Chapter 30 Attention-Deficit/Hyperactivity Disorder
Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood, among the most prevalent chronic health conditions affecting school-aged children, and the most extensively studied mental disorder of childhood. ADHD is characterized by inattention, including increased distractibility and difficulty sustaining attention; poor impulse control and decreased self-inhibitory capacity; and motor overactivity and motor restlessness (Table 30-1). Definitions vary in different countries (Table 30-2). Affected children commonly experience academic underachievement, problems with interpersonal relationships with family members and peers, and low self-esteem. ADHD often co-occurs with other emotional, behavioral, language, and learning disorders (Table 30-3).
Table 30-1 DSM-IV DIAGNOSTIC CRITERIA FOR ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
CODE BASED ON TYPE
Reprinted with permission from American Psychiatric Association: Diagnostic and statistical manual of mental disorders, fourth edition, text revision, Washington, DC, 2000, American Psychiatric Association. Copyright 2000 American Psychiatric Association.
Table 30-2 DIFFERENCES BETWEEN U.S. AND EUROPEAN CRITERIA FOR ADHD OR HKD
| DSM-IV ADHD | ICD-10 HKD |
|---|---|
| SYMPTOMS | |
| Either or both of following: | All of following: |
| PERVASIVENESS | |
| Some impairment from symptoms is present in >1 setting | Criteria are met for >1 setting |
ADHD, attention-deficit/hyperactivity disorder; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, 4th edition; HKD, hyperkinetic disorder; ICD-10, International Classification of Diseases, 10th edition.
From Biederman J, Faraone S: Attention-deficit hyperactivity disorder, Lancet 366:237–248, 2005.
Table 30-3 DIFFERENTIAL DIAGNOSIS OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
PSYCHOSOCIAL FACTORS
DIAGNOSES ASSOCIATED WITH ADHD BEHAVIORS
MEDICAL AND NEUROLOGIC CONDITIONS
Note: Coexisting conditions with possible ADHD presentation include oppositional defiant disorder, anxiety disorders, conduct disorder, depressive disorders, learning disorders, and language disorders. Presence of one or more of the symptoms of these disorders can fall within the spectrum of normal behavior, whereas a range of these symptoms may be problematic but fall short of meeting the full criteria for the disorder.
From Reiff MI, Stein MT: Attention-deficit/hyperactivity disorder evaluation and diagnosis: a practical approach in office practice, Pediatr Clin North Am 50:1019–1048, 2003. Adapted from Reiff MI: Attention-deficit/hyperactivity disorders. In Bergman AB, editor: 20 Common problems in pediatrics, New York, 2001, McGraw-Hill, p 273.
