Pediatrics Book

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ADHD Diagnosis

Aka: ADHD Diagnosis, ADHD DSM V Criteria, Attention Deficit Hyperactivity Disorder Diagnosis, Attention Deficit Disorder Diagnosis
  1. See also
    1. Attention Deficit Disorder in Children
    2. School Problem Evaluation
    3. Attention Deficit Disorder in Adults
    4. ADHD Differential Diagnosis
    5. ADHD Comorbid Conditions
    6. ADHD Non-Pharmacologic Management
    7. ADHD Medications
    8. Dextroamphetamine (Dexedrine, Dextrostat, Adderall) or Lisdexamfetamine (Vyvanse)
    9. Methylphenidate (Ritalin, Methylin, Concerta)
    10. Atomoxetine (Strattera)
  2. Types
    1. Primarily Inattentive Type (314.00)
    2. Primarily Hyperactive-Impulsive Type (314.01)
    3. Combined Type (314.01)
    4. Not otherwise specified (314.9)
  3. Precautions
    1. Diagnosis should be based on evidence from both parents and at least 2 teachers
      1. Consider involving input from school coaches and group leaders in older children or adolescents
      2. Obtain self-report behavioral rating scale from adolescents
    2. Evaluate for ADHD Comorbid Conditions and for ADHD Differential Diagnosis
      1. Additional mood, behavioral or Developmental Disorder is present in 60% of ADHD children
      2. Initial screening for Attention Deficit should also include screening for other associated conditions
    3. Thorough initial evaluation is imperative (see ADHD)
      1. History: Development, Learning, Family History, Social environment
      2. Exam: Complete inclduing Vision, Hearing, Neurologic Exam
      3. Labs and diagnostics are not routinely recommended
    4. Age related precautions
      1. Attention Deficit Disorder cannot be reliably diagnosed under age 4 years old
      2. New onset of Attention Deficit Disorder is less common after age 12 years old
        1. Inattentive type may have a delayed diagnosis
        2. Increased academic demands, especially after fourth grade may unmask previously compensated ADD
        3. Consider alternative diagnoses
          1. See Attention Deficit Differential Diagnosis
          2. Learning Disorder
          3. Mood Disorder
          4. Sleep disorder (e.g. Sleep Apnea, Insomnia)
          5. Substance Abuse
  4. Diagnostics: Scales for Children - Narrow Focused on ADHD
    1. Vanderbilt ADHD Diagnostic Test
      1. Preferred option since it is freely available
      2. Test Sensitivity: 80% parent (69% teacher)
      3. Test Specificity: 75% parent (85% teacher)
      4. NICHQ Vanderbilt Scales for initial and follow-up parent and teacher evaluations
        1. http://www.nichq.org/childrens-health/adhd/resources/vanderbilt-assessment-scales
    2. Conners Parent and Teachers Questionnaires
      1. Gold standard survey, but copyrighted and expensive
      2. (1985) Psychopharmacology Bulletin 21:816
      3. Available from MHS
        1. http://www.mhs.com/product.aspx?gr=cli&prod=conners3&id=overview
    3. Connors Abbreviated Symptom Questionnaire (CASQ)
      1. Test Sensitivity: 83%
      2. Test Specificity: 84%
