Attention-Deficit/Hyperactivity Disorder

Diagnostic Criteria

The official diagnostic criteria presented here (below the list of selected research references) are from DSM-IV -- The Diagnostic and Statistical Manual of Mental Disorders (4th Ed.). Washington, DC: American Psychiatric Association (1994).

It's not what people know that's deceiving; it's what they know that's not true.

    Misdiagnosis. Misclassification. Misintervention. Miseducation. When one hears of instant cures, spontaneous recovery, diet-based remedy, and the like, check the published literature. This website, along with a nearby college or university library, will assist all genuine efforts to "get the facts." In addition, several "starter references" are provided below in our attempt to combat False Authorities.

Please read the following closely, carefully...

Some Facts (New York Daily News, 3/2/99)

• 5 million Americans have been diagnosed with ADD.

• At least 3% of the school-age population has ADD syndrome.

• Another 10% of the school-age population has partial ADD syndrome with other problems, such as anxiety and depression.

• Boys are about four times more likely to develop ADD.

• Up to 65% of children manifest symptoms into adulthood.

• There has been a 700% increase in the amount of Ritalin produced in the U.S.

• 50% of all mental health referrals for children are ADD-related.

Summary: ... a neurological syndrome with three major components: impulsive behavior, distractibility, hyperactivity. So, is this a suddenly "in" diagnosis for confessional parents or a set of behaviors characteristic of most any normal young child not glued to the TV, video machine, or PC?

Not everyone agrees that ADHD is "learning problem" or "handicap." However, among those who do consider it a serious handicap, many genuine authorities suggest that it may result from inadequate levels of two chemicals in the brain: norepinephrine and dopamine. The result: Sensory overload, as the brain fails to screen out sensory input. Flooded with irrelevant sensory input and unable to do anything about it, ADHD kids are prevented from focusing on tasks at hand. Careless mistakes, distractibility, "hyper-ness," inattention in school, half-finished chores at home ....

Word of caution: The following behaviors are often seen in highly intelligent kids, not only in A-D-H-Ders: careless, inattentive, poor listener, fidget-prone, chatterbox, here-and-there and everywhere, sloppy, can't stay on-task very long, on-the-go, and yes, hyperactive! So what? Heck, the child may have a rich family life with lots of love and wants to get on with things; the child might simply be eager to learn and is impatient with those slowing it all down; the child might be the independent sort who knows what he or she wants to do next, if allowed....indeed, the kid may be normal (heaven forbid!).

Tread cautiously! Remember, much like 30 years ago when "LD" was all the rage, these days a hell of a lot of people stand to benefit from yet another label -- drug companies, a huge ADHD-specific educational lobby, workshop presenters, assessment developers, and a gross assortment of hangers-on! Just because industries and individuals stand to gain, you don't have to accept false blame. So read on -- carefully, cautiously, thoroughly, thoughtfully, and with a sense of objective balance.

Assessment

False authorities ignore facts. They want you to believe the fantasies that hold their lives together. Not so long ago, one persistent fantasy was that 'facilitative communication' "worked." A lot of people got hurt, some individuals were sued, and too much heartache and personal hurt was dumped on well- meaning people until research debunked that notion. Only false authorities and dreamers continue to cling to 'FC therapy'.
     These days a pet fantasy is that eager, energetic kids "must" be ADHD! That too shall pass. In the meantime, read the research, search the literature, contact the experts. If you do, you will discover a fact conveniently ignored by the fantasy-huggers: No published research documents the assertion that all or even most of "really active" kids are ADHD. How easily ignorance discounts research.

     There are several assessment tools used by genuine experts to evaluate children regarding ADHD. Some of those instruments are: (1) DSM (below). (2) ADHD Rating Scale (DuPaul, 1991). (3) Attention Problems subscale of the Child Behavior Checklist (Achenbach, 1991). (4) Diagnostic Interview Schedule for Children (Fisher, Wicks, Shaffer, Piacentini, & Lapkin, 1992).
     Generally, no one tool is relied upon for a determination; other of the instruments (and still others) are used to confirm, verify, and re-verify that the assessment is as accurate as extant science presently allows (see Shapiro citation below).

References (just the facts)

Atkins, M.S., Pelham, W.E., & Licht, M.H. (1985). A comparison of objective classroom measures and teacher ratings of attention deficit disorder. Journal of Abnormal Child Psychology, 13, 155-167.

Barkley, R.A. (1990). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York, NY. Guilford Press.

Barkley, R.A. (1998). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment (2nd ed.) New York, NY: Guilford Press.

Barkley, R.A. (1997). ADHD and the nature of self-control. New York, NY: Guilford Press.

Barkley, R.A., DuPaul, G.J., & McMurray, M.B. (1990). Comprehensive evaluation of attention deficit disorder with and without hyperactivity as defined by research criteria. Journal of Consulting and Clinical Psychology, 58, 775-789.

Comings, D.E., & Comings, B.G. (1984). Tourette's syndrome and attention deficit disorder with hyperactivity: Are they genetically related? Journal of the American Academy of Child Psychiatry, 23, 138-146.

Cowan, N. (1995). Attention and memory: An integrated framework. New York: Oxford University Press.

DuPaul, G.J. & Stoner, G. (1994). ADHD in the schools: Assessment and intervention strategies. New York, NY: Guilford Press.

Frick, P.J., & Lahey, B.B. (1991). The nature and characteristics of attention- deficit hyperactivity disorder. School Psychology Review, 20, 163-173.

Goldstein, S. & Goldstein, M. (1998). Attention deficit hyperactivity disorder: A guide for practitioners. New York, NY: Wiley Interscience Press.

