ADHD stands for Attention Deficit Hyperactivity Disorder. It is fast becoming one of the commonest childhood behavioural disorders. In many children it is diagnosed between ages three and seven and may continue up to adolescence or adulthood.

Main symptoms of ADHD

The prominent symptoms include lack of attention, concentration, difficulty in controlling impulsiveness and behaviour and over activity.

While symptomatology differs among children, diagnosis when based on these symptoms need to be categorized in several steps.

In addition, children and individuals with ADHD also commonly may develop concomitant mental ailments like anxiety disorders, depression, learning disabilities, sleep disorders etc.

Diagnosis of ADHD

Diagnosis is made on the basis of criteria set by the American Psychiatric Association’s Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV-TR).

A standard diagnosis based on these criteria keeps diagnosis uniform. This is important since symptoms of ADHD may often be overlapping, which makes the condition difficult to diagnose. (1)

The symptomatology may be classified as per the disease classification –

1. Predominantly hyperactive and impulsive:
   1. The major symptoms of hyperactivity include: –
      1. Fidgeting
      2. Talking continuously
      3. Constant running,playing or touching
      4. Difficulty sitting still through meals, school or story telling sessions
      5. Constantly moving
   2. The major symptoms of impulsivity include:-
      1. Impatience
      2. lack of emotional restraint and acting without regards to consequences<
      3. Speaking out of turn
      4. Difficulty waiting for turns
      5. Habit of interrupting conversations
2. Predominantly inattentive:
   1. The major symptoms of inattention include:-
      1. Easily distracted, often forgetful. Switching from one activity to another
      2. Difficulty in focussing
      3. Easily bored with one task
      4. Difficulty in concentrating and learning something new
      5. Difficulty in completing tasks and losing implements (pencils, paper etc.) needed to complete tasks or activities
      6. Inability to pay attention to instructions
      7. Daydreaming, confused and slow movements
      8. Difficulty in processing information accurately and quickly
      9. Difficulty in following instructions
   Children with predominantly inattentive ADHD often sit quietly and have difficulty in interacting with peers. These children often get missed out while diagnosing ADHD as most parents and teachers fail to notice their behavioural problem. For diagnosis of ADHD the symptoms must be present for at least six months. (2)
3. Combined type – These children display a mixture of symptoms of hyperactivity-impulsiveness and inattention. These children are more difficult to diagnose.

Variation in symptoms of ADHD

Symptoms vary among boys and girls. While ADHD commonly manifests as hyperactivity among boys; girls are more likely to be inattentive.

Inattention also varies between boys and girls. Girls who are inattentive often daydream and are confused when spoken to. However, boys who are inattentive may play or fiddle without purpose.

Boys with ADHD are more difficult to manage by parents, teachers and caregivers. Thus their behaviour is often more conspicuous than girls. (3)

Symptoms of comorbid conditions like anxiety disorders, depressions, sleep related problems, learning disabilities are also seen among children with ADHD. These need careful evaluation and management.

How severe do symptoms need to be to be classified as ADHD?

Some amount of high energetic behaviour, inattention and is common among normal preschoolers. Many preschoolers have a short attention span and this may be seen among older children and adolescents as well.

However, these children often show normal attention span for tasks they love like listening to or playing music, painting etc. The attention span may be low for homework or other tasks that they find uninteresting.

Over activity is also common among preschoolers. They may also be more active when they are tired, anxious or hungry. Sometimes the problems may surface only at home and not show up at school or public places.

Parents and caregivers should be suspicious of behaviour problems if they notice such inattention, impulsivity or over activity in their child that lasts over six months, occurs in more than one environment (home as well as school), disrupts play, daily activities and school work on a regular basis and hampers peer and adult relationships. (3)

Parents may consult their paediatrician if they suspect such symptoms in their child. They may then be referred to specialists who would use a panel of behavioural tests to diagnose the condition.

A detailed medical evaluation to exclude other causes of inattention or hyperactivity is important as is diagnosis of comorbid conditions. (3)