The essential features of this disorder are developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity. People with the disorder generally display some disturbance in each of these areas, but to varying degrees. Manifestations of the disorder usually appear in most situations, including at home, in school, at work, and in social situations, but to varying degrees. Some people, however, show signs of the disorder in only one setting, such as at home or at school.
Symptoms typically worsen in situations requiring sustained attention, such as listening to a teacher in a classroom, attending meetings, or doing class assignments or chores at home. Signs of the disorder may be minimal or absent when the person is receiving frequent reinforcement or very strict control, or is in a novel setting or a one-to-one situation (e. g. , being examined in the clinician’s office, or interacting with a videogame. )
Impulsiveness is often demonstrated by blurting out answers to questions before they are completed, making comments out of turn, failing to await one’s turn in group tasks, failing to heed directions fully before beginning to respond to assignments, interrupting the teacher during a lesson, and interrupting or talking to other children during quiet work periods. Hyperactivity may be evidenced by difficulty remaining seated, excessive jumping about, running in classroom, fidgeting, manipulating objects, and twisting and wiggling in one’s seat.
At home, inattention may be displayed in failure to follow through on others’ requests and instructions and in frequent shifts from one uncompleted activity to another. Problems with impulsiveness are often expressed by interrupting or intruding on other family members and by accident-prone behavior, such as grabbing a hot pan from the stove or carelessly knocking over a pitcher. Hyperactivity may be evidenced by an inability to remain seated when expected to do so and by excessively noisy activities. When children play games with their friends, it is difficult for them to follow the rules of the games or to listen to other children.
Impulsiveness is frequently demonstrated by not being able to await one’s turn in games, interrupting, grabbing objects (not with malevolent intent), and engaging in potentially dangerous activities without considering the possible consequences, e. g. , riding a skateboard over extremely rough terrain. Hyperactivity may be shown by excessive talking and by an inability to play quietly and to regulate one’s activity to conform to the demands of the game. Age-specific features. In preschool children, the most prominent features are generally signs of gross motor over-activity, such as excessive running or climbing.
The child is often described as being on the go and “always having his motor running. ” You can observe inattention by watching those children shifting frequently from one activity to another. They say that, in older children and adolescents, the most prominent features tend to be excessive fidgeting and restlessness. In adolescents, impulsiveness is often displayed in social activities, such as initiating a diverting activity on the spur of the moment instead of attending to a previous commitment (e. g. joy riding instead of doing homework, or partying, daring games etc. )
Associated features vary as a function of age, and include low self-esteem, mood lability, low frustration tolerance, and temper outbursts. Academic underachievement is characteristic of most children with this disorder. Non-localized, “soft,” neurological signs and motor-perceptual dysfunctions (e. g. , poor eye-hand coordination) may be present. Age at onset. In approximately half of the cases, onset of the disorder is before age four.
Frequently the disorder is not recognized until the child enters school. Impairment. Some impairment in social and school functioning is common. Complications. School failure is the major complication. Predisposing factors. Central nervous system abnormalities, such as the presence of neurotoxins, cerebral palsy, epilepsy, and other neurological disorders, are thought to be predisposing factors. Disorganized or chaotic environments and child abuse or neglect may be predisposing factors in some cases. Prevalence.
The disorder is common; it may occur in as many as 3% of children. Course. In the majority of cases manifestations of the disorder persist throughout childhood. Oppositional Defiant Disorder often develops later in childhood in those with ADHD. Studies have indicated that the following features predict a poor course: coexisting Conduct Disorder, low IQ, and severe mental disorder in the patients. Familial pattern. The disorder is believed to be more common in first-degree biologic relatives of people with the disorder than in the general population.
Among family members, the following disorders are thought to be overrepresented: Specific Developmental Disorders, Alcohol Dependence or Abuse, Conduct Disorder, and Antisocial Personality Disorder. Here are the diagnostic criteria for 314. 01 Attention-deficit Hyperactivity Disorder. It says that a criterion is met only if the behavior is considerably more frequent than that of most people of the same mental age, which I find somewhat challenging, since it seems to imply that one is “normal” if one acts like “most people”.
