• talks excessively
• often blurts out answers before questions have been completed
• often has difficulty awaiting turn
• often interrupts or intrudes on others
The American Academy of Pediatrics recently developed new guidelines for the diagnosis of ADHD with input from a panel of medical, mental health, and educational experts. The new guidelines, designed for primary care physicians diagnosing ADHD in children aged six to 12 years, include the following recommendations:
• ADHD evaluations should be performed by the primary care clinician for children who show signs of school difficulties, academic under-achievement, troublesome relationships with teachers, family members, and peers, and other behavioral problems.
• Questions to parents, either directly or through a pre-visit questionnaire, regarding school and behavioral issues may help alert physicians to possible ADHD.
• In diagnosing ADHD, physicians should use DSM-IV criteria, which require that symptoms be present in two or more of a child's settings, and that the symptoms interfere with the child's academic or social functioning for at least six months.
• The assessment of ADHD should include information obtained directly from parents or care-givers, as well as a classroom teacher or other school professional, regarding the core symptoms of ADHD in various settings, the age of onset, duration of symptoms, and degree of functional impairment.
• Evaluation of a child with ADHD should also include assessment for coexisting conditions: learning and language problems, aggression, disruptive behavior, depression, or anxiety.
• Because as many as one-third of children diagnosed with ADHD also have a coexisting condition, other diagnostic tests (sometimes considered positive indicators for ADHD) have been reviewed and considered not effective. These tests include lead screening, tests for generalized resistance to thyroid hormone, and brain image studies.
Of course, all children sometimes have trouble paying attention, following directions, or being quiet, but for children with ADHD, these behaviors occur more frequently and are more disturbing.
Although the primary symptoms associated with ADHD are inattention, distractibility, and hyperac-tivity, some current researchers now recognize ADHD as a condition that primarily affects impulse controls that delay response to external or internal stimuli. The inability of impulse controls to delay response has a significant effect on memory and executive functions that involve holding verbal or visual information in mind in order to process it, reflecting on previous experience and learning to change behavior based on it, and reconstituting prior emotional states as a means to self-understanding and development.
Symptoms of ADHD may include failing to sustain attention while playing or performing tasks, difficulty completing tasks, difficulty with organization and planning, difficulty with impulsive behavior, such as blurting out answers, acting inappropriately, and/or fidgeting and restlessness. There may also be an inability to self-monitor or self-regulate behavior, and an impaired sense of the passage of time. Individuals with ADHD frequently have difficulty getting started, lose focus, and do not finish projects. Short- and long-term planning abilities may be greatly diminished, and disorganization can result from an inability to mindfully plan, act, and complete even the most basic tasks, such as cleaning a room. Individuals with ADHD often display risk-taking or conflict-seeking behaviors and may exhibit poor judgment in social or interpersonal contexts.
At the same time, individuals with ADHD may also display paradoxical behaviors, such as the ability to focus intensively on a task over a period of time, very strong intellectual, verbal, and problemsolving skills, and extraordinary creativity. Characteristically, both types of behavior may occur within a single place, such as a class or work environment. Because the performance of individuals with ADHD can be strong, especially when they are very interested, subsequent failure to perform at the same level is often perceived as a lack of self-discipline or effort. Adults who are diagnosed late in life often report severe and lifelong problems in school, job, or with personal relationships. They may feel misunderstood and are frequently misdi-agnosed, given the range of varying symptoms that can develop as a result of an attention disorder or a coexisting condition.
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