The specific criteria for diagnosis require at least six symptoms of inattention or hyperactivity-impulsivity (or both) that have persisted for at least 6 months. In addition, ADHD is specified by the severity based on social or occupational functional impairment: mild (minor impairment), moderate (impairment between "mild" and "severe"), or severe (symptoms in excess of those required to meet diagnosis; marked impairment).

Brain imaging, such as functional MRI or SPECT scans, has been useful for research, but no clinical indication exists for these procedures because the diagnosis is clinical.

For more on the diagnostic criteria of ADHD, read here.

The three types of ADHD are predominantly inattentive, predominantly hyperactive/impulsive, and combined. The specific criteria for ADHD are:

• Inattentive: This must include at least six of the following symptoms of inattention that must have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

  • Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities

  • Often has difficulty sustaining attention in tasks or play activities

  • Often does not seem to listen to what is being said

  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)

  • Often has difficulties organizing tasks and activities

  • Often avoids or strongly dislikes tasks (such as schoolwork or homework) that require sustained mental effort

  • Often loses things necessary for tasks or activities (school assignments, pencils, books, tools, or toys)

  • Often is easily distracted by extraneous stimuli

  • Often forgetful in daily activities

• Hyperactivity/impulsivity: This must include at least six of the following symptoms of hyperactivity-impulsivity that must have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

  • Fidgeting with or tapping hands or feet, squirming in seat

  • Leaving seat in classroom or in other situations in which remaining seated is expected

  • Running about or climbing excessively in situations where this behavior is inappropriate (in adolescents or adults, this may be limited to subjective feelings of restlessness)

  • Difficulty playing or engaging in leisure activities quietly

  • Unable to be or uncomfortable being still for extended periods of time (may be experienced by others as "on the go" or difficult to keep up with)

  • Excessive talking

  • Blurting out answers to questions before the questions have been completed

  • Difficulty waiting in lines or awaiting turn in games or group situations

  • Interrupting or intruding on others (for adolescents and adults, may intrude into or take over what others are doing)

• Other

  • Onset is no later than age 12 years

  • Symptoms must be present in two or more situations, such as school, work, or home

  • The disturbance causes clinically significant distress or impairment in social, academic, or occupational functioning

  • Disorder does not occur exclusively during the course of schizophrenia or other psychotic disorder and is not better accounted for by mood, anxiety, dissociative, personality disorder, or substance intoxication or withdrawal

For more on the types of ADHD, read here.

Studies estimate the mean heritability of ADHD to be 76%, indicating that ADHD is one of the most heritable psychiatric disorders.

Hypotheses exist that include in utero exposures to toxic substances, food additives or colorings, or allergic causes. However, diet, especially sugar, is not a cause of ADHD. How much of a role family environment has in the pathogenesis of ADHD is unclear, but it certainly may exacerbate symptoms.

ADHD is associated with a number of other clinical diagnoses. Studies have demonstrated that many individuals have both ADHD and antisocial personality disorder. These individuals are at higher risk for self-injurious behaviors. ADHD is also linked to addictive behavior.

In children, ADHD is three to five times more common in boys than in girls. Some studies report an incidence ratio of as high as 5:1. The predominantly inattentive type of ADHD is found more commonly in girls than in boys.

For more on the presentation of ADHD, read here.

In children with ADHD, stimulant therapy is more effective than behavioral therapy or regular community care (medication management by primary care provider). This finding has been borne out for the treatment of adults with ADHD as well.

Atomoxetine (Strattera®) has become a second-line—and in some cases, first-line—treatment in children and adults with ADHD because of its efficacy and classification as a nonstimulant. However, studies have reported that the overall effect of atomoxetine has not been as extensive as that reported for stimulants.

Behavioral psychotherapy is often effective when used in combination with an effective medication regimen. Behavioral therapy or modification programs can help diminish uncertain expectations and increase organization.

Metacognitive therapy in adults involves the principles and techniques of cognitive and behavioral therapies to enhance time management. In doing so, these have made adult patients with ADHD better able to counter the anxiety and depressive symptoms they experience in task performance.

For more on the treatment of ADHD, read here.

ADHD can be comorbid with the following conditions:

• Other developmental learning disorders

• Conduct disorder or oppositional defiant disorder

• Bipolar disorder

• Tourette syndrome

• Pervasive developmental disorder

• Mental retardation

For decades, speculation and folklore have suggested that foods containing preservatives or food coloring, or foods high in simple sugars, may exacerbate ADHD. Many controlled studies have examined this question. To date, no adequate dataset has confirmed the speculation.

For more on long-term care of ADHD, read here.

Editor's Recommendations Attention Deficit Hyperactivity Disorder Pediatric Attention Deficit Hyperactivity Disorder

 

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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this article: Stephen Soreff. Quiz: Do You Know the Signs, Symptoms, and Best Practices for Attention-Deficit/Hyperactivity Disorder? Medscape. Sep 14, 2015.