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Attention deficit hyperactivity disorder diagnosis

Thecurrentdebatearoundattentiondeficithyperactivitydisorder(ADHD)centresonwhetheritis aformaldisorderoraclusterofsymptoms.Thenumberofbehaviouralanddevelopmental disordersthataffectyoungchildrenwithsymptomsofADHDisincreasing.Thismeansitis importanttoproperlyassessthecausesoftheirsymptoms.Theirsymptomscaninclude: Difficultypayingattention Impulsivity Overactivity.

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Allyoungchildrenhavealimitedattentionspanandsometimesdothingswithoutthinking.Onlya fewofthesechildrenhaveADHD.Thereisnosingletest.Adiagnosiscanonlybemadeaftera rangeofinformationiscollected,especiallyfromtheparents. Apaediatrician,childpsychologistorchildpsychiatristcanmaketheassessmentorarrangea referral.Assessmentsmustincludeadevelopmentalhistoryofthechildspastbehaviours.Issues relatedtoearlyattachmenttoaparentorcaregiver,whichmaycontributetothebehaviour,are alsoassessed.ThediagnosisofADHDismadeafteraclinicalassessmentandsupplementedbya varietyofinternationallyrecognisedscales. Inattention criteria Thefollowingcriteriaforinattentionareoftenusedtodiagnosetheinattentioncomponentof ADHD.Sixormoreofthesesymptomsofinattentionmustbepresentforatleastsixmonthstoa degreethatisaproblemandinconsistentwithdevelopmentallevel.Tomeetthesecriteriathechild must,onaregularbasis: Failtogivecloseattentiontodetailsormakecarelessmistakesinschoolwork,workor otheractivities. Havedifficultysustainingattentionintasksorplayactivities. Notseemtolistenwhenspokentodirectly. Notfollowthroughoninstructionsandfailtofinishschoolwork,choresordutiesinthe workplace(butnotbecausetheyarebeingwilfulordonotunderstandinstructions). Havedifficultyorganisingtasksandactivities. Avoid,dislikeorbereluctanttoengageintasksthatrequiresustainedmentaleffort(such asschoolworkorhomework). Losethingsnecessaryfortasksoractivities(forexample:toys,schoolassignments, pencils,booksortools). Beeasilydistracted. Beforgetfulindailyactivities.

Hyperactivity-impulsivity criteria Thefollowingcriteriaareoftenusedtodiagnosethehyperactivity-impulsivitycommonlyassociated withADHD.Sixormoreofthesesymptomsmustbepresentforatleastsixmonthstoadegree thatisaproblemandinconsistentwiththechildsdevelopmentallevel. Hyperactivity Oftenfidgetswithhandsorfeetorsquirmsinseat. Oftenleavesseatinclassroomorinothersituationsinwhichremainingseatedisexpected. Oftenrunsaboutorclimbsexcessivelyinsituationsinwhichitisinappropriate. Oftenhasdifficultyplayingorengaginginleisureactivitiesquietly. Isoftenonthegooroftenactsasifdrivenbyamotor.

Attentiondeficithyperactivitydisorder-diagnosis

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Oftentalksexcessively.

Impulsivity Oftenblurtsoutanswersbeforequestionshavebeencompleted. Oftenhasdifficultywaitinginturn. Ofteninterruptsorintrudesonothers(forexample,buttsintoconversationsorgames).

Other criteria Othercriteriamayinclude: Somehyperactive-impulsiveorinattentivesymptomsthatcausedimpairmentwerepresent beforetheageofsevenyears. Someimpairmentfromthesymptomsispresentintwoormoresettings,suchasatschool andathome. Theremustbeclearevidenceofclinicallysignificantimpairmentinsocial,academicor occupationalfunctioning. Thesymptomsdonotoccurexclusivelyduringthecourseofadevelopmentaldisorder,a mentalillnesslikeschizophreniaorotherpsychoticdisorder,andarenotbetteraccounted forbyanotherdisorder(forexample:mooddisorder,anxietydisorder,dissociativedisorder orapersonalitydisorder).

Type of disorder Usingtheabovecriteria,thehealthprofessionalcandeterminethetypeofdisorder,including: ADHD combined type-ifbothcriteriaforinattentionandhyperactivity-impulsivityare metforthepastsixmonths. ADHD predominantly inattentive type-ifcriteriaforinattentionaremetbutthe criteriaforhyperactivity-impulsivityarenotmetinthepastsixmonths. ADHD predominantly hyperactive-impulsive type-ifcriteriaforhyperactivityimpulsivityaremetbutthecriteriaforinattentionarenotmetinthepastsixmonths.

Possible contributing factors TheexactcauseofADHDisunknown,butsuspectedcontributingfactorsmayinclude: Neurophysiology-includingdifferencesinbrainanatomy,electricalactivityand metabolism. Genetics-someresearchsuggestspossiblegenemutationsmaybepresent. Drugs-druguse(nicotineandcocaine)bythemotherduringpregnancymaycontribute. Lead-chronicexposuretolowlevelsofleadmayinfluencebehaviourandbrainchemistry. Lack of early attachment-ifababydoesnotbondwithaparentorcaregiver,orhas traumaticexperiencesrelatedtotheattachment,itcancontributetoinattentionand hyperreactivity. Childhood post traumatic stress disorder-thismaypresentwithfeaturesofADHD, yetrequiredifferenttreatment.

Where to get help Yourdoctor Paediatrician TheSpecialistChildrensServices,DepartmentofHumanServicesVictoriaTel.(03)9096 0000 TheResourceCentreforChildHealthandSafety(CHAS)Tel.(03)93456429 AttentionDeficitDisorderVictoria(ADDVic)Tel.1800233842 HyperactiveChildrensAssociationofVictoria(ACTIVE)Tel.(03)96502570

Things to remember Attentiondeficithyperactivitydisorder(ADHD)isoneofanumberofbehaviouraland developmentaldisordersthataffectyoungchildren. AchildwithADHDhasthreemainproblems:inattention,impulsivityandoveractivity.

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Thereisnosingletest,andadiagnosiscanonlybemadeafterarangeofinformationis collected,especiallyfromtheparents.

This page has been produced in consultation with, and approved by:

MonashUniversity-CentreforDevelopmentalPsychiatry&Psychology

Copyight 1999/2009StateofVictoria.ReproducedfromtheBetterHealthChannel(www.betterhealth.vic.gov.au)at nocostwithpermissionoftheVictorianMinisterforHealth.Unauthorisedreproductionandotherusescomprisedinthe copyrightareprohibitedwithoutpermission. ThisBetterHealthChannelfactsheethaspassedthrougharigorousapprovalprocess.Forthelatestupdatesandmore informationvisitwww.betterhealth.vic.gov.au.

Attentiondeficithyperactivitydisorder-diagnosis

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