Diagnosis of attention deficit hyperactivity disorder

The diagnostic criteria for attention deficit hyperactivity disorder are constantly being modified. Comparing the various editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association, one can see that these changes primarily concern the core symptoms. According to DSM-IV, attention deficit hyperactivity disorder is divided into three main types:

1. combined type, in which both main components are expressed: inattention and hyperactivity/impulsivity;
2. type with predominant attention deficit;
3. type with a predominance of hyperactivity and impulsivity.

Significant symptoms must be present for at least 6 months and occur in more than one setting (home, school, work, or other social settings). Symptoms must be severely disruptive to the patient's daily activities and must begin before age 7.

Currently, the diagnosis of attention deficit hyperactivity disorder is based solely on clinical data, since there are no laboratory tests or biological markers that could confirm it. The main diagnostic methods are: interviews with parents, children, teachers, observation of parents and children, behavioral assessment scales, physical and neurological examinations, neuropsychological testing. Otoneurological and ophthalmological examinations may be required. During the first visit, it is necessary to collect a detailed anamnesis of life and disease. It is important to clarify the characteristics of the child's development, the dynamics of symptoms, past somatic or neurological diseases, family and psychosocial factors that can affect the child's behavior. Any deviations are considered clinically significant only if they go beyond the norm inherent in a given age and level of intellectual development.

To collect the necessary information, various general and specific assessment (rating) scales are used. General scales, for example, include the frequently used Achenbach's Child Behavior Checklist (CBCL), which has two versions - for parents and for teachers, allows one to quickly form an impression of the behavioral characteristics of a given child and can be used for screening. More specific to attention deficit hyperactivity disorder are the scales developed by Connors (Connors, Barkley, 198S): Connors Parent Rating Scale (CPRS), Connors Teacher Rating Scale (CTRS), Connors Teacher Questionaire (CTQ), and Abbreviated Rating Scale (ARS). The Swanson scale (SNAP) and the Pelham Disruptive Behavior Disorder Scale are also used to assess various manifestations of ADHD. Specialized neuropsychological tests for attention (e.g., Continuous Performance Task - CPT) or memory (e.g., Pared Associate Learning - PAL) cannot be used in isolation to establish a diagnosis.

To avoid false positive and false negative diagnoses of attention deficit hyperactivity disorder, the examination should include the following points.

1. A thorough survey of parents, relatives and teachers involved in the upbringing of children, with an emphasis on the main symptoms of attention deficit hyperactivity disorder, as well as obtaining detailed information about the developmental characteristics, academic performance, psychological characteristics of the child, past illnesses, family relationships, and social conditions.
2. A conversation with the child, taking into account his level of development, with an assessment of the symptoms of attention deficit hyperactivity disorder, as well as anxiety and depressive manifestations, suicidal ideas, and psychotic symptoms.
3. Physical examination to identify sensory pathology (e.g. hearing or vision impairment) and focal neurological symptoms.
4. Neuropsychological examination to identify “weak” and “strong” cognitive functions.
5. Use of general and specific scales for assessing attention deficit hyperactivity disorder.
6. Assessment of speech and language development, gross and fine motor skills.

Attention deficit hyperactivity disorder is diagnosed in the United States according to the DSM-III, DSM-III-R, and DSM-IV criteria. Although they have some differences in the characteristics of the main symptoms, they are basically similar. In DSM-IV, the symptoms are divided into two groups:

1. associated with attention deficit and
2. associated with hyperactivity and impulsivity.

Each of these groups includes 9 symptoms. Diagnosis of the combined type of attention deficit hyperactivity disorder requires the presence of at least 6 of the 9 symptoms in each group. The type with a predominance of attention disorder is diagnosed when at least six symptoms characterizing attention deficit are found, but no more than 5 symptoms related to hyperactivity and impulsivity. The type with a predominance of hyperactivity and impulsivity is diagnosed when at least 6 symptoms related to hyperactivity and impulsivity are found, but no more than 5 symptoms related to attention deficit. In any case, the symptoms must represent a significant deviation from the condition characteristic of children with a comparable level of development, and be frequent and severe enough to disrupt the child's life.

Diagnostic criteria for attention deficit hyperactivity disorder

A. Presence of 1st or 2nd criterion:

1. At least six of the following symptoms of attention deficit disorder that persist for at least six months to a degree that causes maladaptation and is not appropriate for developmental level

Attention deficit disorder

• Inability to concentrate on details or makes frequent careless mistakes during schoolwork, work, or other activities
• Often unable to maintain attention while completing tasks or playing games
• Often gets distracted when listening to direct speech
• Often unable to follow instructions and complete tasks at school, work, or home (not due to negativity or lack of understanding of instructions)
• Often has difficulty organizing tasks and other activities
• Often avoids or tends to avoid tasks that require prolonged mental effort (at school or at home)
• Frequently loses things needed to complete tasks or activities (e.g., toys, school supplies, textbooks, pencils, tools)
• Often easily distracted by extraneous stimuli
• Often forgetful in daily activities

2. At least six of the following symptoms of hyperactivity and impulsivity that persist for at least six months to a degree that causes maladaptation and is not appropriate for developmental level

Hyperactivity

• Frequent fidgeting with your arms or legs or fidgeting
• Often leaves the classroom or other areas even though he or she should be sitting
• Runs and climbs relentlessly in inappropriate situations (in adolescents and adults, only an internal feeling of restlessness is possible)
• Often unable to play quiet games or spend leisure time in a calm environment
• Often in constant motion or acting "like a wind-up machine"
• Often overly talkative

Impulsiveness

• Often shouts out an answer before listening to the question
• Often can't wait for his turn
• Often interrupts others or butts into conversations (during conversation or play)

B. Some symptoms of hyperactivity, impulsivity and attention deficit disorder that cause maladaptation appear before the age of 7 years

B. Maladjustment caused by symptoms is evident in two or more domains (e.g., school, work, or home)

G. There are clinically significant impairments in life activities in the social, educational or professional spheres

D. The symptoms are not associated with a pervasive developmental disorder, schizophrenia, or other psychotic disorders, and are not better explained by another mental disorder (including a mood, anxiety, dissociative, or personality disorder)

In those cases (especially in adolescents and adults), when at the time of examination the symptoms no longer fully satisfy the specified criteria, partial remission is stated.

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