Greenhill, L.L. & Osman, B.B. (1991). Ritalin: Theory and patient management. New York, NY: Liebert, Inc.

Halperin, J.M., Gittelman, R., Klein, D.F., & Rudel, R.G. (1984). Reading-disabled hyperactive children: A distinct subgroup of attention deficit disorder with hyperactivity? Journal of Abnormal Child Psychology, 12, 1-14.

Henker, B., & Whalen, C.K. (1989). Hyperactivity and attention deficits. American Psychologist, 44, 216-223.

Hinshaw, S.P. (1994). Attention deficits and hyperactivity in children. Thousand Oaks, CA: Sage.

Lahey, B.B., Strauss, C.C., & Frame, C.L. (1984). Are attention deficit disorders with and without hyperactivity similar or dissimilar disorders? Journal of the American Academy of Child and Adolescent Psychiatry, 23, 302-309.

Landau, S., & Moore, L.A. (1991). Social skill deficits in children with attention-deficit hyperactivity disorder. School Psychology Review, 20, 235-251.

Matson, J.L. (1993). Handbook for hyperactivity in children. Boston, MA: Allyn & Bacon

McBurnett, K., Lahey, B.B., & Pfiffner, L.J. (1993). Diagnosis of attention deficit disorder in DSM-IV: Scientific basis and implications for education. Exceptional children, 60, 108-117.

Meents, C.K. (1989). Attention deficit disorder: A review of the literature. Psychology in the Schools, 26, 168-178.

Nadeau, K.G. (1995). A comprehensive guide to attention deficit disorder in adults. New York, NY: Brunner/Mazel Publishers.

Prior, M., & Sanson, A. (1986). Attention deficit disorder with hyperactivity: A critique. Journal of Child Psychology and Psychiatry, 27, 307-319.

Ray, B.A. (1969). Selective attention: The effects of combining stimuli which control incompatible behavior. Journal of the Experimental Analysis of Behavior, 12, 539-550.

Ray, B.A. (1972). Strategy in studies of attention: A commentary on D.L. Mostofsky's Attention: Contemporary theory and analysis. Journal of the Experimental Analysis of Behavior, 17, 293-297.

Shapiro, E.S. (1996). Academic skills problems: Direct assessment and intervention (2nd ed.). New York: Guilford.

Varley, C.K. (1984). Attention deficit disorder (the hyperactive syndrome): A review of selected issues. Journal of Developmental and Behavioral Pediatrics, 5, 254-258.

Waldman, I.D., & Lilienfeld, S.O. (1991). Diagnostic efficiency of symptoms for oppositional defiant disorder and attention-deficit hyperactivity disorder. Journal of Consulting and Clinical Psychology, 59, 732-738.

Wallander, J.L., & Hubert, N.C. (1985). Long-term prognosis for children with attention deficit disorders with hyperactivity (ADD/H). In B.B. Lahey & A.E. Kazdin (Eds.), Advances in clinical child psychology (Vol. 8, pp. 114-147). New York: Plenum.

Weiss, G., & Hechtman, L.T. (1993). Hyperactive children grown up (2nd ed.). New York: Guilford.

The Genuine Authority Definition of ADHD

Source: DSM-IV -- The Diagnostic and Statistical Manual of Mental Disorders (4th Ed.). Washington, DC: American Psychiatric Association (1994).

Page 83

"314.00 Attention-Deficit/Hyperactivity Disorder

Characteristics of ADHD have been demonstrated to arise in early childhood for most individuals. This disorder is marked by chronic behaviors lasting at least six months with an onset often before seven years of age."

"(A) Either (1) or (2):

    (1) six (or more) of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with the developmental level:

Inattention
(a) often fails to give close attention to details or makes careless mistakes

(b) often has difficulty sustaining attention

(c) often does not seem to listen when spoken to directly

(d) often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)

(e) often has difficulty organizing tasks and activities

(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)

(g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)

(h) is often easily distracted by extraneous stimuli

(i) is often forgetful in daily activities

         OR
    
(2) six (or more) of the following symptoms of hyperactivity have persisted for at least six months to a degree that is maladaptive and inconsistent with the developmental level:

Inattention
(a) often fidgets with hands or feet or squirms in seat

(b) often leaves seat in classroom or in other situations in which remaining seated is expected

(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)

(d) often has difficulty playing or engaging in leisure activities quietly

(e) is often "on the go" or often acts as if "driven by a motor"

(f) often talks excessively

Impulsivity
(g) often blurts out answers before questions have been completed

(h) often has difficulty awaiting turn

(i) often interrupts or intrudes on others (e.g., butts into conversations or games)

(B)Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

(C)Some impairment from the symptoms is present in 2 or more settings (e.g., at school for work and at home).

(D)There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

(E)The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorders, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorer (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder)."

Remember:

As yet, there is no biological or psychological test that makes a definitive diagnosis diagnosis of ADHD. Clinical history of abnormality and impairment are thus important ingredients of any diagnosis.

A diagnosis of ADHD will often include assessment of intellectual, academic, social and emotional functioning. A medical examination is also important -- to rule out possible causes of ADHD-like symptoms (e.g., adverse reaction to medications, thyroid problems, etc.)

Treatment often involves (a) medication or (b) a non-medical treatment (often involving psychosocial interventions) or (c) a combination of the two approaches (called multimodality treatment).

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(Please go to References Section of this website for a wide selection of published articles on attention issues from top research journals.)

Reminder: Please consider downloading Biblio-Refs -- THE practical Research Assistant, if you're serious.