What are the diagnosis criteria of attention deficit?
According to the DSM-IV, a child has attention deficit disorder if he or she presents at least six symptoms in one of the following three categories: inattention, hyperactivity and impulsivity. He or she must present these symptoms before the age of 7, for at least 6 months, and to a degree that does not correspond to the mental development of a child of the same age.
Inattention: The child often cannot pay attention to details or makes absent-minded mistakes in homework, tasks or other activities; often has difficulty sustaining attention in work or games; often does not seem to be listening when spoken to directly; often does not comply with instructions and cannot finish homework, household chores or work duties (not due to oppositional behaviour or the inability to understand instructions); often has difficultly organizing tasks or activities; often avoids, dislikes, or is reluctant to perform tasks that require sustained mental effort (such as school work or home work); often loses items that are necessary for work or activities (e.g., toys, school assignments, pencils, books or tools); is often easily distracted by extraneous stimuli is often forgetful in daily activities
Hyperactivity: The child 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 or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness); often has difficultly playing or engaging in leisure activities quietly; is often "on the go" or acts as if "driven by a motor"; often talks excessively
Impulsivity: often blurts out answers before a question has been completed; often has difficulty awaiting turn; often interrupts or intrudes on others (e.g., butts into conversations or games)
NOTES: These criteria are only considered based on their frequency and intensity and based on the mental age of the child. These criteria are ranked in decreasing order of importance according to data collected during trials carried out throughout the United States based on the criteria of the DSM III-R relating to behavioural disorders. These behaviour criteria must be observed in both the family and school environment. (It should be noted, however, that certain introverted or shy children may express their ADHD either more or exclusively in the family environment; others are stimulated particularly in the presence of group peers or in a pressure situation). Source: Diagnosis and Statistical Manual of Mental Disorders, 1993, American Psychiatric Association. Source: Diagnosis and Statistical Manual of Mental Disorders, 1993, American Psychiatric Association.
Source: Diagnostic and Statistical Manual of Mental Disorders, 1993, American Psychiatric Association.
What are the risk factors for ADHD: genetics, environment?
Genetic factors explain 80% of cases, while environmental factors account for 20%. No specific gene has been formally implicated as of yet. There are multiple suspected environmental factors: tobacco or alcohol consumption during pregnancy, a lack of oxygen during delivery, severe stress during pregnancy, etc.
Ridha Joober, MD, PhD. and Natalie Grizenko, MD, 2008
What is the difference between attention deficit with and without hyperactivity?
Attention deficit can be present by itself; in this case, it is called attention deficit disorder (ADD). However, this symptom is usually associated with motor hyperactivity and impulsivity. When these symptoms are present, the disorder is called attention deficit hyperactivity disorder (ADHD). There are also rare cases of hyperactivity without attention disorder.
- Ridha Joober, MD, PhD and Natalie Grizenko, MD, 2008
Does eating sugar cause hyperactivity?
This is a common question. I myself have noted in my personal life that certain people become more agitated when they eat sugar. However, I don't know of any scientifically rigorous study that has evaluated the effect of products containing sugar. Many parents are convinced that sugar does cause hyperactivity; however, when their children are tested with sugar or artificial sweeteners, they do not see any behaviour difference.
-Ridha Joober, MD, PhD, Mini-Psych School 2010
Are psychologists allowed to assess ADHD?
Since 2009, psychologists can assess mental disorders, including ADHD. Just like psychiatrists, psychologists must use the ADHD assessment criteria listed in the DSM-5 manual. They can therefore also assess the presence of associated or concomitant disorders.
How do you know whether someone has ADHD and not some other kind of psychological distress or family problems?
This question is very important. If a child is hyperactive because of psychological distress within the family and this is constant, the child will always be prone to suffering and dysfunction. The child's developmental history will often give clues to help us determine the cause. If a child has never presented with hyperactivity before the age of eight and then suddenly becomes impulsive, refuses to work, is inattentive, and does nothing at school, then this change is drastic. We then need to look at the family environment to see what could have triggered this change. If it is a type of distress, then resolving this distress could change the child's clinical profile. In these cases, it is probably unnecessary to prescribe medication.
-Ridha Joober, MD, PhD, Mini-Psych School 2010
Are boys and girls affected differently by attention deficit disorders?
