Attention-Deficit Hyperactivity Disorder (ADHD) (Medical Mutual)

Table 1. Five Criteria for ADHD 1. Symptoms Î Inattention: ≥ 6 of following symptoms of inattention have persisted ≥ 6 mo to a degree that is maladaptive and inconsistent with developmental level: > Often fails to pay close attention to details or makes careless mistakes in schoolwork, work, or other activities > Often has difficulty in sustaining attention in 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, workplace duties (not due to oppositional behavior or failure to understand) > Often has difficulty organizing tasks and activities > Often avoids, dislikes, or is reluctant to engage in tasks requiring sustained mental effort (eg, schoolwork, homework) > Often loses things necessary for tasks or activities (eg, written instructions, school assignments, textbooks, pencils, tools, toys) > Often easily distracted by extraneous stimuli > Often forgetful in daily activities AND/OR Î Hyperactivity/impulsivity: ≥ 6 of following symptoms of hyperactivity-impulsivity have persisted ≥ 6 mo to a degree that is maladaptive and inconsistent with developmental level: > Hyperactivity ` Often fidgets with hands or feet and squirms in seat ` Often leaves seat in classroom or other situations where remaining seated is expected ` Often runs about or climbs excessively in situations where considered inappropriate (in adolescents, may be limited to subjective feelings of restlessness) ` Often has difficulty playing or engaging in leisure activities quietly ` Often "on the go" or acts as if "driven by a motor" ` Often talks excessively > Impulsivity ` Often blurts answers before questions completed ` Often has difficulty awaiting turn ` Often interrupts/intrudes on others (eg, butts into conversation, games) PLUS: 2. Some inattention or hyperactivity-impulsivity to be consistent symptoms causing impairment present before age 7 3. Some impairment from symptoms present in 2 or more settings (eg, home, school/work, social a ) 4. Clear evidence of clinically significant impairment in social, academic, or occupational functioning 5. Symptoms do not occur exclusively during course of a pervasive developmental disorder, schizophrenia, or psychotic disorder and are not better accounted for by another mental disorder (eg, mood disorder, anxiety disorder, dissociative disorder, personality disorder) Types of ADHD ADHD, Combined Type: Criteria for inattention AND hyperactivity-impulsivity met for past 6 mo (DSM-IV code 314.01; ICD-10 code F90.0) ADHD, Predominantly Inattentive Type: Criteria for inattention met but criteria for hyperactivity-impulsivity NOT met for past 6 mo (DSM-IV code 314.00; ICD-10 code F98.8) ADHD, Predominantly Hyperactive-Impulsive Type: Criteria for hyperactivity-impulsivity met but criteria for inattention NOT met for past 6 mo (DSM-IV code 314.01; ICD-10 code F90.0) a Clinical consensus is that severe impairment in one setting can warrant treatment for ADHD (eg, inordinate amount of time after school completing schoolwork not done in class). NOTE: • Symptoms may not be observable when patient is in highly structured or novel settings, engaged in interesting activity, receiving one-to-one attention or supervision, or in a situation with frequent rewards for appropriate behavior. • Symptoms typically worsen in situations that are unstructured, minimally supervised, boring, or require sustained attention or mental effort. • In adolescents, symptoms include restlessness (rather than hyperactivity as seen in children), impaired academic performance, low self-esteem, poor peer relations, and erratic work record.

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