Unfortunately, no simple test such as a blood test or urinanalysis exists to determine if a child has this disorder. Diagnosing AD/HD [ ADD OR ADHD ] is complicated and much like putting together a puzzle. An accurate diagnosis requires an assessment conducted by a well-trained professional (usually a developmental pediatrician, child psychologist, child psychiatrist, or pediatric neurologist) who knows a lot about AD/HD [ ADD OR ADHD ] and all other disorders that can have symptoms similar to those found in AD/HD [ ADD OR ADHD ]. Until the practitioner has collected and evaluated all the necessary information, he or she must follow the same rule of thumb as the parent or teacher who sees the behavior and suspects that the child has the disorder: Assume the child might have AD/HD [ ADD OR ADHD ].
The AD/HD [ ADD OR ADHD ] diagnosis is made on the basis of observable behavioral symptoms in multiple settings. This means that the person doing the evaluation must use multiple sources to collect the information needed.
What Are the Signs and Symptoms of ADHD in children?
As can be seen, the primary features associated with the disability are inattention, hyperactivity, and impulsivity. The discussion below describes each of these features and lists their symptoms, as given in the DSM-IV.
- Inattention - A child with AD/HD [ ADD OR ADHD ] is usually described as having a short attention span and as being distractible. In actuality, distractibility and inattentiveness are not synonymous. Distractibility refers to the short attention span and the ease with which some children can be pulled off-task. Attention, on the other hand, is a process that has different parts. We focus (pick something on which to pay attention), we select (pick something that needs attention at that moment) and we sustain (pay attention for as long as is needed). We also resist (avoid things that remove our attention from where it needs to be), and we shift (move our attention to something else when needed). When we refer to someone as distractible, we are saying that a part of that person's attention process is disrupted. Children with AD/HD [ ADD OR ADHD ] can have difficulty with one or all parts of the attention process. Some children may have difficulty concentrating on tasks (particularly on tasks that are routine or boring). Others may have trouble knowing where to start a task. Still others may get lost in the directions along the way. A careful observer can watch and see where the attention process breaks down for a particular child.
- Hyperactivity - Excessive activity is the most visible sign of AD/HD [ ADD OR ADHD ]. The hyperactive toddler/preschooler is generally described as "always on the go" or "motor driven." With age, activity levels may diminish. By adolescence and adulthood, the overactivity may appear as restless, fidgety behavior (American Psychiatric Association, 1994).
- Impulsivity - When people think of impulsivity, they most often think about cognitive impulsivity, which is acting without thinking. The impulsivity of children with AD/HD [ ADD OR ADHD ] is slightly different. These children act before thinking, because they have difficulty waiting or delaying gratification. The impulsivity leads these children to speak out of turn, interrupt others, and engage in what looks like risk-taking behavior. The child may run across the street without looking or climb to the top of very tall trees. Although such behavior is risky, the child is not really a risk-taker but, rather, a child who has great difficulty controlling impulse. Often,the child is surprised to discover that he or she has gotten into a dangerous situation and has no idea of how to get out of it.
It is important to note that, in the DSM-IV, hyperactivity and impulsivity are no longer considered as separate features. According to Barkley (1990), hyperactivity-impulsivity is a pattern stemming from an overall difficulty in inhibiting behavior.
In addition to problems with inattention or hyperactivity-impulsivity, the disorder is often seen with associated features. Depending on the child's age and developmental stage, parents and teachers may see low frustration tolerance, temper outburts, bossiness, difficulty in following rules, disorganization, social rejection, poor self-esteem, academic underachievement, and inadequate self-application (American Psychiatric Association, 1994).
