Attention Deficit Hyperactivity Disorder

Diagnostic criteria of attention deficit hyperactivity are constantly being modified. Comparing the various editions of the Manual on Diagnosis and Statistics of Mental Illness (DSM), published by the American Psychiatric Association, it can be noted that these changes primarily concern the main symptoms. According to DSM-IV, attention deficit hyperactivity disorder is divided into three main types:

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

Expressed symptoms should be present for at least 6 months and manifest in more than one situation (at home, at school, at work or in other social situations). Symptoms should significantly hamper the life of the patient and manifest at the age of 7 years.

Currently, the diagnosis of attention deficit hyperactivity is based solely on clinical data, since there are no laboratory tests or biological markers that could confirm it. Basic diagnostic methods: conversation with parents, children, teachers, observation of parents and children, behavioral evaluation scales, physical and neurological research, neuropsychological testing. Oto-neurological and ophthalmological studies may be required. During the first visit it is necessary to collect a detailed anamnesis of life and disease. It is important to find out the features of the child's development, the dynamics of the symptoms, the transferred somatic or neurological diseases, family and psychosocial factors that can affect the behavior of the child. These or other deviations are regarded as clinically significant only if they go beyond the norm inherent in this age and the level of intellectual development.

To collect the necessary information, various general and specific evaluation (rating) scales are used. Common scales, for example, include the frequently used Achenbach's Child Behavior Checklist (CBC), which has two versions - for parents and teachers, that allows you to quickly get an impression of the particular behavior of this child and can be used for screening. More specific for attention deficit hyperactivity include the scales developed by Connors (Burberry, 198S): the Connors Parent Rating Scale (CPRS), the Connors Teacher Rating Scale (CTRS), the Questionnaire Connors Teacher's Questionaire (CTQ), Abbreviated Rating Scale (ARS). To assess the different manifestations of DVG, the Swanson scale (SNAP), the Disruptive Behavior Disorder Scale scale are also used. Specialized neuropsychological attention tests (for example, Continuous Performance Task (CPT) or memory (for example, Pared Associate Learning (PAL)) can not be used in isolation to establish a diagnosis.

In order to avoid false positive and false negative diagnosis of attention deficit hyperactivity, the survey should include the following points.

1. Careful interview of parents, relatives and teachers involved in the upbringing of children, with emphasis on the main symptoms of attention deficit hyperactivity, as well as obtaining detailed information about the characteristics of development, achievement, psychological characteristics of the child, past illnesses, relationships in the family, social conditions.
2. Talk with the child, taking into account the level of its development, with an assessment of the symptoms of attention deficit hyperactivity, as well as anxious and depressive manifestations, suicidal ideation, psychotic symptoms.
3. Physical examination with the detection of pathology of the sensory organs (eg, hearing and vision impairment) and focal neurological symptoms.
4. Neuropsychological study with the identification of "weak" and "strong" cognitive functions.
5. The use of general and specific scales to assess attention deficit hyperactivity.
6. Assessment of the development of speech and language, general and fine motor skills.

The diagnosis of attention deficit hyperactivity in the US is conducted in accordance with the criteria of DSM-III, DSM-III-R and DSM-IV. Although they have some differences in the characteristics of the main symptoms, they are basically similar. In DSM-IV, symptoms are divided into two groups:

1. related to violation of attention and
2. associated with hyperactivity and impulsivity.

Each of these groups includes 9 symptoms. The diagnosis of a combined type of attention deficit hyperactivity requires the presence of at least 6 of 9 symptoms in each group. A type with a predominance of attention breakdown is diagnosed when there are at least six symptoms characterizing attention deficit, but not more than 5 symptoms related to hyperactivity and impulsivity. A type with a predominance of hyperactivity and impulsivity is diagnosed with at least 6 symptoms related to hyperactivity and impulsivity, but not more than 5 symptoms associated with attention deficit. In any case, the symptoms should 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 life of the child.

Diagnostic criteria of attention deficit hyperactivity disorder

A. Availability of the 1st or 2nd criterion:

1. At least six of the following symptoms of impaired attention, persisting for at least six months in the degree causing disadaptation, and not at the level of development

Violation of attention

• Not able to focus on the details or makes frequent mistakes in inattention during training sessions, work or other activities
• Often unable to maintain attention when performing tasks or games
• Often distracted when listening to a directly inverted speech
• Often unable to follow instructions and complete the tasks performed at school, at work, at home (which is not due to negativity or misunderstanding of the instructions)
• Often experiencing difficulties in organizing the performance of tasks and other activities
• Often avoids or tends to avoid assignments that require prolonged mental stress (in school or at home)
• Often, he loses the things necessary to carry out assignments or certain activities (for example, toys, school supplies, textbooks, pencils, tools)
• It is often easily distracted by extraneous stimuli
• Often forgetful in daily activities

2. At least six of the following symptoms of overactivity and impulsiveness, persisting for at least six months in a degree causing disadaptation, and not corresponding to the level of development

Hyperactivity

• Frequent fussing with arms or legs or fidgeting in place
• Often repays a classroom or other places, despite the fact that he must sit
• Running relentlessly and climbing in an inappropriate situation (adolescents and adults can only have an inner sense of anxiety)
• Often unable to play quiet games or spend leisure time in a relaxed environment
• Often is in constant motion or act "as a routine"
• Often talkative

Impulsiveness

• Often cries out the answer, not having listened to the question
• Often can not wait his turn
• Often interrupts others or wedges into a conversation (during a conversation or game)

B. Some of the symptoms of hyperactivity, impulsivity, and attention disorders that cause maladaptation occur before the age of 7

B. Disadaptation caused by symptoms manifests itself in two or more spheres (for example, at school, at work or at home)

D. There are clinically significant impairments in social, educational or occupational fields

D. Symptoms are not associated with a general developmental disorder, schizophrenia or other psychotic disorders, they can not be better explained by the presence of another mental disorder (including affective, anxiety, dissociative or personality disorder)

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

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]