Hyperactivityimpulsivity

Six or more of the following symptoms, persisting for at least six months to a degree maladaptive and inconsistent with developmental level:

Hyperactivity

• often fidgets with hands or feet or squirms in seat

• often leaves seat in classroom or in other situations in which remaining seated is expected

• 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)

• often has difficulty playing or engaging in leisure activities quietly

• often "on the go" or often acts as if "driven by a motor"

• often talks excessively

Impulsivity

• often blurts out answers before questions have been completed

• often has difficulty awaiting turn

• often interrupts or intrudes on others

Some hyperactive-impulsive or inattentive symptoms cause impairment present before age seven

Some impairment from the symptoms present in two or more settings, such as school and home

Clear evidence of clinically significant impairment in social, academic, or occupational functioning

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 (mood disorder, anxiety disorder, dissociative disorder, personality disorder)

DSM code based on type:

• Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type (DSM code 314.00): Inattention, but not hyperactivity-impulsivity during the previous six months

• Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type (DSM code 314.01): Hyperactivity-impulsivity but not inattention during the previous six months

• Attention-Deficit/Hyperactivity Disorder, Combined Type (DSM code 314.01): Both inattention and hyperactivity-impulsivity during the previous six months

1980, when the third edition (DSM-III) was published, researchers had begun to focus on the deficits of attention in these children, so two diagnostic categories were established: "Attention Deficit Disorder with Hyperactivity (ADD with H)" and "Attention Deficit Disorder without Hyperactivity (ADD without H)." After the publication of DSM-III, many researchers argued that there were no empirical data to support the existence of the ADD without H diagnosis. In other words, it was difficult to find any children who were inattentive and impulsive but who were not hyperactive. For this reason, in 1987, when the revised DSM-III-R was published, the only diagnostic category for these children was "Attention-Deficit Hyperactivity Disorder (ADHD)."

With the publication of the fourth version of the manual, the DSM-IV, in 1994, three distinct diagnostic categories for ADHD were identified: ADHD Predominantly Hyperactive-Impulsive Type, ADHD Predominantly Inattentive Type, and ADHD Combined Type. The type of ADHD diagnosed is dependent upon the number and types of behavioral symptoms a child exhibits. Six of nine symptoms from the Hyperactivity-Implusivity list but fewer than six symptoms from the Inattention list lead to a diagnosis of ADHD Predominantly Hyperactive-Impulsive Type. Six of nine symptoms from the Inattention list but fewer than six symptoms from the Hyperactivity-Implusivity list lead to a diagnosis of ADHD Predominantly Inattentive Type. A child who exhibits six of nine behavioral symptoms simultaneously from both lists receives a diagnosis of ADHD Combined Type.

While the diagnostic definition and specific terminology of ADHD will undoubtedly continue to change throughout the years, the interest in and commitment to this disorder will likely continue. Children and adults with

ADHD, as well as the people around them, have difficult lives to lead. The research community is committed to finding better explanations of the etiology and treatment of this common disorder.

Sources for Further Study

Barkley, Russell A. "Attention-Deficit Hyperactivity Disorder." In Treatment of Childhood Disorders, edited by E. J. Mash and R. A. Barkley. 2d ed. New York: Guilford Press, 1998. This chapter provides a thorough discussion of different treatments for ADHD children, including stimulant medication, antidepressant medication, behavior therapy, parent training, teacher training, and cognitive-behavioral therapy. Each treatment modality is discussed in a fair and objective manner, and empirical research is provided to support the conclusions given.

_. Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. 2d ed. New York: Guilford Press, 1998. Provides comprehensive discussion of nearly all aspects of ADHD, including assessment, diagnosis, and treatment. Also notable for a thorough discussion of ADHD in older adolescents and adults. This excellent and comprehensive book is written by one of the leading researchers in the investigation of ADHD.

Kendall, Philip C. "Attention-Deficit Hyperactivity Disorder." In Childhood Disorders. Hove, East Sussex, England: Psychology Press, 2000. A volume in the series Clinical Psychology, A Modular Course. A succinct but thorough discussion of ADHD, including current research on cognitive and neuropsychological performance of children with the disorder. Wender, Paul H. ADHD: Attention-Deficit Hyperactivity Disorder in Children and Adults. New York: Oxford University Press, 2000. A comprehensive overview of ADHD history, diagnosis, treatment. Discusses strengths associated with ADHD as well as problems associated with the disorder. Wodrich, David L. Attention-Deficit/Hyperactivity Disorder: What Every Parent Wants to Know. 2d ed. Baltimore: Paul H. Brookes, 2000. A book aimed at the general public, containing practical advice and clear descriptions of ADHD and related disorders, as well as resources for treatment.

Vicky Phares; updated by Virginia Slaughter

See also: Cognitive Behavior Therapy; Drug Therapies; Learning Disorders.

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