that the above answers are typical responses – based on interviews with parents of children with ADHD with hyperactivity. If your responses to some of the questions are different, it does not mean that your child is not an ADHD sufferer. Not all the questions are based on the symptoms according to which ADHD is formally diagnosed, but we will get to the more technical aspects later.
Questionnaire (behavioural checklist)
The questionnaire or behavioural checklist which follows is based on the Connors questionnaire in which the questions are based on the symptoms according to which ADHD is diagnosed. A number of similar questionnaires are available from schools and practices. The Connors questionnaire is also commonly used to determine the effectiveness of medication. The child’s behaviour is assessed in terms of criteria for identifying ADHD as contained in the DSM (Diagnostic and Statistical Manual of Mental Disorders) – these are the guidelines of the American Psychiatric Association for the diagnosis of psychiatric conditions. The previous version was known as DSM-4-TR. DSM-5 was published in June 2013. Although the diagnostic criteria are the same in the previous and current versions of the DSM, the criteria are now explained using examples that are more relevant to the behaviour of teenage and adult ADHD sufferers.
The questionnaire will give you a good indication of whether your child is an ADHD sufferer. It is usually completed by a parent, as well as an educator who knows the child well. Sometimes a child’s behaviour at home differs markedly from behaviour at school. When this is the case, other factors may be at play. Bear in mind that the questionnaire which follows summarises the symptoms in ADHD children. The precise description of the diagnostic criteria according to the DSM-5 follows later.
Read the statements and circle the number that, in your opinion, most accurately indicates the frequency of the particular behaviour. Also indicate under “Yes” or “No” whether, in your view, the behaviour is problematic for a child of her or his particular age.
Evaluation key
1 – Never
2 – Seldom
3 – Sometimes
4 – Often
5 – Always
Count the number of responses you have marked as “yes” in the “Problematic” column. If for items 1-9 there are six or more “yes” responses that you have rated with a 4 or 5, the child you have evaluated has an ADHD profile. The same applies to items 10-18.
Now add up the evaluation rates of the “yes” items:
Total A: Items 1-9 (4 or 5 and “Yes”)
Total B: Items 10-18 (4 or 5 and “Yes”)
If Total A or Total B is 24 or more, and that score is representative of the behaviour of the child in at least two functioning areas (for example, at home and at school), the child has enough ADHD symptoms for a diagnosis.
The behavioural criteria for items 1-9 on the questionnaire relate to symptoms of inattentiveness or poor concentration. The behavioural criteria for items 10-18 relate to symptoms of hyperactive and impulsive behaviour. This means that a child may, for example, have a serious concentration problem without being hyperactive. We’ll take a closer look at various types of attention-deficit disorder in chapter 2.
The main purpose of this and other similar questionnaires is to be used as an aid by parents, teachers and therapists. Sometimes it is used to calculate percentages of ADHD behaviour. I am sceptical about this, because all the items are then usually brought into the equation, when we ought only to consider those characteristics that create difficulties in adaptation and are not age-appropriate. I’m also hesitant about stereotyping children by allocating a number to them.
According to the guidelines of the new DSM, the clinician making the diagnosis is expected to indicate the level of severity of the disorder. It should be specified whether the person suffers from a “mild”, “moderate” or “severe” degree of ADHD.
I trust that by now you have a good understanding of the symptoms and general image of ADHD. We’ll tackle the rest step by step.
2
General questions about ADHD and related conditions
Part 1: Questions about ADHD
Confusion about terminology
The abbreviation ADHD stands for attention deficit hyperactivity disorder and is commonly used by lay people, support groups and professionals. Other terms and abbreviations used include:
•attention deficit hyperactivity syndrome (ADHS)
•attention deficit disorder (ADD)
•attention deficit syndrome
•attention deficit
•attention deficit disorder without hyperactivity
•attention deficit disorder with hyperactivity
ADD stands for attention deficit disorder and refers to people diagnosed with ADHD without hyperactivity.
What is ADHD?
ADHD can be defined as a neurochemical imbalance in certain areas of the brain. There is a strong genetic component, which means that ADHD can be hereditary.
How is ADHD diagnosed?
In the previous chapter we used a more informal questionnaire or checklist to look at how ADHD is diagnosed. In this chapter the formal diagnosis of ADHD is explored in more detail.
ADHD is diagnosed according to a list of diagnostic criteria or symptoms that are specified in the DSM-5 (see below). To date there is no blood test or other clinical examination such as a scan or electroencephalogram (EEG) that can be used to diagnose ADHD. However, data bases resulting from research by institutions such as the Brain Resource Centre in Australia show clearly that the brainwave activity of ADHD sufferers deviates from the norm, as is the case with other brain disorders.
Some clinicians hold the view that advanced scans such as the SPECT (single photon emission computed tomography) and PIT (photo image tomography) do show up differences. At the International Congress of Psychology in Cape Town in 2012, there was talk of the DSM-5 possibly containing criteria including EEG data for the diagnosis of ADHD, but this did not happen. The biggest change in the DSM-5 is the examples that have been added to facilitate the diagnosis of adult sufferers. The American NIMH (National Institute of Mental Health), the largest mental health research organisation in the world, announced in May 2013 that they would no longer be basing their research on the DSM-5 categories of disorders, but rather on the cognitive, genetic and neurological components thereof. Neurotherapy is one such therapy which focuses on neurological aspects, which could mean a lot more research being conducted on it in the next few years. However, the criteria discussed below are the only available for the diagnosis of ADHD at this stage.
DSM-5 diagnostic criteria for ADHD
1 Inattentiveness
a.The person often fails to pay close attention to detail and makes careless mistakes in school work, work or other activities (details are overlooked or omitted, for example, or the work is inaccurate).
b.The person often has difficulty sustaining attention in tasks and play activities (finds it difficult to remain focused during lectures, conversations or long reading sessions, for example).
c.The person does not seem to listen when spoken to directly (the person’s thoughts seem to be elsewhere, for instance, even in the absence of any obvious distraction).
d.The person often does not follow through on instructions