New diagnosis guidelines for ADHD

By BRUCE EPSTEIN

© St. Petersburg Times, published June 7, 2000

Between 4 and 12 percent of all school age children may have attention deficit hyperactivity disorder, making it the most common childhood neurobehavioral disorder.

Children with this condition experience significant functional problems such as school difficulties, academic underachievement, troublesome relationships with family members and peers, and behavioral problems. Almost all of these youngsters suffer from low self-esteem and lack of self-confidence.

In recent years, there has been growing interest in ADHD as well as concerns about possible over-diagnosis and over-medication. Surveys among pediatricians and family physicians across the country revealed wide variations in diagnostic criteria and treatment methods for ADHD.

All effective treatment must begin with an accurate, well-established diagnosis. That's why the American Academy of Pediatrics released new recommendations in May 2000 for the evaluation of school-age children with attention-deficit/hyperactivity disorder. A panel of medical, psychological and developmental experts developed the new diagnostic guidelines. The guidelines are designed for children ages 6 to 12. Diagnosis of hyperactivity and ADHD in children 5 and younger is unreliable, because children change so rapidly during the preschool years.

The diagnosis guidelines recommend that ADHD evaluations be initiated for children age 6 to 12 who are experiencing the following:

School difficulties

Academic underachievement

Troublesome interpersonal relationships with family members and peers and/or low self-esteem

The academy urged parents and teachers to help the child's physician by providing the doctor with information about the child's school and behavioral problems. This can be done by either speaking directly to the doctor or by filling out pre-visit questionnaires. Of particular importance is teacher questionnaires available to most doctors that describe the child's classroom behavior and performance.

In diagnosing ADHD, physicians were encouraged to use strict medical criteria developed by the American Psychiatric Association. These guidelines require that ADHD symptoms be present in two or more of a child's settings. For example, a child must show symptoms at both school and home. Also, the symptoms must be present for at least six months and adversely affect both the child's academic and social functioning in order to be diagnosed as ADHD.

Evaluation of a child with ADHD should also include assessment for co-existing conditions: learning and language problems, aggression, disruptive behavior, depression or anxiety. As many as one-third of children diagnosed with ADHD also have a co-existing condition. Other diagnostic tests, sometimes considered positive indicators for ADHD, have been reviewed and considered not effective. These tests include lead screening, tests for thyroid hormone, chemical analysis of hair follicles, and brain image studies.

It is hoped that with the new diagnostic guidelines, the diagnosis of ADHD will occur less often, while ensuring that those children who have ADHD will receive proper evaluation and treatment. The academy is also developing treatment guidelines, which are scheduled for release later this year.

Diagnostic Criteria for Attention-Deficit Hyperactivity Disorder, American Academy of Psychiatry

A. Either 1 or 2:

1. Should have 6 or more of the following symptoms of inattention, persisting for at least 6 months to a degree that is maladaptive and inconsistent with developmental level.

Often fails to give close attention to detail, makes careless mistakes.

Often has difficulty sustaining attention in tasks or play.

Often does not seem to listen when spoken to directly.

Often does not follow through and fails to finish tasks.

Has difficulty organizing tasks and activities.

Avoids or dislikes tasks requiring sustained mental effort.

Often loses things necessary for tasks or activities.

Is often easily distracted by extraneous stimuli.

Is often forgetful in daily activities.

2. Should have 6 or more of the following symptoms of hyperactivity-impulsivity persisting for at least 6 months to a degree that is maladaptive and inconsistent with developmental level.

Often fidgets or squirms when sitting.

Has difficulty remaining seated when required to do so.

Often runs about or climbs excessively in inappropriate situations.

Has difficulty playing quietly.

Is often "on the go," acts as if "driven by a motor."

Often talks excessively.

Often blurts out answers to questions before they have been completed.

Has difficulty awaiting turn.

Often interrupts or intrudes on others.

B. Onset of some symptoms before the age of 7.

C. Symptoms occur in two or more settings (home and school, for example).

D. Clear evidence of significant impairment in social or academic functioning.

E. Not caused by a pervasive development disorder or another other psychologic disorder, including anxiety or depression.

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