      3. May be preferred Connors Questionnaire (brevity, efficacy) but is also costly
    4. ADHD Rating Scale 5
      1. Dupaul (1998) ADHD Rating Scale, Guilford
      2. https://pcptoolkit.beaconhealthoptions.com/wp-content/uploads/2016/01/cms-quality-child_adhd_rating_scale_screener.pdf
    5. Brown ADD Rating Scales
      1. Purchased from Brown Clinic
    6. Copeland Symptom Checklist for ADD
      1. https://cookchildrens.org/SiteCollectionDocuments/pediatrics/ADHD-Checklist.pdf
  5. Diagnostics: Scales for Children - Broad Screening for ADHD and Comorbidity
    1. Child and Adolescent Behavior Inventory
      1. https://clinical-practice-and-epidemiology-in-mental-health.com/VOLUME/15/PAGE/44/FULLTEXT/
      2. Test Sensitivity 83%
      3. Test Specificity: 91%
    2. Child Behavior Checklist
      1. https://www.apa.org/depression-guideline/child-behavior-checklist.pdf
    3. Pediatric Symptoms Checklist
      1. https://www.brightfutures.org/mentalhealth/pdf/professionals/ped_sympton_chklst.pdf
    4. Strengths and Difficulties Questionairre
      1. https://sdqinfo.org/
  6. Diagnostics: Scales for adults
    1. Adult ADHD Rating Scale-IV
    2. Adult ADHD Self-Report Scale Symptom Checklist v1.1
      1. https://add.org/wp-content/uploads/2015/03/adhd-questionnaire-ASRS111.pdf
    3. Brown Attention-Deficit Disorder Rating
    4. Connors Adult ADHD Rating Scales
    5. Current Symptoms Scale by Barkley and Murphy
    6. Wender-Reimherr Adult Attention-Deficit Disorder Scale
  7. Diagnosis: General Criteria
    1. ADHD Symptoms and signs onset before 12 years
    2. Symptoms and signs persists for 6 months or longer
    3. Impairment in more than 1 setting
    4. Severity beyond developmental level
    5. Interferes with social, academic or occupational functioning
    6. Not exclusively due to other mental health condition (e.g. Major Depression, Anxiety Disorder, Substance Abuse, Psychosis)
  8. Diagnosis: Inattentive ADHD Criteria (6 of 9 present)
    1. Fails to give close attention to details
    2. Difficulty sustaining attention
    3. Does not appear to listen
    4. Has difficulty following instructions
    5. Difficulty with organization
    6. Avoids tasks requiring sustained attention
    7. Often loses things
    8. Easily distracted
    9. Forgetful in daily activities
  9. Diagnosis: Hyperactive, Impulsive ADHD Criteria (6 of 9 present)
    1. Fidgets or squirms
    2. Difficulty staying seated
    3. Runs or climbs inappropriately (or feeling restless in adolescents and adults)
    4. Difficulty engaging in activities quietly
    5. Always "on the go", "driven by a motor"
    6. Talks excessively
    7. Blurts out answers
    8. Difficulty in waiting their turn
    9. Interrupts or intrudes upon others
  10. References
    1. (2013) DSM 5, APA
    2. Accardo (1999) Pediatr Clin North Am 46:845-56 [PubMed]
    3. Barbaresi (1996) Mayo Clin Proc 71:463-71 [PubMed]
    4. Chang (2020) Am Fam Physician 102(10):592-602 [PubMed]
    5. Felt (2014) Am Fam Physician 90(7): 456-64 [PubMed]
    6. Smucker (2001) Am Fam Physician 64:817-32 [PubMed]
    7. Post (2012) Am Fam Physician 85(9):890-896 [PubMed]

