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ADHD, 2.02 (V) Diagnostic Criteria

2.02 (V) Diagnostic Criteria

Welcome to Module 2. In this module, we're gonna talk about the ADHD diagnostic guidelines and criteria. We're gonna talk about evidence-based assessment tools that clinicians can use to diagnose ADHD. We'll then move to a focus on how to identify impairment in daily life function, which may be the most important aspect of the ADHD diagnostic process. And then finally, we'll end with some discussion about how our diagnostic process can be aligned with eventual treatment implementation. Really the main reason why we're doing the diagnosis in the first place. We wanna figure out how to help the child or youth in their daily life functioning. There are a number of current guidelines that can be relied upon for figuring out the best way to diagnose ADHD. The US Department of Education, a team put together by the American Psychological Association, psychiatrists, as well as pediatricians, all generally agree that the diagnostic process should include the collection of both parent and teacher rating scales. It also includes an interview with the parent that helps to determine the age of onset of the disorder. It also can help the clinician figure out the degree to which the symptoms are causing impairment or problems in functioning. And all of the guidelines suggest that DSM criteria should be used. That's the Diagnostic and Statistical Manual of Mental Disorders. We currently use the DSM-V, the guidelines have generally been the same since the late 80s, early 90s. But generally, there are two general collections of symptoms that children with ADHD may have, that includes a inattentive or hyperactive impulsive general group of symptoms. Some children have both of those groups together, and they're thought to have a combined presentation for ADHD. The DSM-V criteria did make a few modifications are worth noting. It used to be that children had to have the symptoms present before the age of seven. The current guidelines and the diagnostic criteria say that the symptoms have to be present before the age of 12, so they became a little bit more inclusive, include age of onset in middle school. Older adolescents and adults don't have to have six symptoms of inattention or hyperactivity impulsivity, they only have to have five. And that's probably because some of the symptoms and the diagnostic criteria are more appropriate for younger children. For example, often does not remain seated when, or remain seated as expected, is something we see often with young children. That seems to go away a bit, as adolescents and young adults can stay in their seat, but just feel really restless, per their report. Finally, the clinician adds some specifiers in the diagnostic criteria that is, whether or not it's mainly an attentive presentation of the symptoms, a mainly hyperactive impulsive presentation, or a combined presentation. And they can also add a specifier for severity, whether it's mild, moderate or severe. Other commonalities amongst the diagnostic decision making guidelines are that impairment and functioning must be assessed across settings. That includes home, school, or other places, like on a sports team, or in Scouts, or in non structured peer relationship activities. Also there needs to be an evaluation about whether or not comorbid problems are present. This includes things like learning disorders, internalizing disorders, like depression or anxiety. Sometimes a clinician may be evaluating for comorbid tic disorders or other medical disorders, as well. However, all the guidelines say that you should use the DSM criteria when making a diagnosis. When we look at the symptoms of inattention, they include things like not paying attention to details or making careless mistakes. Being disorganized, being forgetful, losing things, also includes difficulty with persistence in tasks. So children with ADHD, because it's probably hard for them to focus and pay attention, often avoid having to pay attention for a long time. And so they'll opt out of a task, like homework or seat work assignment, where they really gotta button down and focus for a long period of time. The hyperactive impulsive symptoms include being on the go, interrupting others, sometimes blurting out answers, finishing someone's question before they even get a chance to answer the whole question. And then the fidgety, squirmy, out of seat behavior, kind of really active behavior. As I mentioned before, the diagnosis can yield one of three concentrations. Primarily inattentive concentration, primarily hyperactive-impulsive concentration or combined concentration. For the decision making processes, this is important, but as we'll talk about when we discuss impairment, the actual diagnosis doesn't tell us anything about what that child needs in terms of a treatment effort. All it does is say this child has behaviors that are eligible for being diagnosed with ADHD. Once we figure out the diagnosis, we should be moving right to now, what are we gonna do to help. Just one note. There are a number of things that are not evidence-based for ADHD. So there's no medical test that can diagnose ADHD. Unfortunately, unlike, perhaps if a child has Strep throat, you go to the doctor's office, you get a cheek swab or a throat swab, they can tell you very rapidly, yes this is Strep, no, it's not Strep. There is nothing like that currently in the field for diagnosing ADHD. And so we have to rely on parent and teacher reports of their observations of the child's behavior. It's also not evidence-based to asked the child about their symptoms, so a pediatrician or a psychologist cannot meet with a child, talk to them about their symptoms, and then determine whether or not the child has ADHD. That's because children are typically very poor reporters of the extent to which their ADHD symptoms are present and impacting their functioning. They generally have poor insight into their problems, and that's why we rely on other reporters to tell us about the child. Allergy tests cannot rule in or rule out ADHD. Certainly can rule in or rule out allergies, but they can't tell us about ADHD. And there are no brain scans presently available that would allow as to know whether or not a child has ADHD or not.


