Diagnosis of Attention Deficit Disorder

In the most current assessment guidelines published by the American Psychiatric Association, Diagnostic and Statistical Manual for Mental Disorders IV (DSM4), the disorder is known as Attention Deficit Disorder and has several types including: (1) predominantly inattentive; (2) predominantly impulsive or (3) combined. Individuals with this condition usually have many (but not all) of the following symptoms:

Inattention:

• often fails to finish what he starts
• doesn’t seem to listen
• easily distracted
• has difficulty concentration or paying attention
• doesn’t stick with a play activity

Impulsivity:

• often acts without thinking & later feels sorry
• shifts excessively from one activity to another
• has difficulty organizing work
• needs a lot of supervision
• speaks out loud in class
• doesn’t wait to take turns in games or groups

Hyperactivity:

• runs about or climbs on things excessively
• can’t sit still and is fidgety
• has difficulty staying in his seat and bothers classmates
• excessive activity during sleep
• always on the "go" and acts as if "driven"

Emotional Instability:

• angry outbursts
• social loner
• blames others for problems
• fights with others quickly
• very sensitive to criticism

The diagnosis can be made by "ruling out" other medical or psychiatric causes for the symptoms and by then determining that the patient meets the DSM4 criteria for Attention Deficit Disorder. In some cases psychological testing is also used to help determine the diagnosis. The testing may be in the form of questionnaires such as the Conners Rating Scale or the Child Behavior Check List. Sometimes, a computerized neuropsychological test such as the TOVA, IVA or Gordon Diagnostic System may be used. These tests are known as continuous performance tests and measure a person’s ability to pay attention, tune out distractions and their impulse control while performing a repetitive task over a period of time ( 6 to 15 minutes). This type of testing can be helpful. More extensive batteries may be offered by various practitioners but are not necessary to provide the necessary data to make a diagnosis.

True Attention Deficit Disorder patients usually start showing symptoms by the time they start school. Some very impulsive children are diagnosed as early as 2 or 3 years old. Another group appears to develop more severe symptoms around the fourth grade. These children may have always had Attention Deficit Disorder but were able to compensate for the condition. As school requires more work and more organization skills, these children may reach a point where they become unable to compensate and exhibit "full blown" Attention Deficit Disorder symptoms. Some children may remain undiagnosed until they are in their teens. More recently adults have been diagnosed as having Attention Deficit Disorder. These individuals had the disorder as children but were not properly identified during their childhood.

Causes of Attention Deficit Disorder

The symptoms of Attention Deficit Disorder are caused by a neurological dysfunction within the brain. Several studies using PET scans have confirmed that there is a definite difference in brain functioning between a group of individuals diagnosed with Attention Deficit Disorder and those without it. The underlying physiological mechanism which causes Attention Deficit Disorder is still not thoroughly understood and remains under scientific study. It is presumed that brain chemistry is out of balance and that specific chemicals called neurotransmitters may be lacking in individuals with Attention Deficit Disorder. In two research studies, when the Attention Deficit Disorder subjects were given their medication and rescanned, their brain activity appeared to be much more like that of the normal group. Another interesting finding of these studies is that the areas of the brain in the Attention Deficit Disorder group where brain activity was lower than in the normal group are known to be associated with such functions as attention and concentration as well as planning and organization. These are the very functions that are impaired in persons with Attention Deficit Disorder. PET scans are considered to be very invasive because they involve the injection of radioactive material into the individual and therefore are not appropriate for diagnostic purposes. To date only two studies of Attention Deficit Disorder using PET scans have been conducted.

Attention Deficit Disorder may be either inherited or acquired. Recent research in genetics has definitely shown that Attention Deficit Disorder runs in families. The specific chromosomes that are involved have not been fully identified though more clues are being discovered as research progresses. Like many other disorders, a child may have the symptoms while his parents may not. Usually there are aunts, uncles, grandparents or cousins with the disorder.

Attention Deficit Disorder may be acquired through various conditions that cause insult (damage) to the brain. During pregnancy and delivery these include the use of drugs during pregnancy, toxemia, infectious diseases, overexposure to radiation, prematurity, complicated delivery. After birth these include meningitis, encephalitis, seizures from fever, head injury and lead toxicity. Excessive use of sweets does not cause Attention Deficit Disorder though it may make the symptoms worse for some individuals who already have the condition

Since many children with Attention Deficit Disorder appear to "outgrow" the condition it can also be looked at as a developmental disorder. Some children seem to develop the ability to pay attention and concentrate later than others just as there is a wide range to timing for developing the ability to walk, talk or be potty trained. In the past, children with Attention Deficit Disorder and other learning disabilities were labeled as "underachievers" in their younger years and then reclassified as "late bloomers" when their development in this area finally caught up with their peers.

Today, many adults look back and realize they had a learning disability or Attention Deficit Disorder as a child which they may or may not have been able to overcome. Some people with Attention Deficit Disorder become very successful. However, others continue to have significant symptoms as adults. Some were not able to adapt or compensate on their own and did not receive any help from teachers, parents or professionals. These individuals often dropped out of school and may today be social drop outs of one kind or another. It is for this last reason that children who exhibit signs of Attention Deficit Disorder or learning disabilities should receive all the help necessary and available to spare them the frustration and anguish often associated with these conditions.

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