Attention-deficit hyperactivity disorder psychiatric examination
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2], Haleigh Williams, B.S.
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Overview
A complete psychiatric examination should be performed by a psychiatrist, with additional information provided by teachers, if applicable. Psychiatric examination should focus on the DSM V criteria for ADHD, as well as on symptoms that would differentiate ADHD from other psychiatric diagnoses.
Psychiatric Examination
Many of the symptoms of ADHD occur from time to time in everyone. In those with ADHD, these symptoms occur frequently and impairs regular life functioning, typically at school or at work. ADHD patients often perform poorly in task-oriented settings, as well as experiencing difficulty with social functioning. No objective physical test exists for the diagnosis of ADHD. As with many other psychiatric and medical disorders, the formal diagnosis is made by a qualified professional in the field based on a set number of criteria. In the United States, these criteria are set forth by the American Psychiatric Association in their Diagnostic and Statistical Manual of Mental Disorders (DSM), 5th edition.
Additional Diagnostic Information
In the tenth edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) the symptoms of ADD are given the name "Hyperkinetic disorders". When a conduct disorder (as defined by ICD-10[1]) is present, the condition is referred to as "Hyperkinetic conduct disorder". Otherwise the disorder is classified as "Disturbance of Activity and Attention", "Other Hyperkinetic Disorders" or "Hyperkinetic Disorders, Unspecified". The latter is sometimes referred to as, "Hyperkinetic Syndrome".[1]
The American Academy of Pediatrics Clinical Practice Guideline for children with ADHD emphasizes that a reliable diagnosis is dependent upon the fulfillment of three criteria:[2]
- The use of explicit criteria for the diagnosis using the DSM-IV-TR.
- The importance of obtaining information about the child’s symptoms in more than one setting.
- The search for coexisting conditions that may make the diagnosis more difficult or complicate treatment planning.
The first criterion can be satisfied by using an ADHD-specific instrument such as the Conners' Rating Scale.[3] The second criterion is best fulfilled by examining the individual's history. This history can be obtained from parents and teachers, or a patient's memory.[4] The requirement that symptoms be present in more than one setting is very important because the problem may not be with the child, but instead with teachers or parents who are too demanding. The use of intelligence testing, psychological testing, and neuropsychological testing (to satisfy the third criterion) is essential in order to find or rule out other factors that might be causing or complicating the problems experienced by the patient.[5]
The Centers for Disease Control and Prevention (CDC) state that a diagnosis of ADD should only be made by trained health care providers, as many of the symptoms may also be part of other conditions, such as bodily illness or other physiological disorders, such as hypothyroidism. It is not uncommon that physically and mentally nonpathological individuals exhibit at least some of the symptoms from time to time. Severity and pervasiveness of the symptoms leading to prominent functional impairment across different settings (school, work, social relationships) are major factors in a positive diagnosis.
References
- ↑ 1.0 1.1 ICD Version 2006: F91. World Health Organization. Retrieved on December 11, 2006.
- ↑ Perrin JM, Stein MT, Amler RW, Blondius TA. 2001. "Clinical practice guideline: treatment of school-aged children with Attention Deficit/Hyperactivity Disorder". Pediatrics 108 (4):1033-1044. PMID 11581465
- ↑ Conners CK, Sitarenios G, Parker JD, Epstein JN (1998). "Revision and restandardization of the Conners Teacher Rating Scale (CTRS-R): factor structure, reliability, and criterion validity". Journal of abnormal child psychology. 26 (4): 279–91. PMID 9700520.
- ↑ Ratey, John; Hallowell, Edward. Driven to Distraction first edition, p. 42
- ↑ Ninivaggi, F. J. "Borderline intellectual functioning and academic problem." In: Sadock B.J. Sadock, V.A., eds. Kaplan & Sadock's Comprehensive Textbook of psychiatry. 8th ed. Vol. II. Baltimore: Lippincott William and Wilkins; 2005: 2272–76.