ADHD: WHAT IS IT?

Although the history of individuals having problems with inattention dates all the way back to one of Shakespeare’s characters in King Henry VIII, serious clinical interest in this grouping of symptoms appears to have developed around 1902. An English physician, George Still, published descriptions of children in his practice whom he described as having a deficit in “volitional inhibition.” Over the years various diagnostic terms have been used including “minimal brain dysfunction” (MBD), “hyperkinetic reaction of childhood,” and Attention Deficit Disorder (ADD). The current terminology for this disorder is attention-deficit/hyperactivity disorder (ADHD).

The Primary Symptoms of ADHD:

At this time, two major symptoms are believed to be characteristic of ADHD: 1) inattention and 2) hyperactive-impulsive behavior (American Psychiatric Association, 2013).

Inattention is characterized by an individual’s inability to sustain attention to tasks and follow rules or instructions as well as others the same age. These children also tend to be much more disorganized, distracted, and forgetful. Common complaints about these children include being easily distracted, failing to finish assignments, having difficulty concentrating and difficulty listening.

Hyperactive-impulsive children may have difficulty staying seated, they may play noisily, talk excessively, interrupt others and have trouble waiting their turn. These problems may first appear as early as 3 or 4 years of age.

Inattentive symptoms tend to surface a little later, usually around the time that formal schooling begins-about six or seven.

The following list comes from: Centers for Disease Control and Provention 
www.cdc.gov/ncbddd/adhd/diagnosis.html
DSM-5 Criteria for ADHDPeople with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development:

1. Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
   • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
   • Often has trouble holding attention on tasks or play activities.
   • Often does not seem to listen when spoken to directly.
   • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
   • Often has trouble organizing tasks and activities.
   • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
   • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
   • Is often easily distracted
   • Is often forgetful in daily activities.
2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
   • Often fidgets with or taps hands or feet, or squirms in seat.
   • Often leaves seat in situations when remaining seated is expected.
   • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
   • Often unable to play or take part in leisure activities quietly.
   • Is often "on the go" acting as if "driven by a motor".
   • Often talks excessively.
   • Often blurts out an answer before a question has been completed.
   • Often has trouble waiting his/her turn.
   • Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:

• Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
• Several symptoms are present in two or more setting, (such as at home, school or work; with friends or relatives; in other activities).
• There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
• The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.

Based on the types of symptoms, three kinds (presentations) of ADHD can occur:Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.
Because symptoms can change over time, the presentation may change over time as well.