Diagnosis of hyperactic disorder/ ADHD

In the UK hyperactivity is termed hyperkinetic disorder

• symptoms should be evident in early life, if only in retrospect; for ICD-10, by age 7 years and for DSM-5, by age 12 years
• ADHD may persist into adult life.

Attention Deficit / Hyperactivity Disorder (ADHD) is defined by the 'core' signs of impulsiveness, hyperactivity and inattention. There are three subtypes:

• 'combined type' ADHD with signs of hyperactivity / impulsivity and inattention
• 'predominantly inattentive type' ADHD with inattention but not hyperactivity/impulsivity
• 'predominantly hyperactive-impulsive type' ADHD with hyperactivity/impulsivity but not inattention

There are other diagnostic criteria required for the diagnosis of ADHD. These include:

• the signs have persisted for six months or more to a degree that is inconsistent with the developmental level of the child and are maladaptive
• there is evidence of impairment of academic or social functioning
• the impairment of functioning is present in at least two settings (generally at school and at home)
• some of the signs that resulted in impairment were present before the child was seven years of age

Notes (2):

• diagnosis of ADHD should only be made by a specialist psychiatrist, paediatrician or other appropriately qualified healthcare professional with training and expertise in the diagnosis of ADHD, on the basis of:
  • a full clinical and psychosocial assessment of the person; this should include discussion about behaviour and symptoms in the different domains and settings of the person's everyday life, and
  • a full developmental and psychiatric history, and
  • observer reports and assessment of the person's mental state
• for a diagnosis of ADHD, symptoms of hyperactivity/impulsivity and/or inattention should:
  • meet the diagnostic criteria in DSM-V or ICD-10 (hyperkinetic disorder), and
  • be associated with at least moderate psychological, social and/or educational or occupational impairment based on interview and/or direct observation in multiple settings, and
  • be pervasive, occurring in two or more important settings including social, familial, educational and/or occupational settings
• as part of the diagnostic process, include an assessment of the person's needs, coexisting conditions, social, familial and educational or occupational circumstances and physical health. For children and young people, there should also be an assessment of their parents' or carers' mental health
• ADHD should be considered in all age groups, with symptom criteria adjusted for age-appropriate changes in behaviour

Reference:

• (1) NICE (October 2000). Guidance on the Use of Methylphenidate (Ritalin, Equasym) for Attention Deficit / Hyperactivity Disorder (ADHD) in childhood.
• (2) NICE (March 2018). Attention deficit hyperactivity disorder Diagnosis and management of ADHD in children, young people and adults