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ADHD or ADD is characterized by a majority of the following symptoms being present in either category (inattention or hyperactivity). These symptoms need to manifest themselves in a manner and degree which is inconsistent with the child's current developmental level. That is, the child's behavior is significantly more inattentive or hyperactive than that of his or her peers of a similar age:
A. Either (1) or (2):
(1) inattention: six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
(b) often has difficulty sustaining attention in tasks or play activities
(c) often does not seem to listen when spoken to directly
(d) often does not follow through on instructions and fails to finish school work, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
(e) often has difficulty organizing tasks and activities
(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
(g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
(h) is often easily distracted by extraneous stimuli
(i) is often forgetful in daily activities
(2) hyperactivity-impulsivity: six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
Hyperactivity
(a) often fidgets with hands or feet or squirms in seat
(b) often leaves seat in classroom or in other situations in which remaining seated is expected
(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
(d) often has difficulty playing or engaging in leisure activities quietly
(e) is often "on the go" or often acts as if "driven by a motor"
(f) often talks excessively
Impulsivity
(g) often blurts out answers before questions have been completed
(h) often has difficulty awaiting turn
(i) often interrupts or intrudes on others (e.g., butts into conversations or games)
B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.
C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).
D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder , Schizophrenia , or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder , Anxiety Disorder , Dissociative Disorders , or a Personality Disorder ).
Code based on type:
314.01 Attention-Deficit/Hyperactivity Disorder, Combined Type: if both Criteria A1 and A2 are met for the past 6 months
314.00 Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type: if Criterion A1 is met but Criterion A2 is not met for the past 6 months
314.01 Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type: if Criterion A2 is met but Criterion A1 is not met for the past 6 months
Coding note: For individuals (especially adolescents and adults) who currently have symptoms that no longer meet full criteria, "In Partial Remission" should be specified.
Associated Features:
Learning Problem.
Hyperactivity.
Differential Diagnosis:
Some disorders have similar symptoms. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.
Age-appropriate Behaviors in Active Children;
Mental Retardation;
Understimulating Environments;
Oppositional Behavior;
Another Mental Disorder;
Pervasive Developmental Disorder;
Psychotic Disorder;
Other Substance-Related Disorder Not Otherwise Specified.
Cause:
ADHD is not caused by poor parenting or family problems. One early theory was that attention disorders were caused by minor head injuries or damage to the brain, and thus for many years ADHD was called "minimal brain damage" or "minimal brain dysfunction." The vast majority of people with ADHD however have no history of head injury or evidence of brain damage however.
ADHD is likely to be caused by biological factors which influence neurotransmitter activity in certain parts of the brain, and which have a strong genetic basis. Studies have shown a link between a person's ability to pay continued attention and the level of activity in the brain. Specifically researchers measured the level of glucose used by the areas of the brain that inhibit impulses and control attention. In people with ADHD, the brain areas that control attention used less glucose, indicating that they were less active. It appears from this research that a lower level of activity in some parts of the brain may cause inattention and other ADHD symptoms.
Treatment:
A wide variety of treatments have been used for ADHD including, but not limited to, various psychotropic medications, psychosocial treatment, dietary management, herbal and homeopathic treatments, biofeedback, meditation, and perceptual stimulation/training. Of these treatment strategies, stimulant medications and psychosocial interventions have been the major foci of research. Overall, these studies support the efficacy of stimulants and psychosocial treatments for ADHD and the superiority of stimulants relative to psychosocial treatments. However, there are no long-term studies testing stimulants or psychosocial treatments lasting several years.
Counseling and Psychotherapy:
Psychosocial treatment of ADHD has included a number of behavioral strategies such as contingency management such as those utilising; point/token reward systems, timeout, response cost. Clinical behavior therapy (parent, teacher, or both are taught to use contingency management procedures), and cognitive-behavioral treatment (e.g., self-monitoring, verbal self-instruction, problem-solving strategies, self-reinforcement). Cognitive-behavioral treatment has not been found to yield beneficial effects in children with ADHD. In contrast, clinical behavior therapy, parent training, and contingency management have produced beneficial effects.
Pharmacotherapy:
Methylphenidate (MPH).
Desipramine.
Dextroamphetamine.
Pemoline.
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