The Diagnostic and Statistical Manual for Psychiatric Disorders, Fifth Edition (DSM-V) is often used to define the typical presentations of a child, adolescent, or adult whose behaviour suggests a diagnosis of ADHD. For the exact table, please refer to the DSM-V itself; however, the following notes provide an overview summary.
There are three ‘presentations’ or groups of behaviour:
There are nine symptoms or characteristic behaviours for Hyperactive/Impulsive, and nine for Inattentive. For children or adolescents up to the age of 17, to have a diagnosis determined, six of the nine behaviours in Hyperactive/Impulsive or Inattentive must be demonstrated. These behaviours should be noted in at least two different contexts and they must have lasted for at least six months. As well, they should be at a level that is inconsistent with normal developmental behaviour. For the Mixed presentation to be recognised as a diagnosis, the requirements for both presentations must be met (six of nine behaviours for each of Hyperactive and Inattentive).
Motor or physical movements: fidgets, taps, restless, finds it hard to stay seated, swings on chairs, runs, climbs; ‘driven’ – a dynamo;
Social and Personal Style Differences: finds it difficult to be quiet in social settings, talks excessively, in conversations might blurt out the answer or interrupt or might finish the sentence for the other person, finds it hard to wait and take turns, has limited capacity to regulate social behaviour (butts in, uses the possessions of others without permission).
Attentiveness: poor at close attention, makes careless mistakes, unable to maintain focus and attention even for short periods of time, is easily distracted by events in their setting (noise, movement, etc.);
Interaction and Learning Style: seems distracted or unfocused when you are talking to them, poorly organised with school work (does not follow instructions, does not finish school or homework), avoids tasks that require a lot of sustained effort, is poorly organised (poor time management, disorganised work space), loses important things, forgets daily chores and requirements.
First of all, ADHD is not confined to children and teenagers – ADHD often persists into adulthood and many adults present with some or all of the symptoms described above. Whether they need a diagnosis depends more on their own ‘need to know.’ Some adults are conflicted about their difficulty in managing attention, or acting impulsively, or finding that they are constantly ‘on the go.’ For some adults, a diagnosis off ADHD provides a welcome relief from not understanding their own behaviour. A consequence of diagnosis, for some people, is a visit to their medical practitioner to discuss the pros and cons of taking medication to deal with the ADHD symptoms.
But for young people, ADHD symptoms have implications for school and relationships. There is general agreement in the research on ADHD that at least a quarter and perhaps up to one-third of children and adolescents diagnosed with ADHD also have a co-occurring diagnosis – Learning Disabilities. There are different terms to describe a condition where a person has a substantial degree of difficulty with language, and/or written expression, and/or reading, and/or mathematics. One term in common use in USA is Specific Learning Disabilities (SLD); another is dyslexia. For more information on SLD refer to this website: https://www.psychiatry.org/patients-families/specific-learning-disorder/what-is-specific-learning-disorder
There is consensus that if a child has ADHD there is a high probability that there is a genetic-familial link (father, uncle or grandfather or mother, aunt, grandmother). But this does not help to confirm the diagnosis. There are quite specific guidelines for the assessment and the following gives an indication of the information that needs to be collected under specific conditions. I will use the expression student to replace child/adolescent as we are talking about school age children in this blog.
Who diagnoses? A specialist psychiatrist, paediatrician, or a health care professional, for example, a psychologist who has the training and expertise in ADHD.
What information is collected? The more developmental information one has – the better. Remember that the ADHD symptoms should have been present before age 7 and have lasted for at least six months. As well, the presentations will be causing significant impairment either at home or at school or in social settings. The symptoms will be unusual for the student’s level of development – and the symptoms are not a result of another physical or mental condition.
So, interviews, assessment in the clinic, teacher and parent reports, reports by other professionals are necessary for background information. It is essential to have thorough information on the student’s behaviour in at least two settings, typically home and school. As well, a complete history of the impact on the student’s general functioning is important.
What do I do at CBT? I integrate all of the background information to ensure a comprehensive picture of the student’s overall performance and behaviour is considered. Some years ago, I edited, with a colleague, a book on ADHD titled ADHD: Medical, Educational and Psychological Perspectives. Obviously, then, I believe in collecting all of the relevant information and perspectives.
I then use the industry standard rating scale, the Conners 3. There is one version for the teacher and one for the parents. These ratings can be completed online and when the parent and teacher are finished, I collate and examine all of the information. If necessary, I can make a school visit to observe the student and to discuss with the teacher their perspective. Obviously, it is easier to observe a primary school age child than an adolescent in high school!
On the basis of the information provided, I write a comprehensive report with suggested interventions. The parents can then share this report with their GP, Paediatrician, or Child Psychiatrist. I also write an abbreviated report that can be given to the teacher to help with classroom planning.
One issue always arises during this process – should I medicate my child or not? While I have conducted research on parents’ approach to medication, and while I know the literature on the pros and cons of medication, this is not my area of expertise. I suggest to the parents that they should discuss medication issues with their medical professional such as the child’s paediatrician or child psychiatrist.
Finally, and this is most important of all, during this process I explain clearly to the child/adolescent, the target of all this activity, what it means to be experiencing ADHD symptoms and what a diagnosis might mean. After all, it is not only the parents and teachers who have to live with the symptoms and presentations – it is the children or adolescents themselves. If they have a clear understanding of the issues and appreciate that there is nothing ‘wrong’ with them, they usually feel more relaxed and relieved. Sometimes, I tell them that many adults experiencing ADHD say they actually benefit from the extra energy and excitement this fascinating ‘disorder’ brings with it!
This blog was written by Professor Jeff Bailey, registered psychologist and previous school principal. Jeff works at our Nerang clinic conduting child cognitive, educational and diagnostic assessments, providing a unique set of experience given his dual qualificataion in psychology and eduction. You can read more about Dr Jeff here. If you are concerned your child may have ADHD, the first step is to speak with your GP and ask to be referred to a psychologist experienced in working with children with ADHD. If you wish to consult CBT Professionals or Jeff Bailey, please download our Referral Fact Sheet Here and take it with you to your long consultation with your GP. We look forward to being of assistance.