Attention-Deficit Hyperactivity Disorder

"He never sits still, he’s always into something. She won’t pay attention to what I say. He doesn’t think before he acts. In school, she’s up and out of her seat in a flash. He’s not doing well in school, and is behind his peers".

These kinds of concerns, voiced by parents and teachers, are the main presenting problems for children who receive the diagnosis of Attention-Deficit Hyperactivity Disorder (ADHD). Only a few disorders of youth garner as much public interest and are so surrounded by controversy as ADHD. Most of the general public has at least passing knowledge of the disorder, which is widely referred to as attention-deficit disorder or hyperactivity. These terms reflect the changing conceptualizing of the disorder. Controversy about ADHD has focused on both its nature and the pharmacological treatment that was widely introduced in the late 1960s. The issues of how best to view and treat the disorder still exist.

Diagnostic Criteria
What we now refer to as ADHD was first described in the mild-1800s. Early conceptualizations of ADHD emphasized over activity or motor restlessness, and the terms hyperkinesis, hyperkinetic reaction, and hyperkinetic syndrome were variously applied. However, several other behavioral problems were recognized as being associated with hyperactivity, especially attention deficits and impulsivity. In time, attention deficits took center stage and hyperactivity was downgraded.
This shift in conceptualization was so important that the disorder was referred to in DSM-III (1980) as attention deficit disorder with hyperactivity (ADDH), or without hyperactivity. Clearly, attention problems had become the core for diagnosis. In DSM-III-R (1987), the disorder was relabeled Attention-Deficit Hyperactivity Disorder (ADHD), and the category of attention deficit without hyperactivity was effectively dropped. ADHD echoed the past by again giving greater recognition to hyperactivity. Children were diagnosed on the basis of displaying eight of fourteen behaviors, which could be different mixes of inattention, hyperactivity, and impulsivity.
DSM-IV (1994) brought further change and a slightly different label: Attention-Deficit/Hyperactivity Disorder. Notably new is that people can be placed into three categories based on displaying predominantly attention deficits, predominantly attention deficits, predominantly hyperactivity-impulsivity, or both attention deficits and hyperactivity. There is research support for the validity and usefulness of this subgrouping.
The diagnosis demands onset before age seven and the display of symptoms for at least six months. Because the criterion behaviors appear to some degree in normal children and may vary with developmental level, a diagnosis is given only when symptoms are at odds with developmental level. In addition, the youngster’s functioning must be judged as somewhat maladaptive in at least two settings (e.g., home and school); that is, ADHD must be at least somewhat pervasive over settings. The requirement of pervasiveness is also new in DSM-IV and merits further comment.
Behavioral manifestations of ADHD depend somewhat on the setting in which they are observed. Some children appear pervasively inattentive, and impulsive with parents, teachers, or peers. Others appear to show disturbed behavior in only one setting and are said to show situational ADHD. Evidence exists that pervasiveness is linked to severity of the disorder and other correlates. The ICD diagnostic system has long required that symptoms be displayed; thus, DSM and ICD are now in agreement on this point. Nevertheless, concern is expressed that the requirement of pervasiveness may fail to identify cases with relatively mild symptoms (August and Garfinkel, 1993).
Despite the modifications of labels and diagnostic criteria over the last few decades, there has been wide agreement that attention deficits, hyperactivity, and impulsivity are primary in ADHD. In general, we will use the labels attention-deficit hyperactivity disorder (ADHD) or hyperactivity to refer to youth displaying these problems.

Behavior Disorders of Childhood by Rita Wicks-Nelson & Allen C. Israel

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