Attention deficit hyperactivity disorder (C1263846)

Definition (MEDLINEPLUS)

Is it hard for your child to sit still? Does your child act without thinking first? Does your child start but not finish things? If so, your child may have attention deficit hyperactivity disorder (ADHD). Nearly everyone shows some of these behaviors at times, but ADHD lasts more than 6 months and causes problems in school, at home and in social situations.

ADHD is more common in boys than girls. It affects 3-5 percent of all American children.

The main features of ADHD are

  • Inattention
  • Hyperactivity
  • Impulsivity

No one knows exactly what causes ADHD. It sometimes runs in families, so genetics may be a factor. There may also be environmental factors.

A complete evaluation by a trained professional is the only way to know for sure if your child has ADHD. Treatment may include medicine to control symptoms, therapy, or both. Structure at home and at school is important. Parent training may also help.

NIH: National Institute of Mental Health

Definition (NCI) A disorder characterized by a marked pattern of inattention and/or hyperactivity-impulsivity that is inconsistent with developmental level and clearly interferes with functioning in at least two settings (e.g. at home and at school). At least some of the symptoms must be present before the age of 7 years.
Definition (MSH) A behavior disorder originating in childhood in which the essential features are signs of developmentally inappropriate inattention, impulsivity, and hyperactivity. Although most individuals have symptoms of both inattention and hyperactivity-impulsivity, one or the other pattern may be predominant. The disorder is more frequent in males than females. Onset is in childhood. Symptoms often attenuate during late adolescence although a minority experience the full complement of symptoms into mid-adulthood. (From DSM-IV)
Definition (PSY) A behavior disorder in which the essential features are signs of developmentally inappropriate inattention, impulsivity, and hyperactivity.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D001289
ICD9 314.9, 314.01, 314
ICD10 F90.9, F90
SnomedCT 7461003, 154940006, 154952004, 192634008, 42584006, 154951006, 192126003, 192592000, 192134009, 192596002, 229717000, 192129005, 229713001, 406506008
DSM4 314.9, 314.01
English Attention Deficit Disorder with Hyperactivity, Attention Deficit Disorders with Hyperactivity, Attention Deficit Hyperactivity Disorder, Attention Deficit Hyperactivity Disorders, Hyperkinetic Syndrome, Syndromes, Hyperkinetic, Hyperkinetic syndrome of childhood, Unspecified hyperkinetic syndrome of childhood, Attention deficit disorder of childhood with hyperactivity, Attention-Deficit Disorder, Predominantly Hyperactive-Impulsive Type, Attention-Deficit/Hyperactivity Disorder NOS, Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type, HYPERKINETIC SYNDROME, Hyperactivity Disorder NOS, Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type, Hyperactive child syndrome, Att deficit hyperactivity dis, Attentn deficit hyperkin disor, Childhood hyperkinetic syndr., Childhood hyperkinetic syndrome, Hyperkinetic disorder, unsp, Hyperkinetic disorder, unspecified, [X]Hyperkinetic disorder, unsp, [X]Hyperkinetic disorder, unspecified, Hyperkinetic disorders, HYPERACTIVITY OF CHILDHOOD, ATTENTION DEFICIT-HYPERACTIVITY DISORDER, Attention deficit hyperactivity disorder (ADHD), ATTENTION DEFICIT HYPERACTIVITY DIS, ATTENTION DEFICIT DIS WITH HYPERACTIVITY, ADD - Attention deficit disorder with hyperactivity, ADD-Attn def dis with hyperact, ADDH, ADHD (attention