2.02 (V) Diagnostic Criteria

Welcome to Module 2. In this module, we're gonna talk about the ADHD diagnostic guidelines and criteria. We're gonna talk about evidence-based assessment tools that clinicians can use to diagnose ADHD. We'll then move to a focus on how to identify impairment in daily life function, which may be the most important aspect of the ADHD diagnostic process. And then finally, we'll end with some discussion about how our diagnostic process can be aligned with eventual treatment implementation. Really the main reason why we're doing the diagnosis in the first place. We wanna figure out how to help the child or youth in their daily life functioning. There are a number of current guidelines that can be relied upon for figuring out the best way to diagnose ADHD. The US Department of Education, a team put together by the American Psychological Association, psychiatrists, as well as pediatricians, all generally agree that the diagnostic process should include the collection of both parent and teacher rating scales. It also includes an interview with the parent that helps to determine the age of onset of the disorder. It also can help the clinician figure out the degree to which the symptoms are causing impairment or problems in functioning. And all of the guidelines suggest that DSM criteria should be used. That's the Diagnostic and Statistical Manual of Mental Disorders. We currently use the DSM-V, the guidelines have generally been the same since the late 80s, early 90s. But generally, there are two general collections of symptoms that children with ADHD may have, that includes a inattentive or hyperactive impulsive general group of symptoms. Some children have both of those groups together, and they're thought to have a combined presentation for ADHD. The DSM-V criteria did make a few modifications are worth noting. It used to be that children had to have the symptoms present before the age of seven. The current guidelines and the diagnostic criteria say that the symptoms have to be present before the age of 12, so they became a little bit more inclusive, include age of onset in middle school. Older adolescents and adults don't have to have six symptoms of inattention or hyperactivity impulsivity, they only have to have five. And that's probably because some of the symptoms and the diagnostic criteria are more appropriate for younger children. For example, often does not remain seated when, or remain seated as expected, is something we see often with young children. That seems to go away a bit, as adolescents and young adults can stay in their seat, but just feel really restless, per their report. Finally, the clinician adds some specifiers in the diagnostic criteria that is, whether or not it's mainly an attentive presentation of the symptoms, a mainly hyperactive impulsive presentation, or a combined presentation. And they can also add a specifier for severity, whether it's mild, moderate or severe. Other commonalities amongst the diagnostic decision making guidelines are that impairment and functioning must be assessed across settings. That includes home, school, or other places, like on a sports team, or in Scouts, or in non structured peer relationship activities. Also there needs to be an evaluation about whether or not comorbid problems are present. This includes things like learning disorders, internalizing disorders, like depression or anxiety. Sometimes a clinician may be evaluating for comorbid tic disorders or other medical disorders, as well. However, all the guidelines say that you should use the DSM criteria when making a diagnosis. When we look at the symptoms of inattention, they include things like not paying attention to details or making careless mistakes. Being disorganized, being forgetful, losing things, also includes difficulty with persistence in tasks. So children with ADHD, because it's probably hard for them to focus and pay attention, often avoid having to pay attention for a long time. And so they'll opt out of a task, like homework or seat work assignment, where they really gotta button down and focus for a long period of time. The hyperactive impulsive symptoms include being on the go, interrupting others, sometimes blurting out answers, finishing someone's question before they even get a chance to answer the whole question. And then the fidgety, squirmy, out of seat behavior, kind of really active behavior. As I mentioned before, the diagnosis can yield one of three concentrations. Primarily inattentive concentration, primarily hyperactive-impulsive concentration or combined concentration. For the decision making processes, this is important, but as we'll talk about when we discuss impairment, the actual diagnosis doesn't tell us anything about what that child needs in terms of a treatment effort. All it does is say this child has behaviors that are eligible for being diagnosed with ADHD. Once we figure out the diagnosis, we should be moving right to now, what are we gonna do to help. Just one note. There are a number of things that are not evidence-based for ADHD. So there's no medical test that can diagnose ADHD. Unfortunately, unlike, perhaps if a child has Strep throat, you go to the doctor's office, you get a cheek swab or a throat swab, they can tell you very rapidly, yes this is Strep, no, it's not Strep. There is nothing like that currently in the field for diagnosing ADHD. And so we have to rely on parent and teacher reports of their observations of the child's behavior. It's also not evidence-based to asked the child about their symptoms, so a pediatrician or a psychologist cannot meet with a child, talk to them about their symptoms, and then determine whether or not the child has ADHD. That's because children are typically very poor reporters of the extent to which their ADHD symptoms are present and impacting their functioning. They generally have poor insight into their problems, and that's why we rely on other reporters to tell us about the child. Allergy tests cannot rule in or rule out ADHD. Certainly can rule in or rule out allergies, but they can't tell us about ADHD. And there are no brain scans presently available that would allow as to know whether or not a child has ADHD or not.