Attention Deficit Hyperactivity Disorder

In 1994, the American Psychiatric Association (APA), published the Fourth Edition of its Diagnostic and Statistical Manual (DSM-IV). The DSM-IV classifies the disorder known as Attention Deficit Hyperactivity Disorder (ADHD) into three subtypes. These are:

ADHD Predominantly Inattentive Type: This diagnosis is for children, adolescents and adults who meet the criteria for Inattention but not for Hyperactivity and Impulsivity.

ADHD Predominantly Hyperactive-Impulsive Type: This diagnosis is for children, adolescents and adults who meet the criteria for Hyperactivity and Impulsivity but not for Inattention.

ADHD Combined Type: This diagnosis is for children, adolescents and adults who meet the criteria for Inattention, Hyperactivity and Impulsivity.

ADHD INFORMATION AND GUIDELINES

By Steven Singerman, M.Ed., M.S.W., R.S.W.

When a person presents with the constellation of behaviors that are common to Attention Deficit Hyperactivity Disorder, the clinician needs to conduct a thorough and comprehensive assessment since a manifestation of these behaviors does not necessarily equate with having ADHD. In fact, what may appear to be ADHD may be something different which, if left unidentified or misdiagnosed, can have serious consequences. The following list identifies a number of problem areas whose symptoms mimic those of ADHD:

1. Learning Disabilities
2. Cognitive deficits such as impairments in processing, output, language, memory,organization, mental energy and other areas.
3. Inappropriate classroom placement.
4. Sensory impairments
5. Psycho-social problems
6. Exposure to moderate or severely upsetting life events.
7. Exposure to loss or trauma
8. Depressive Disorders (including Juvenile Mania, or Manic Depression/Bi-Polar)
   Anxiety Disorders
9. Certain personality disorders
10. Various medical conditions
11. Sleep disorders
12. Petit-mal seizures
13. Fetal Alcohol Syndrome
14. Misuse of prescriptions, over the counter or street drugs

It is unfortunate that ADHD has become somewhat of a catch all label for almost anyone who exhibits some form of attentional, overactive, impulsive, non-compliant or disruptive behavior. This causes a disservice to the area and to those involved with it. On the other hand, many people with ADHD have been misdiagnosed, weren't identified earlier on, or for some reason have fallen through the cracks in the system. It is also possible that ADHD is only part of the individual's profile, and that in addition they have other co-existing problems. In fact, research indicates that at least 65-75% of people with ADHD have at least one other of the following disorders: Mood Disorder such as Depression, Anxiety Disorder, Oppositional Defiant Disorder, Conduct Disorder, Learning Disability, Tourette's Syndrome, or others. If these co-existing problems are not properly identified and addressed, there will be further and significant impairment in functioning. One also has to consider that there is a reciprocal relationship between the person with ADHD and their environment (i.e. family, school, work, social relationships). This further shapes and is shaped by intrapsychic forces. The synergy that all this creates often takes on a life and course of its own, and frequently becomes more problematic than the ADHD itself.

The ADHD spectrum is comprised of very difficult problems with far reaching tentacles and implications that can terribly tax individuals, families, educators and society as a whole. Research indicates that there is a high level of parent-child conflict, sibling difficulties, marital discord, anxiety, depression, and sometimes mistreatment in a number of these families. This may be related to the despair and stress of trying to manage a highly unmanageable child who seems designed to make any parent or educator feel inadequate, inept, helpless, hopeless, guilty and rageful. In fact, a number of traditional parenting and educational approaches do not work with this population. On the other hand, many people with attention deficit disorders grow to become leaders in society. [ For a list of famous people who have ADHD or learning disabilities, please send a self addressed stamped envelope to Concerned Parents' Seminars, 270 Acton Avenue , Toronto, ON, M3H 4J3.]

Those who meet the diagnostic criteria for ADHD do not represent one uniform group. Rather, ADHD is comprised of a very diverse group of people. Hence, "treatment" approaches and interventions can vary greatly from one person to the next.

In view of the above, a cautious and multi-modal approach to assessment and intervention must be employed. Conducting a rigorous and systematic evaluation will help to determine the therapeutic issues, and rule out or identify other problem areas. Rapid assessment followed by quickly moving into treatment is not recommended. In fact, a quick assessment followed by a medication prescription is contra-indicated and unethical. Rather, a legitimate assessment takes many hours and should include the following:

• Questionnaires and standardized rating scales completed by parents, educators, and child (depending on age).
• Child and parent interviews.
• Detailed medical, developmental, social, family and symptom history.
• Psycho-educational and/or neuro-developmental assessment.
• Telephone or face-to-face interview with the child's teacher(s).

Currently there exists no known cure for ADHD. However, given the extent of our knowledge and experience, ADHD should not prevent someone from leading a highly successful, productive and happy life. It is possible to become so specific about each person's profile that a strategic multi modal approach can be tailored to each person's situation. When this is judiciously implemented over the long term, the ADHD behaviors and impairments can be managed successfully in the majority of people.