ADHD: Fact, Fiction and Beyond
A Comprehensive Study of Attention Deficit Hyperactivity Disorder
by Dr. Victoria Martin, M.D.
The diagnosis of ADHD is best made by taking an extensive history and evaluating the level of impairment in functioning experienced by the individual in various areas of his life. The only recognized standard by which a diagnosis of ADHD can be made is by using the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). There is no “test” available that has been recognized by the AMA, APA or other governing organization for diagnosing either children or adults. It may be helpful to get information from teachers and extended family members when evaluating children and from spouses when evaluating adults. The more perspectives obtained the more accurate the diagnosis will be.
Recently there have been some computerized continuous performance tests developed for children with extensive norms which are becoming more widely understood and accepted but these tests can only indicate the presence of ADHD symptoms and cannot differentiate whether they result from true ADHD or some other disorder with overlapping symptomatology. The diagnostic interview schedule for children (DISC) has extensive data on reliability and validity available and covers all 31 DSM diagnoses known to occur in children. It takes the average parent an hour or longer to complete. The schedule for affective disorders and schizophrenia for school age children – present and lifetime version (K-SADS-PL) can generate up to 32 DSM-IV childhood diagnoses and can only be administered by clinicians. It works like an algorithm where the answers to certain questions determine the questions to follow. There is some reliance on clinical judgment in integrating parent report and child report. Test-retest reliability data on the K-SADS-PL is good, ranging from .9 for depression to .63 for ADHD.
The most common comorbid disorders with ADHD are as follows:
|OPPOSITION DEFIANT DISORDER AND CONDUCT DISORDER||42%-61%|
|TOURETTE’S/TIC DISORDER WITH ADHD||49%-100%|
|OBSESSIVE-COMPLUSIVE DISORDER WITH ADHD||6%-33%|
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