9 Jan 2020
One day a little patient with his mom came to doctor's appointment. The boy was hyperactive, he never stopped moving, couldn't sit still, was chatting all the time, his attention was leaping from one object to another… and his mom was always screaming: "Calm down! Sit down! Shut up! How tired I am!" Apparently, such situation was typical in their life. Mom was very annoyed by her son's behavior. The boy felt that he wasn't like the rest and it drove him into depression and his behavior became the worst.

So, what happened to him?

This boy and 120mln such children around the world have the attention-deficit/hyperactivity disorder (ADHD).

Attention-deficit/hyperactivity disorder is considered to be a chronic, neurobehavioral disorder that is classically characterized by symptoms of inattention, impulsivity, and hyperactivity. The disorder is particularly relevant in today's society as it is one of the most common diagnoses in educational and children's mental health settings. ADHD is believed to typically onset in early childhood, although diagnosis is typically determined in the school age years. Furthermore, many children diagnosed with the disorder go on to have problems related to education, social functioning, and/or other mental illness as adolescents and young adults.

Three subtypes of ADHD are now recognized: predominantly inattentive, predominantly hyperactive/impulsive, and a combined type, characterized by a combination of the first 2 subtypes.

What is the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) criteria for diagnosing ADHD?

Predominantly inattentive type.
Inattention is the inability to complete a task carefully, pay attention, or think about, listen to, or watch someone or something. When it comes to ADHD, children must have had 6 of the symptoms listed below (5 for individuals older than 17 years):
1. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities;
2. Often has trouble holding attention on tasks or play activities;
3. Often does not seem to listen when spoken to directly;
4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, sidetracked);
5. Often has trouble organizing tasks and activities;
6. Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework);
7. Often loses things necessary for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones);
8. Is often easily distracted;
9. Is often forgetful in daily activities.

Predominantly hyperactive/impulsive type.
People with ADHD also have problems with hyperactivity and impulsivity. Hyperactivity is simply having a high level of activity or excitement. Impulsivity is defined as acting suddenly on an idea or emotion, without first thinking it through. To diagnose hyperactivity, a person must have had 6 of the following symptoms (5 for individuals older than 17 years):
1. Often fidgets with or taps hands or feet or squirms in seat;
2. Often leaves seat in situations when remaining seated is expected;
3. Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless);
4. Often unable to play or take part in leisure activities quietly;
5. Is often "on the go," acting as if "driven by a motor";
6. Often talks excessively;
7. Often blurts out an answer before a question has been completed;
8. Often has trouble waiting for his or her turn;
9. Often interrupts or intrudes on others (e.g., butts into conversations or games).

And the last one is ADHD combined type. The individual meets the criteria for both inattention and hyperactive-impulsive clinical features.

A diagnosis is based on the symptoms that have occurred over the past 6 months.

1) American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Publishing; 2013
2) Sharma, A., & Couture, J. (2013). A Review of the Pathophysiology, Etiology, and Treatment of Attention-Deficit Hyperactivity Disorder (ADHD). Annals of Pharmacotherapy, 48(2), 209–225. doi:10.1177/1060028013510699
3) Matthews, M., Nigg, J. T., & Fair, D. A. (2013). Attention Deficit Hyperactivity Disorder. Current Topics in Behavioral Neurosciences, 235–266. doi:10.1007/7854_2013_249

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