Diagnosing ADHD

Diagnosing an adult with Attention Deficit Hyperactivity Disorder (ADHD) can be challenging. Symptoms of ADHD in adults can be subtle and subjective. The criteria for ADHD emphasizes a childhood history consistent with ADHD, which requires the patient's subjective report of symptoms.¹

For an accurate diagnosis, a history of the patient's childhood behavior, together with an interview with his life partner, a parent, close friend, or other close associate, will be needed. A physical examination and psychological tests should also be given. Comorbidity with other conditions may exist such as specific learning disabilities, anxiety, or affective disorders.²

These criteria for ADHD are specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV).

Primary symptoms of ADHD include hyperactivity, inattention, and impulsivity. Behavioral examples of these core symptoms include³:

1. Hyperactivity
• Roaming around a room
• Talking incessantly
• Inability to sit through a lesson
2. Inattention
• Difficulty in filtering out unnecessary distractions
• Being distracted or sidetracked by the movement of people or of objects
3. Impulsivity
• Acting before thinking
• Demonstrating a very short temper
• Behavior that includes yelling or hitting

The behaviors must appear early in life, before age 7. This early symptom history is important in diagnosing ADHD.

ADHD contains subtypes with predominant traits.

The subtypes include:

• An inattentive subtype
• A hyperactive-impulsive subtype
• A combined subtype

REFERENCES:

1. Searight HR, Burke JM, Rottnek F. Adult ADHD: evaluation and treatment in family medicine. Am Fam Physician. 2000;62(9):2077-86.
2. Strock M. Attention Deficit Hyperactivity Disorder [NIMH Web site]. 2003 (rev). Available at: http://www.nimh.nih.gov/publicat/ADHD.cfm. Accessed July 20, 2005.
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. DSM-IV-TR. In: Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence: Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder. Washington, DC: American Psychiatric Association; 1994:92-93.