deficit hyperactivity disorder), unspecified hyperkinetic syndrome of childhood (diagnosis), attention deficit hyperactivity disorder, hyperactive child syndrome, childhood hyperkinetic syndrome, unspecified hyperkinetic syndrome of childhood, attention-deficit hyperactivity disorder (diagnosis), ADHD (attention-deficit hyperactivity disorder), attention-deficit hyperactivity disorder, Attention deficit-hyperactivity disorder, Attention deficit/hyperactivity disorder, Attention deficit/hyperactivity disorder NOS, ADHD, predominantly hyperactive-impulsive type, Syndrome hyperkinetic, Hyperkinetic synd NOS, Attn deficit w hyperact, attention deficit disorder with hyperactivity, Attention-deficit hyperactivity disorders, Attention-deficit hyperactivity disorder NOS, Attention Deficit Disorder with Hyperactivity [Disease/Finding], minimal brain dysfunction, attention deficits disorder hyper, disorder hyperactivity, hyperkinetic disorder, attention deficit hyper disorder, hyperactivity disorder, addh, attention deficit(hyper) disorder, attention deficit hyperactivity disorder (ADHD), Attention deficit hyperactivity disorder, hyperactive impulsive type, Attention deficit disorder with hyperactivity, Unspecified hyperkinetic syndrome, Disorders, Attention Deficit-Hyperactivity, Deficit-Hyperactivity Disorders, Attention, Deficit-Hyperactivity Disorder, Attention, Attention Deficit-Hyperactivity Disorders, Attention Deficit-Hyperactivity Disorder, Disorder, Attention Deficit-Hyperactivity, ADD, Attention deficit disorder (disorder), Childhood hyperkinetic syndrome (disorder), Hyperkinetic syndrome NOS (disorder), Attention deficit disorder, [X]Hyperkinetic disorder, unspecified (disorder), Attention deficit-hyperactivity disorder (ADHD), Attention-deficit hyperactivity disorder, Attention deficit hyperactivity disorder, predominantly hyperactive impulsive type, Attention deficit hyperactivity disorder, predominantly hyperactive impulsive type (disorder), Hyperkinetic syndrome, Overactive child syndrome, Attention deficit hyperkinetic disorder, Hyperkinetic disorder, Attention deficit hyperactivity disorder (disorder), ADHD - Attention deficit disorder with hyperactivity, Attention deficit hyperactivity disorder, attention deficit disorder; with hyperactivity, child; hyperactivity, disorder; attention deficit, with hyperactivity (ADHD), disorder; hyperactivity, disorder; hyperkinetic, hyperactivity; child, hyperactivity; disorder, hyperkinetic; disorder, hyperkinetic; syndrome, syndrome; hyperkinetic, ADHD, Hyperkinetic syndrome NOS, attention deficit disorder, Disorder;attent deficit(hyper), hyperkinetic syndrome
Italian Disturbo da deficit di attenzione/iperattività, Sindrome del bambino iperattivo, ADHD, Sindrome ipercinetica non specificata dell'infanzia, Disturbo da deficit di attenzione-iperattività, Disturbo da deficit di attenzione associato ad iperattività, Disturbo da deficit di attenzione/iperattività NAS, Disturbo da deficit di attenzione dell'infanzia con iperattività, Sindrome ipercinetica dell'infanzia, Sindrome ipercinetica, Disturbi da deficit di attenzione con iperattività, ADHD, con predominanaza del tipo iperattivo-impulsivo, Disturbo da deficit di attenzione con iperattività
