Attention deficit hyperactivity disorder (AD/HD) is a condition first evident in early childhood. Symptoms include deficits in attention, concentration, and short-term memory. Behaviorally, children with AD/HD are overly active (as if "driven by a motor") and unable to remain seated, highly distractible, and impulsive. Concerns about AD/HD often initially arise during kindergarten or first grade, since these deficits significantly impair academic performance and are disruptive in a typical classroom.
Recent data suggest a 6–8% prevalence rate, though some believe it to be higher. AD/HD disproportionately affects males with a sex ratio between 3:1 and 9:1, with more conservative figures in clinic, rather than community, samples.
There are two essential clusters of AD/HD symptoms: inattentiveness and hyperactivity/impulsivity. To meet DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria for an AD/HD diagnosis, there must be six symptoms of either inattention (failing to give attention to detail, problems maintaining attention, not appearing to listen when spoken to directly, failure to follow through on instructions and to complete schoolwork or other tasks, problems with organization, avoiding activities requiring sustained concentration, losing important items, being easily distracted, and forgetfulness), or hyperactivity/impulsivity (fidgeting, inability to remain seated, inappropriate running and climbing, difficulty playing quietly, acting as if "driven by a motor," excessive talking, blurting out answers before questions are finished, difficulty taking turns, intruding upon others' activities and/or conversations), or of both clusters.
Case Illustration 1: Preschool Child
Four-and-a-half year old Ronnie has been dismissed from three preschools during the past 9 months. Ronnie's mother brings a teacher's note chronicling Ronnie's recent behavior:
- 2/25="Ran out of classroom and was on his way out of the building before I stopped him."
- 2/28="Threw all of the students' coats on the floor … won't listen when he's told to hang them up."
- 3/2="Would not sit through story time. Threw milk cartons during lunch time."
In your examination room, Ronnie is laying across your stool face down yelling, "I'm flying," while pushing off from the walls with his feet. His mother, appearing exhausted, makes a few half-hearted attempts to get Ronnie to settle down but quickly gives up saying, "You see doctor, this is what it's like."
The two clusters of symptoms, inattentive and hyperactive/impulsive, lead to three basic AD/HD subtypes: inattentive type, hyperactive/impulsive type, and mixed type (with features of both the former types).
While there are no precise longitudinal figures, AD/HD is increasingly accepted as a lifelong condition for many, if not most, patients. Development, however, does affect the symptom picture. The DSM-IV criteria best reflect AD/HD in children from 5 years until early adolescence. Research indicates that at around age 9, hyperactivity and impulsivity begin to become less pronounced, while inattention and other cognitive deficits persist.
The DSM-IV criteria and accompanying behavioral examples have been criticized as primarily depicting the condition ...