DSM-IV Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder
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, (e.g., 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 do not happen only during the course of schizophrenia or another psychotic disorder. The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
No labs to exist to suggest ADHD, rather they will help rule-out other causes. ADHD is diagnosed by a careful psychiatric history, family history, evaluating ADHD symptoms as above, and searching for functional impairment at home, work, and relationships.
The primary treatment for ADHD is prescribed stimulants (i.e. Adderall, Concerta, Ritalin). ADHD is caused by functional impairments in the brain’s dopamine and norepinephrine neurotransmitter pathways. ADHD psychostimulants possess treatment efficacy because they increase neurotransmitter activity in these systems. These traditional stimulants come with many possible side effects, include increased blood pressure, heart rate, anorexia, anxiety, dehydration, and insomnia, due to the fact that they are in amphetamine family and similar to illegal drugs like cocaine. There has been reported incidents of sudden death in patients with underlying serious heart problems who were taking standard stimulant doses. Up to a 1/3 of patients often discontinue these stimulants because of uncontrolled symptoms and adverse effects. Thus, the use of these drugs are prescribed very cautiously and carefully for children, and often discouraged for many adults. Strattera is a non-stimulant, without abuse potential (unlike amphetamines), that is usually used as first-line treatments of adults and some children. Second line treatment choices are some antidepressant medications like Wellbutrin and Norpramin.
Though the mainstay of ADHD treatment is pharmacotherapy, some research suggest healthier and safer alternatives, like cognitive therapy. Relaxation and discipline are very important in treating ADHD and can be accomplished through yoga and mediation. Most diets that have been promoted for ADHD involve eliminating foods thought to increase hyperactivity, such as sugar and caffeine. If you notice that a certain food causes a change in your symptoms, you may want to try eliminating it from your diet to see if it makes a difference. A study published in the May 5, 2005, issue of Pediatrics, suggested fish oil could be beneficial, as it stated “A lack of certain polyunsaturated fatty acids may contribute to dyslexia and attention-deficit/hyperactivity disorder.” For the study, schoolchildren were given fish oil supplements rich in omega-3 essential fatty acids (EFAs) for a period of three months. The children showed significant improvements in behavior, reading, and spelling. It has been suggested that a fish oil supplement, with a high ratio (4:1) of omega-3 fatty acids (EPA) to omega-6 fatty acids, at 1 gram a day could be promising. St. John’s wort has limited research on its use for ADHD. It contains hypericin, which is thought to increase dopamine within the brain, but does have multiple drug interactions including benzodiazepines (i.e. Xanax, Valium, Klonopin), so should be used cautiously after discussion with your medical provider.
Being able to check your email on the phone, text, play a game on the tablet, cook, all while watching tv, helps support why ADHD continues to remain on the rise. Over the last 8 years, two million more children in the United States have been diagnosed with ADHD, and 2-3 million of them will probably continue ADHD well into adulthood. The current lifestyle for most helps develop ADHD. As technology rises and more distractions are possible, we often find ourselves frequently multi-tasking and easily losing focus. Research shows that multitasking is not nearly as efficient as we like to believe, and can even be harmful to our health. Multitasking is really just task-switching...your attention is actually expended on the energy of switching gears, wasting productivity. So if you feel that you may have ADHD, the best place to start is assessing your lifestyle and habits. Instead of multitasking, do things in batches, which usually saves time. Practice regular relaxation and discipline as ADHD lacks attention and restraint.
Often people with ADHD have demoralizing thinking. They tend to believe everything is either all good or bad, that things will always turn out negative, exaggerate minor problems while diminishing accomplishments, and feel inferior. Irrational thoughts typically stop you from being productive. The use of cognitive-behavioral therapy (CBT) focuses on thinking and the way thoughts influence how one feels and acts. So changing the way you think can help with organization, focus, and impulsivity. Start your own CBT by practicing realistic strategies and plans to solve three common ADHD problems: time management, organization, and planning. Exercise increases brain blood flow and the release of dopamine and growth factors, increasing brain function and helping ADHD symptoms. A good starting point is planning, starting, and continuing a work-out plan.
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