*This research is mostly relaying on Diagnostic and Statistical Manual of Mental Disorders (IV or 5)

General criteria of ADHD

1. Presence of symptoms of inattention, hyperactivity, and impulsiveness.

2. Onset before the age of 7 years and usually from birth.
3. At least moderate impairment of functioning in more than one setting (school, home and health care, i.e. your consulting room).
4. At least moderate impairment of function in several domains (school achievement, friendships, leisure activity or home life).
5. The symptoms do not happen only during the course of a pervasive developmental disorder, schizophrenia or other psychotic disorder. The symptoms are not better
accounted for by another mental disorder (for example, mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).

The DSM criteria break down ADHD symptoms into two main groups: inattentive and hyperactive-impulsive. Six of the nine symptoms in each section must be present for a
‘combined type’ diagnosis of ADHD. If there are insufficient symptoms for a combined diagnosis then predominantly inattentive (ADHD-I) and hyperactive (ADHD-H) diagnoses
are available. Additionally, symptoms must be: chronic (present for 6 months), maladaptive, functionally impairing across two or more contexts, inconsistent with developmental
level and differentiated from other mental disorders.
Differences in ADHD Criteria in Children and Adults (DSM-5, pp.60)
The essential feature of attention-deficit/hyperactivity disorder (ADHD) is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or
development. manifests behaviorally in ADHD as:
among adults
ADHD is diagnosed approximately 1.6 times more
often in men than in women.
may manifest as extreme restlessness or wearing
others out with their activity
Impulsive behaviors may manifest as social
intrusiveness (e.g., interrupting others excessively)
and/or as making important decisions without
consideration of long-term consequences (e.g.,
taking a job without adequate information).
wandering off task, lacking persistence, having
difficulty sustaining focus, and being disorganized
and is not due to defiance or lack of
comprehension.
Older children and young people often present with
a persistence less than their peers (<30 minutes), a
lack of focus on details of a task, poor planning
ahead, fidgetiness, poor self-control and reckless
risk taking.
DSM-IV-TR allows a category of ‘ADHD in partial
1
Impulsivity refers to hasty actions that occur in the moment without forethought and that have high potential for harm to the individual (e.g., darting into the street without
looking).
among children Symptoms of ADHD
ADHD is diagnosed approximately twice as often in Sex difference
boys than in girls.
refers to excessive motor activity (such as a child Hyperactivity
running about) when it is not appropriate, or
excessive fidgeting, tapping, or talkativeness
Impulsivity may reflect a desire for immediate Impulsivity1
rewards or an inability to delay gratification. Can
manifest in elderly age too.
Often fails to give close attention to details or Inattention
makes careless mistakes in schoolwork, at work, or
during other activities (e.g., overlooks or misses
details, work is inaccurate). // Often has difficulty
sustaining attention in tasks or play activities (e.g.,
has difficulty remaining focused during lectures,
conversations, or lengthy reading).
Children of primary school age typically present Age
with inability to sustain attention beyond ten
minutes whilst undertaking moderately challenging
activities, premature changes of activity and
appearing to be forgetful, disorganised and
distracted by the environment. In addition they
 remission’ for individuals who no longer meet the
full criteria; this criterion is particularly relevant for
adults where some of the symptoms may have
declined with age but where significant
impairments related to the symptoms remain.
Even in the absence of a specific learning disorder,
academic or work performance is often impaired.
individuals with ADHD may exhibit cognitive
problems on tests of attention, executive function,
or memory, although these tests are not sufficiently
sensitive or specific to serve as diagnostic indices.
disruptive behavior, issues with impulse-control,
and conduct disorders.
often act out of turn, interrupt other children and
blurt out an answer, are restless when calmness
would be expected and frequently break the rules
in a thoughtless way.
Mild delays in language, motor, or social Learning capability
development.
may include low frustration tolerance, irritability, or Mood swings
mood lability.

