What Are the Criteria for Diagnosing AD/HD?
One of the most common complaints teachers have about children and teenagers in classroom settings has to do with restless, impulsive, and inattentive behavior. Do all of these kids have AD/HD? In this article, Sam Goldstein, Ph.D., addresses this question.
No, they do not. In fact, the most common complaints of parents and teachers, particularly about young children, relate to restless, impulsive, and inattentive behavior. Just as not every sneeze is indicative of a cold, so too not every restless, impulsive, and inattentive behavior is indicative of AD/HD. When these problems are chronic, pervasive, occur across multiple situations, are not easily modified by behavior management or environmental manipulation, and, most importantly, cause significant day-in-and-day-out impairment, they may be indicative of AD/HD.
Ten years ago, the diagnostic process used for AD/HD did not require significant impairment for a diagnosis to be made. The current diagnostic protocol developed by the American Psychiatric Association requires symptoms be present in two or more major life domains and cause clinically impairing problems as compared to the general population. It is exactly for this reason that a thorough assessment beyond just a symptom count is essential when AD/HD is suspected.
In fact, when simple symptom counts are used as an initial screening for AD/HD, researchers have found that nearly one out of five children may meet symptom count in large, general populations. However, when more careful assessment is completed with these children focusing on the chronic nature of the problems, symptom severity, and impairment in general life, the numbers of those that meet the diagnostic criteria for AD/HD reduces significantly. In carefully controlled studies, the incidence of AD/HD is well under 10 percent, with a 3 to 5 percent figure reasonably representing children experiencing impairing symptoms sufficient to warrant a full syndrome diagnosis.
In reality, AD/HD is a very common condition, affecting at least one out of twenty kids to a significantly impairing degree. However, recognizing the commonality of the condition must be accompanied by a responsibility to avoid over-identification or diagnosis. It is rare that a child demonstrating hyperactive, impulsive, and inattentive problems is not thought to experience AD/HD. The problem then is false positives (over-identifying kids as having AD/HD) rather than false negatives (under-identifying kids with AD/HD).
The more specific we can be in identifying the symptoms, behaviors, and achievement problems kids with AD/HD experience in the classroom, the better prepared teachers will be to identify children at-risk and make appropriate referrals for assessment. Before a child at-risk for a diagnosis of AD/HD enters an organized school setting, his temperament exerts a significant influence on life experience and interactions with kids and adults. These children enter school with a number of misperceptions concerning themselves and their environment. In school settings, they are often victims of their temperament, making it difficult for them to persist with repetitive, uninteresting activities, and victims of their learning history that often reinforces them for beginning but not completing tasks. Teachers tend to focus on misbehavior rather than on its termination. This often further disrupts the classroom by having a disinhibitory effect on other children.
In school settings, children with AD/HD demonstrate a normal range of intellectual ability. Thus 2 percent of the population of children receiving a diagnosis of AD/HD suffer from sub-borderline intellectual ability with 2 percent demonstrating gifted intellect. The more intelligent child with AD/HD often manages to survive during the elementary school years and may not be referred for problems until academic and organizational demands increase dramatically in junior high school. At that point, even bright children with AD/HD begin to experience problems that interfere with school performance.
Children with AD/HD often under perform in academic subjects requiring practice for proficiency. Thus, absent any specific type of learning disability, they often struggle with the non-phonetic aspects of spelling, attention to detail in mathematics, and the execution (punctuation, spelling, etc.) of written language. The majority of children with AD/HD do not suffer from a learning disability. Only approximately 20 to 30 percent may experience a specific skill weakness, in addition to AD/HD, that causes them to fall behind academically.
Regardless of family, socioeconomic status, age, and gender, the limited self-control of children with AD/HD exerts a strong negative effect on their achievement, attitude toward school, and general behavior in school and social relations. Children with AD/HD are rarely chosen by peers as best friends, partners in activities, or seat mates. In the early elementary school years, they may be oblivious to their struggles, but by middle school years they tend to develop a rather helpless approach to school. In classroom settings, they may exhibit more negative verbalization and physical activity than their classmates.
It is essential that parents of kids with attention problems or AD/HD and school professionals work in a collaborative manner to develop a comprehensive management plan for both home and school. Resources identified below are excellent tools to assist parents, teachers, and kids in developing such an action plan.
AD/HD by Other Names and Acronyms
While Attention-Deficit/Hyperactivity Disorder (AD/HD) is the official term and acronym used by today's mental health care professionals, it is sometimes referred to by other names and abbreviations. For example, it is sometimes called:
- ADHD (without the "slash" in the middle)
- Attention Deficit Disorder (ADD)
- Attention Disorder