Dutch aandachtstekort-hyperactiviteitsstoornis NAO, hyperkinetisch syndroom, niet-gespecificeerd hyperkinetisch syndroom op kinderleeftijd, aandachtstekort-hyperactiviteitsstoornis, hyperkinetisch syndroom van de kinderleeftijd, syndroom hyperkinetisch, hyperactief kindsyndroom, ADHD, aandachtstekortstoornis met hyperactiviteit op kinderleeftijd, ADHD, overwegend hyperactief-impulsief type, Hyperkinetische stoornis, aandachtstekortstoornis; met hyperactiviteit, hyperactiviteit; kind, hyperactiviteit; stoornis, hyperkinetisch; stoornis, hyperkinetisch; syndroom, kind; hyperactiviteit, stoornis; aandachtstekort, met hyperactiviteit (ADHD), stoornis; hyperactiviteit, stoornis; hyperkinetisch, syndroom; hyperkinetisch, Hyperkinetische stoornis, niet gespecificeerd, aandachtstekortstoornis met hyperactiviteit, Hyperkinetische stoornissen, Aandachtstekortstoornis met hyperactiviteit, Syndroom, hyperkinetisch
French Hyperactivité avec déficit de l'attention, Trouble d'hyperactivité avec déficit de l'attention (ADHD), Trouble déficitaire de l'attention avec hyperactivité SAI, Syndrome d'hyperkinésie, Trouble déficitaire de l'attention de l'enfance avec hyperactivité, Syndrome d'hyperactivité de l'enfant, Syndrome hyperkinétique de l'enfance non précisé, Syndrome hyperkinétique de l'enfance, Trouble hyperkinétique, Trouble d'hyperactivité avec déficit de l'attention, SYNDROME D'HYPERKINESIE, ADHD, type prédominant hyperactif/impulsif, Déficit de l'attention/hyperactivité, Syndrome hyperkinétique, Déficit de l'attention avec hyperactivité, Syndrome de l'enfant hyperactif, Trouble de déficit de l'attention avec hyperactivité, Trouble déficitaire de l'attention avec hyperactivité, Déficit d'attention et hyperactivité, TDHA, THADA
German hyperkinetisches Syndrom des Kindesalters, Aufmerksamkeitsdefizit-Hyperaktivitaetsstoerung, ADDH, hyperaktives Kind-Syndrom, hyperkinetisches Syndrom, unspezifisches hyperkinetisches Syndrom des Kindesalters, Aufmerksamkeitsdefizitstoerung des Kindesalters mit Hyperaktivitaet, Aufmerksamkeitsdefizit/Hyperaktivitaetsstoerung NNB, Syndrom hyperkinetisch, ADHD, HYPERKINETISCHES SYNDROM, Hyperkinetische Stoerung, nicht naeher bezeichnet, Hyperkinetische Stoerungen, ADHD, vorwiegend hyperaktiv-impulsiver Typ, Aufmerksamkeitsdefizit/Hyperaktivitaetsstoerung, Hyperkinetisches Syndrom, ADHS, Aufmerksamkeitsdefizitsyndrom mit Hyperaktivität, Aufmerksamkeitsstörung mit Hyperaktivität
Portuguese Síndrome hiperquinética na infância, Síndrome hiperquinética, Perturbação de défice de atenção com hiperactividade, Perturbação de défice de atenção da infância com hiperactividade, Perturbação de défice de atenção/hiperactividade, Perturbação de défice de atenção/hiperactividade NE, Síndrome de criança hiperactiva, Síndrome hiperquinética NE da infância, Síndrome hipercinética, SINDROME HIPERCINETICO, ADHD, tipo predominantemente hiperactivo/impulsivo, Transtorno do Deficit de Atenção com Hiperatividade, Disfunção Cerebral Mínima, Transtorno da Falta de Atenção com Hiperatividade, ADHD, TDAH, Transtorno da Falta de Atenção, Défice de atenção/perturbação de hiperactividade, Síndrome Hipercinética, Transtorno de Hiperatividade e Falta de Atenção
Spanish Síndrome hipercinético de la infancia, Síndrome hipercinético no especificado de la infancia, Síndrome hipercinético, Síndrome hipercinético infantil, Trastorno por déficit de atención de la infancia con hiperactividad, Trastorno por déficit de atención con hiperactividad NEOM, HIPERCINETICO SINDROME, TDAH, con predominio hiperactivo-impulsivo, trastorno de hiperactividad con déficit de atención, con predominio de hiperactividad-impulsividad (trastorno), TDAH, con predominio hiperactivo - impulsivo, trastorno por déficit de atención con hiperactividad, con predominio hiperactivo - impulsivo, trastorno de hiperactividad con déficit de atención, con predominio de hiperactividad-impulsividad, trastorno por déficit de atención con hiperactividad, con predominio hiperactivo - impulsivo (trastorno), síndrome del niño hiperactivo, TDAH, síndrome hipercinético, SAI (trastorno), síndrome hiperquinético, SAI, trastorno por déficit de atención con hiperactividad (trastorno), [X]trastorno hipercinético, no especificado, síndrome hiperquinético, síndrome hipercinético, SAI, [X]trastorno hiperquinético, no especificado, [X]trastorno hipercinético, no especificado (trastorno), trastorno por déficit de atención con hiperactividad, Disfunción Cerebral Mínima, Perturbación de la Actividad y de la Atención, Trastorno o Síndrome Deficitario de la Atención con Hiperactividad, ADHD, Trastorno de Déficit de Atención con Hiperactividad, Trastorno de Hiperactividad con Déficit de Atención, Trastorno de Hiperactividad y Déficit de Atención, síndrome hiperquinético, SAI (trastorno), Trastorno por déficit de atención con hiperactividad, trastorno de hiperactividad con déficit de atención (trastorno), trastorno de hiperactividad con déficit de atención, Síndrome Hipercinético, Trastorno por Déficit de Atención con Hiperactividad, Trastorno Hipercinético con Déficit de la Atención
Japanese 過活動を伴う小児期の注意欠陥障害, 運動過多症候群, 注意欠陥多動性障害ＮＯＳ, 過活動を伴う注意欠陥障害, ＡＤＨＤ, 小児の過活動症候群, 児童期の過動症候群、詳細不明, 小児期の運動過多症候群, ﾁｭｳｲｹｯｶﾝﾀﾄﾞｳｾｲｼｮｳｶﾞｲ, ｶｶﾂﾄﾞｳｦﾄﾓﾅｳｼｮｳﾆｷﾉﾁｭｳｲｹｯｶﾝｼｮｳｶﾞｲ, ｼｮｳﾆｷﾉｳﾝﾄﾞｳｶﾀｼｮｳｺｳｸﾞﾝ, ﾁｭｳｲｹｯｶﾝﾀﾄﾞｳｾｲｼｮｳｶﾞｲNOS, ｳﾝﾄﾞｳｶﾀｼｮｳｺｳｸﾞﾝ, ｼｮｳﾆﾉｶｶﾂﾄﾞｳｼｮｳｺｳｸﾞﾝ, ADHD, ｶｶﾂﾄﾞｳｦﾄﾓﾅｳﾁｭｳｲｹｯｶﾝｼｮｳｶﾞｲ, ｼﾞﾄﾞｳｷﾉｶﾄﾞｳｼｮｳｺｳｸﾞﾝｼｮｳｻｲﾌﾒｲ, 注意欠陥性行動異常障害, 注意欠損多動障害, 注意欠陥障害, 注意欠陥多動障害, 脳損傷-微細, 活動過剰性注意集中障害, 多動症候群, 注意不足活動亢進症, 最小脳機能不全, 微細脳損傷, ＡＤＨＤ、多動性−衝動性優勢型, ADHDﾀﾄﾞｳｾｲｼｮｳﾄﾞｳｾｲﾕｳｾｲｶﾞﾀ, 注意欠陥多動性障害, 活動過剰性注意欠陥障害
Swedish ADHD
Finnish Aktiivisuuden ja tarkkaavuuden häiriö
Russian MINIMAL'NAIA MOZGOVAIA DISFUNKTSIIA, MOZGOVAIA DISFUNKTSIIA MINIMAL'NAIA, GIPERAKTIVNOSTI SINDROM S DEFITSITOM VNIMANIIA, GIPERKINETICHESKII SINDROM, VNIMANIIA RASSTROISTVA S GIPERAKTIVNOST'IU, VNIMANIIA DEFITSIT S GIPERAKTIVNOST'IU, ВНИМАНИЯ ДЕФИЦИТ С ГИПЕРАКТИВНОСТЬЮ, ВНИМАНИЯ РАССТРОЙСТВА С ГИПЕРАКТИВНОСТЬЮ, ГИПЕРАКТИВНОСТИ СИНДРОМ С ДЕФИЦИТОМ ВНИМАНИЯ, ГИПЕРКИНЕТИЧЕСКИЙ СИНДРОМ, МИНИМАЛЬНАЯ МОЗГОВАЯ ДИСФУНКЦИЯ, МОЗГОВАЯ ДИСФУНКЦИЯ МИНИМАЛЬНАЯ
Czech Syndrom hyperaktivního dítěte, Syndrom hyperkinetický, Hyperkinetický syndrom v dětství, Blíže neurčený hyperkinetický syndrom v dětství, Porucha se zhoršenou pozorností/hyperaktivitou NOS, Porucha se zhoršenou pozorností v dětství s hyperaktivitou, Porucha se zhoršenou pozorností/hyperaktivitou, Porucha se zhoršenou pozorností-hyperaktivitou, Porucha se zhoršenou pozorností a hyperaktivitou, Hyperkinetický syndrom, ADHD, převážně hyperaktivně-impulzivní typ, pozornost snížená spojená s hyperaktivitou, hyperkinetická porucha, ADHD, hyperkinetický syndrom
Korean 과운동성 장애, 상세불명의 과운동성 장애
Croatian POREMEĆAJ POMANJKANJA PAŽNJE S HIPERAKTIVNOŠĆU
Polish Zespół nadpobudliwości psychoruchowej, Zespół hiperkinetyczny, Zespół nadpobudliwości psychoruchowej z deficytem uwagi, Zaburzenia uwagi z nadpobudliwością, Zespół deficytu uwagi z nadruchliwością, Zespół minimalnego uszkodzenia mózgu, ADHD
Hungarian Figyelemhiányos/hyperactivitasos zavar, Gyermekkori figyelemhiányos zavar hyperactivitással, ADHD, Hyperkinetikus syndroma, ADHD, praedominalisan hyperactív-impulsív típus, Figyelemhiány-hiperaktivitás zavar, Hyperactiv gyermek syndroma, Hiperkinetikus tünetegyüttes, Gyermekkori hiperkinetikus tünetegyüttes, Figyelem hiányos hyperactivitas betegség, Figyelemhiányos/hyperactivitasos zavar k.m.n., A gyermekkor nem meghatározott hyperkinetikus syndromája
Norwegian Oppmerksomhetsforstyrrelse med hyperaktivitet, ADHD, Hyperaktivitet
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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