comorbidity of ADHD

1. ADHD has a negative impact on patient health-related quality of life that may be further exacerbated by, or may increase the risk of, other psychiatric conditions such
as anxiety and depression. (Coghill, Banaschewski, Soutullo, Cottingham & Zuddas. 2017.)
2. There is a high incidence of comorbidity with oppositional defiant disorder (35–50%) and conduct disorders (25%). Similarly comorbid learning disorders, anxiety,
depressive and tic disorders all occur with increased frequency. The majority of children with ADHD do not have any neurological symptoms, although ADHD is more
common in children with epilepsy and other brain pathology. (Ougrin, Chatterton & Banarsee. 2010)
3. Comorbidity of attention deficit hyperactivity disorder (ADHD) and reading disorder (RD) is frequent. Comorbid subjects show a neuropsychological profile
characterized by failure of various cognitive functions with an additive-effect that can determine more severe functional deficits. Comorbid RD may be a marker for a
group of children with ADHD with more severe cognitive deficits, and a worse neuropsychological, academic, and behavioral outcome. (Germanò, Gagliano, &
Curatolo. 2010.)
Over 80% of children with ADHD and 60% of children with RD meet the criteria for at least one additional diagnosis (Willcutt & Pennington, 2000a, 2000b)
 4. Attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) commonly co-occur. With the DSM-5, clinicians are permitted to make an ASD
diagnosis in the context of ADHD. In earlier versions of the DSM, this was not acceptable. Both ASD and ADHD are reported to have had substantial increases in
prevalence within the past 10 years. As a function of both the increased prevalence of both disorders as well as the ability to make an ASD diagnosis in ADHD, there
has been a significant amount of research focusing on the comorbidity between ADHD and ASD in the past few years. (Antshel, Zhang-James, Wagner, Ledesma &
Faraone. 2016.)
5. The association between learning disabilities (LD) and ADHD in children has been known and described since the 1970s. Furthermore, difficulties with diagnostic
confusion and discrimination have characterized the relationship between the two conditions. (Jensen, Martin & Cantwell. 1997).

medical conditions psychiatric conditions

Allergic factors (McGee et aI., 1993), Tourette's syndrome (Knell and Comings. 1993; Kurian. 1994)
asthma (Biederman er ai., 1994) bipolar disorder (West er aI., 1995; Wozniak et al.,1995)
infectious factors (specifically, group A β -hemolytic streptococcal infections) (Swedo Psychiatric comorbidities include oppositional defiant disorder, conduct disorder,
and Kiessling, 1994) anxiety, and depression (Jensen et al., 2001)
thyroid hormonal factors (Hauser et ai., 1993) Other types of comorbidities reported are RD, developmental coordination disorder,
and language disorder (Gilger, Pennington, & DeFries, 1992; Cohen et al., 2000)
Aetiology of ADHD (Ougrin, Chatterton & Banarsee. 2010)
A commonly held view is that there is nothing wrong with children who deal with ADHD apart from bad parenting, chaotic family environment or exposure to child abuse. This is
an important point and is subject to much controversy. The evidence so far points to both genetic and environmental factors playing a role in the aetiology of ADHD.
ADHD phenotype is associated with gene mutations in the dopamine transporter gene (DAT1) and the dopamine D4 receptor gene. There is dysfunction of dopamine and
noradrenalin metabolism, and of neurotransmission located in the prefrontal cortex and associated subcortical structures, that persists well into adulthood. There are various
figures for the heritability of ADHD symptoms. Studies have found up to 80% correlation in identical twins, 32% in fraternal twins and 25% in first-degree relatives.
Environmental effects, including maternal stress and smoking during pregnancy, poor quality early caregiving, perinatal complications and prematurity also play a role in the
aetiology of ADHD. However, there is not enough evidence to say that the children with symptoms of ADHD, who come from chaotic environments, are fundamentally different
from those who come from stable families. The diagnosis of ADHD should certainly not be ruled out purely on the basis that ‘no wonder this child is hyperactive, everyone
would be with this kind of family chaos’.

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