they provide a more straight forward diagnosis algorithm for Adults. Unfortunately the DSM-V guidelines are still written primarily for diagnosing children with the disorder.

 

Dr Russell A. Barkley’s ADHD diagnosis guidelines:

A) Has six (or more) of the following symptoms that have persisted for at least six months to a degree that is maladaptive or developmentally inappropriate.

  • Often is easily distracted by extraneous stimuli or irrelevant thoughts.
  • Often makes decisions impulsively
  • Often has difficulty stopping his or her activities or behaviour when he or she should do so.
  • Often starts a project or task without reading or listening to directions carefully.
  • Often shows poor follow-through on promises or commitments he or she may make to others.
  • Often has trouble doing things in their proper order or sequence.
  • Often more likely to drive a motor vehicle much faster than others. [Alternative symptom for non-drivers: Often has difficulty in engaging in leisure activities quietly].
  • Often has difficulty sustaining attention in tasks or play activities.
  • Often has difficulty organising tasks or activities.

B) Some symptoms that caused impairment were present in childhood to adolescence (before age 16 years).

C) Some impairment from the symptoms is present in two or more settings (e.g. work, educational activities, home life, community functioning, social relationships).

D) There must be clear evidence of clinically significant impairment in social, educational, domestic (dating, marriage or cohabiting, financial, driving, child-rearing, etc), occupational or community 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).

 

Dr Barkley has gone to great length to justify the inclusion of these criteria over the current DSM-V guidelines in his book, ADHD in Adults – What the science says. It’s well worth owning a copy if you or someone you know has ADHD.  So I hope this list of symptoms helps you to understand what ADHD is, and whether you or someone you know might have the condition. The DSM-V criteria is ultimately the diagnosis criteria used by clinicians, so it may also be worth having a look at the official diagnosis guidelines for ADHD.

Tags: