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ADHD is characterized by a pattern of behavior, present in multiple settings (e.g.

,
school and home), that can result in performance issues in social, educational, or
work settings. As in DSM-IV, symptoms will be divided into two categories of
inattention and hyperactivity and impulsivity that include behaviors like failure to
pay close attention to details, difficulty organizing tasks and activities, excessive
talking, fidgeting, or an inability to remain seated in appropriate situations.

Essential features:
A. Persistent pattern of inattention and/or hyperactivity-impulsivity that is more
frequently displayed and is more severe than is typically observed in individuals at
comparable level of development.
B. Some hyperactive-impulsive or inattentive symptoms must have been present
before seven years of age.
C. Some impairment from the symptoms must be present in at least two settings.
D. There must be clear evidence of interference with developmentally appropriate
social, academic or occupational functioning.
E. The disturbance does not occur exclusively during the course of a Pervasive
Developmental Disorder, Schizophrenia, or other Psychotic Disorders and is not better
accounted for by another mental disorder.
Three Subtypes:
Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Type: This
subtype is used if six (or more) symptoms of inattention (but fewer than six symptoms
of hyperactivity-impulsivity) have persisted for at least six months.
Attention-Deficit/Hyperactivity Disorder Predominantly Hyperactive-Impulsive
Type: This subtype should be used if six (or more) symptoms of hyperactivityimpulsivity (but fewer than six of inattention) have persisted for at least six months.
Attention-Deficit/Hyperactivity Disorder Combined Type: This subtype should be
used if six (or more) symptoms of inattention and six (or more) symptoms of
hyperactivity-impulsivity have persisted for at least six months.

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Predominantly hyperactive-impulsive
Most symptoms (six or more) are in the hyperactivity-impulsivity categories.
Fewer than six symptoms of inattention are present, although inattention may
still be present to some degree.

Predominantly inattentive

The majority of symptoms (six or more) are in the inattention category and
fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivityimpulsivity may still be present to some degree.

Children with this subtype are less likely to act out or have difficulties getting
along with other children. They may sit quietly, but they are not paying attention to what they
are doing. Therefore, the child may be overlooked, and parents and teachers may not notice
that he or she has ADHD.

Combined hyperactive-impulsive and inattentive


Six or more symptoms of inattention and six or more symptoms of
hyperactivity-impulsivity are present.
Most children have the combined type of ADHD.

Diagnostic Criteria for the three subtypes of Attention-Deficit/Hyperactivity


Disorder according to DSM-IV:
A. Persistent pattern of inattention and/or hyperactivity-impulsivity that is more
frequently displayed and is more severe than is typically observed in individuals at
comparable level of development. Individual must meet criteria for either (1) or (2):
(1) Six (or more) of the following symptoms of inattention have persisted for at least
six months to a degree that is maladaptive and inconsistent with developmental level:
Inattention
(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 activity
(c) often does not seem to listen when spoken to directly
(d) often does not follow through on instructions and fails to finish schoolwork,
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 looses 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) Six (or more) of the following symptoms of hyperactivity-impulsivity have
persisted for at least six 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 must have been present
before age 7 years.
C. Some impairment from the symptoms is present in at least two settings (e.g., at
school [or work] and at home).
D. There must be clear evidence of interference with developmentally appropriate
social, academic or occupational functioning.
E. The disturbance does not occur exclusively during the course of a Pervasive
Developmental Disorder, Schizophrenia, or other Psychotic Disorders and is not better
accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder,
Dissociative Disorder, or a Personality Disorder).

Signs & Symptoms

Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. It is normal for all
children to be inattentive, hyperactive, or impulsive sometimes, but for children with ADHD,
these behaviors are more severe and occur more often. To be diagnosed with the disorder,
a child must have symptoms for 6 or more months and to a degree that is greater than other
children of the same age.
Children who have symptoms of inattention may:

Be easily distracted, miss details, forget things, and frequently switch from one
activity to another
Have difficulty focusing on one thing

Become bored with a task after only a few minutes, unless they are doing something
enjoyable

Have difficulty focusing attention on organizing and completing a task or learning


something new

Have trouble completing or turning in homework assignments, often losing things


(e.g., pencils, toys, assignments) needed to complete tasks or activities

Not seem to listen when spoken to

Daydream, become easily confused, and move slowly

Have difficulty processing information as quickly and accurately as others

Struggle to follow instructions.


Children who have symptoms of hyperactivity may:

Fidget and squirm in their seats

Talk nonstop

Dash around, touching or playing with anything and everything in sight

Have trouble sitting still during dinner, school, and story time

Be constantly in motion

Have difficulty doing quiet tasks or activities.


Children who have symptoms of impulsivity may:

Be very impatient

Blurt out inappropriate comments, show their emotions without restraint, and act
without regard for consequences

Have difficulty waiting for things they want or waiting their turns in games

Often interrupt conversations or others' activities.


Causes

Scientists are not sure what causes ADHD, although many studies suggest that genes play
a large role. Like many other illnesses, ADHD probably results from a combination of
factors.
Genes. Results from several international studies of twins show that ADHD often runs in
families. Researchers are looking at several genes that may make people more likely to
develop the disorder. Children with ADHD who carry a particular version of a certain gene
have thinner brain tissue in the areas of the brain associated with attention.
Environmental factors. Studies suggest a potential link betweencigarette smoking and
alcohol use during pregnancy and ADHD in children. In addition, preschoolers who are
exposed to high levels of lead, which can sometimes be found in plumbing fixtures or paint
in old buildings, may have a higher risk of developing ADHD.
Brain injuries. Children who have suffered a brain injury may show some behaviors similar
to those of ADHD. However, only a small percentage of children with ADHD have suffered a
traumatic brain injury.
Sugar. The idea that refined sugar causes ADHD or makes symptoms worse is popular, but
more research discounts this theory than supports it. In one study, researchers gave
children foods containing either sugar or a sugar substitute every other day.