Attention Deficit/Hyperactivity Disorder

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The existence and incidence of Attention Deficit/Hyperactivity Disorder has been debated a lot in recent years. Parents, teachers, doctors, therapists, and even the media are getting involved and voicing their concerns about the diagnosis and treatment of ADHD. Some argue that hyperactivity and attention problems are a normal part of childhood - and they are. The difference is that in those suffering from ADHD, the symptoms are more severe and persistent and cause a disruption in functioning.

Without early identification and proper treatment, ADHD often causes serious problems, including lowered self-esteem, failure in school, depression, and substance abuse. It was once believed the symptoms of ADHD disappeared in adolescence, but we now know this is not always true. The symptoms often continue into adulthood, where they continue to cause problems at work and in relationships.

What is ADHD?

ADHD is not a new disorder, but its name has changed many times over the years to reflect the increasing understanding we have of its symptoms and causes. This disorder is characterized by poor attention skills, impulsivity, and, in some cases, hyperactivity. ADHD is a neurobiological disability believed to be caused by a neurotransmitter problem in the central nervous system. Evidence also indicates that ADHD is one of the most inheritable disorders of childhood, affecting up to 3-5 percent of school-aged children in the United States alone.

At this time, there are three categories of ADHD:

1. ADD with hyperactivity
2. ADD without Hyperactivity
3. ADD Residual Type, or Undifferentiated ADD

Diagnostic Criteria for ADHD:

A. Either (1) or (2):

(1) inattention: six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

   (a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
   (b) often has difficulty sustaining attention in tasks or play activities
   (c) often does not seem to listen when spoken to directly
   (d) often does not follow through on instructions and fails to finish school work, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
   (e) often has difficulty organizing tasks and activities
   (f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
   (g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
   (h) is often easily distracted by extraneous stimuli
   (i) is often forgetful in daily activities

(2) hyperactivity-impulsivity: six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Hyperactivity
   (a) often fidgets with hands or feet or squirms in seat
   (b) often leaves seat in classroom or in other situations in which remaining seated is expected
   (c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
   (d) often has difficulty playing or engaging in leisure activities quietly
   (e) is often "on the go" or often acts as if "driven by a motor"
   (f) often talks excessively

Impulsivity
   (g) often blurts out answers before questions have been completed
   (h) often has difficulty awaiting turn
   (i) often interrupts or intrudes on others (e.g., butts into conversations or games)

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorders, or a Personality Disorder).

Code based on type:

314.01 Attention-Deficit/Hyperactivity Disorder, Combined Type: if both Criteria A1 and A2 are met for the past 6 months
314.00 Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type: if Criterion A1 is met but Criterion A2 is not met for the past 6 months
314.01 Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type: if Criterion A2 is met but Criterion A1 is not met for the past 6 months

Coding note: For individuals (especially adolescents and adults) who currently have symptoms that no longer meet full criteria, "In Partial Remission" should be specified.

Driven To Distraction : Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood

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