Yes, boys suffer from attention deficit hyperactivity disorder more often than girls, who suffer more often from pure attention disorder. Boys with this disorder are also at greater risk of suffering from related disorders, such as oppositional defiant disorder, learning disabilities and depression.
- Ridha Joober, MD, PhD and Natalie Grizenko, MD, 2008
Is ADHD becoming more and more frequent in children?
Personally, I do not believe there is an increase in prevalence. The official diagnosis of ADHD is based on five or six predefined criteria. If experts come to a new consensus that decreases the number of criteria, the number of cases of ADHD would increase. I believe that differences in the prevalence of psychiatric diseases stem from changes in diagnostic criteria, which in turn arise from a new concept of psychiatric disorders within society and from the questions: "What do we want to treat? What do we not want to treat?" Answering these important questions is the responsibility not only of doctors but all of society, which includes the general public, experts, pharmaceutical lobby groups, and patient and parent groups—entities that are always evolving. The basic element in all of this is suffering or dysfunction and what we can do to help.
-Ridha Joober, MD, PhD, Mini-Psych School 2010
My son was diagnosed with inattentive-type ADHD in Grade 2, which was then confirmed in Grade 9. Recently, at 22, he was diagnosed as bipolar. Was the original diagnosis incorrect?
No, I don’t think that the initial diagnosis was incorrect. The child’s psychopathology is a little bit diffused, making it difficult to put in a single category. For example, children with bipolar disorder have very frequent temperament changes during the day, fluctuate a lot in mood, and exhibit frequent angry outbursts. People with ADHD have a mood that is very reactive along with hyperactivity that constantly changes over the day. There are ways of differentiating the two diagnoses, but this is sometimes difficult to do in children.
-Ridha Joober, MD, PhD, Mini-Psych School 2010
I have ADD. Will my two daughters automatically get this disorder?
No, but they are at greater risk than children whose parents do not have ADHD.
- Ridha Joober, MD, PhD and Natalie Grizenko, MD, 2008
Can ADHD be confused with the manic phase of bipolar disorder?
It is especially the manic phase that poses a problem. When we deal with full manic phases, the diagnosis is obvious. But if a person is experiencing hypomania, which manifests as accelerated ideas, mild euphoria, a lack of sleep, racing thoughts, and motor hyperactivity, these symptoms can resemble hyperactivity. In this case, the two conditions may be confused. However, if the person has a history of depressive phases, the diagnosis is clearly bipolar disorder.
-Ridha Joober, MD, PhD, Mini-Psych School 2010
At what age can parents begin suspecting ADHD in a child? At what age can a child begin medication?
Symptoms can appear before the age of 3 in the form of motor hyperactivity and impulsivity. However, a diagnosis is often only made once the child has reached school age. It should also be pointed out that a number of children who are hyperactive before school age become less so later on. The question of treatment before school age is currently the subject of much debate in the literature, but guidelines have not yet been established.
- Ridha Joober, MD, PhD and Natalie Grizenko, MD, 2008
How can I know whether my child has attention deficit disorder or simply excess energy?
Behaviour disorders and ADHD are separate disorders that are defined by different and precise criteria; however, they can co-exist in the same child. The same is true for learning disabilities. A psychiatric evaluation is necessary in all cases. Only doctors and specialists in mental health who are experts in ADHD can make a diagnosis. Parents can ask their family doctors to refer them to a specialist.
- Ridha Joober, MD, PhD and Natalie Grizenko, MD, 2008
Will the state of health of my child with ADHD improve as he gets older?
Hyperactivity tends to decrease with age, but inattention and impulsivity persist in many cases.
- Ridha Joober, MD, PhD and Natalie Grizenko, MD, 2008
What causes ADHD?
Douglas' research thus far supports the theory that most people with ADHD have a genetic predisposition to the disorder. It seems that, when people with this genetic predisposition are further stressed by factors such as exposure to toxins before or after birth or a lack of oxygen during birth, ADHD symptoms are most likely to emerge. A developing brain is exquisitely sensitive to outside influences. We already know that, when an area at the front part of the brain called the frontal cortex is traumatized, the delicate transmission of neurotransmitters can be permanently disturbed. By better understanding how these neurotransmitters are disturbed, chances increase that we can better compensate for the damage to the brain system.
- Ridha Joober, MD, PhD and Natalie Grizenko, MD, 2008
