ADHD: Primary Care Perspectives

Table of Contents

1. "My Child is Hyper": How Can My Pediatrician Help?
2. DIAGNOSIS
   1. Diagnostic Criteria
   2. Types of ADHD
3. CO-MORBIDITIES
4. DEPRESSIVE DISORDERS
5. ANXIETY DISORDERS
6. OPPOSITIONAL DEFIANT DISORDER
7. AUTISM
8. PHARMACOLOGIC TREATMENT: STIMULANT MEDICATIONS
9. PHARMACOLOGIC TREATMENT: OTHER MEDICATIONS
10. NON-PHARMACOLOGIC MANAGEMENT OF ADHD
11. POST-TEST
12. USEFUL RESOURCES
13. SELECTED REFERENCES
14. THE AUTHORS

Diagnostic Criteria

The major DSM-IV criteria for ADHD are as follows:

A. Six or more of the following symptoms of inattention:

1. Often fails to give close attention to details or makes careless mistakes;
2. Often has difficulty sustaining attention;
3. Often does not seem to listen when spoken to directly;
4. Often does not follow through on instructions and fails to finish work or chores;
5. Often has difficulty organizing tasks and activities;
6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort;
7. Often loses things necessary for tasks or activities;
8. Is often easily distracted by extraneous stimuli;
9. Is often forgetful in daily activities.

B. Six or more of the following symptoms of hyperactivity/impulsivity:

Hyperactivity

1. Often fidgets with hands or feet or squirms in seat;
2. Often leaves seat in classroom or in other situations where remaining seated is expected;
3. 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);
4. Often has difficulty playing or engaging in leisure activities quietly;
5. Is often "on the go" or acts as if "driven by motor;"
6. Often talks excessively;

Impulsivity

7. Often blurts out answers before questions have been completed
8. Often has difficulty awaiting turn
9. Often interrupts or intrudes on others.

Additional diagnostic criteria include:

• Some symptoms should have begun prior to age 7.
• Some impairment should be present in at least two settings (e.g., both at home and at school).
• There must be clear evidence of clinically significant impairment in functioning as a result of the inattention or hyperactivity/impulsivity.
• The symptoms are not better explained by some other disorder.