chores or duties in the work place (starts tasks but quickly loses focus and is easily distracted, for example).
e.The person often finds it difficult to organise tasks or activities (for example, difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganised work; has poor time management; fails to meet deadlines).
f.The person often avoids or is reluctant to engage in tasks that require sustained mental effort (school work or homework, for example; in older adolescents and adults, the preparation of reports, completion of forms and review of lengthy papers).
g.Items essential to the performance of tasks or activities are often lost (for example, school materials, pencils, books, tools, wallets, keys, paperwork, spectacles, cellphones).
h.The person is easily distracted by extraneous stimuli (among adolescents and adults this may include thoughts about unrelated matters).
i.Frequently forgetful in daily activities (doing chores, running errands, for example; among older adolescents and adults, the answering of calls, paying of accounts and keeping of appointments).
2 Hyperactivity and impulsivity
a.The person often fidgets or taps hands or squirms in his or her seat.
b.The person often leaves his or her seat when remaining seated is expected (leaving their seat in the classroom or office, other workplace or in other situations where they are expected to remain in one place).
c.The person runs around or climbs in situations where it is inappropriate (in adolescents or adults this behaviour may be limited to feelings of restlessness).
d.The person often has difficulty playing or engaging in leisure activities quietly.
e.The person is often “on the go” or behaves as if he or she is “driven by a motor” (for example, is unable or finds it difficult to remain still for long periods, such as in a restaurant or during meetings; others may experience this as restlessness or an inability to keep up).
f.He or she often talks excessively.
g.The person often blurts out answers before questions have been completely formulated. He or she finishes others’ sentences for them and finds it difficult to wait his or her turn to speak or contribute.
h.h. The person often finds it difficult to wait his or her turn (difficulty waiting in a queue, for instance).
i.He or she often interrupts others or intrudes on them (for example, interrupts conversations, games and activities, or uses others’ belongings without permission; adolescents and adults may intrude into or take over what others are doing).
CONDITIONS FOR THE DIAGNOSIS
Before a diagnosis of ADHD can be made in accordance with the above criteria, the following important conditions must be met:
•The symptoms must be present continuously for at least six months.
•The symptoms must be inconsistent with the person’s developmental level.
•Some of the symptoms must have started manifesting before the age of twelve.
•There must be clear evidence that the symptoms interfere with or reduce the quality of social, academic or occupational functioning.
•The symptoms must not be the result of schizophrenia or another psychotic disorder, and should not be better explained by a diagnosis of another mental disorder, for example, anxiety disorder, dissociative disorder, personality disorder or substance intoxication or withdrawal.
•Several inattentive or hyperactive-impulsive symptoms must be present in at least two environments (for example, at school or place of work, among friends and family, or during other activities).
•At least six symptoms under number 1 or six symptoms under number 2 must be present in children below the age of seventeen years. In older adolescents and adults, at least five symptoms under number 1 or five symptoms under number 2 must be present.
•The symptoms must not be due to oppositional behaviour only or due exclusively to defiance or be a result solely of hostility or failure to understand tasks or instructions.
Completing assessment questionnaires like the behavioural checklist in chapter 1, can be useful in eliminating unnecessary or incorrect diagnoses. Such a checklist should be completed by both a parent and a teacher.
According to the diagnostic criteria of the DSM-5, there are three types of ADHD:
ADHD predominantly inattentive presentation
This group of sufferers is also known as the “inattentive group”. In this group, at least six symptoms from number 1 of the DSM-5 criteria are present in children younger than seventeen years, and at least five symptoms in older adolescents and adults. Fewer than six of the symptoms (five in older adolescents and adults) in number 2 are present.
ADHD predominantly hyperactive-impulsive presentation
In this group there are fewer than six symptoms (fewer than five among older adolescents and adults) from number 1, but six or more (at least five among older adolescents and adults) from number 2.
ADHD combined presentation
This group is also known as the “combined group”. In this group there are at least six symptoms from number 1 (at least five among older adolescents and adults) as well as at least six symptoms (at least five among older adolescents and adults) from number 2. This group is also the largest.
The three presentations of ADHD according to the DSM-5 are discussed with examples later.
Dr Daniel G. Amen, an American psychiatrist and neuro-therapist, distinguishes between six forms of ADHD in his book Healing ADD: The Breakthrough Program that Allows You to See and Heal the Six Types of ADD (2001). His findings are based primarily on results from brain scans.
Does ADHD occur only in children?
No. Previously it was believed that children outgrew ADHD. However, this is usually not the case. The hyperactivity component of the combined and hyperactive-impulsive presentations of ADHD usually does diminish with age though. Some adult sufferers have developed improved coping skills that make their ADHD a little less obvious. Most adults over the age of thirty with ADHD were not diagnosed as children. Media interest over the last twenty years has resulted in a greater awareness of ADHD, which has resulted in a higher rate of diagnosis. People recognised the symptoms of ADHD in themselves or in their children and reported it to an expert. Whether the greater focus on ADHD has made professionals more likely to make a diagnosis of ADHD, is open to debate.
What causes ADHD?
For almost a century scientists suspected that brain injuries caused ADHD. Later it was determined that only between five and ten per cent of ADHD sufferers may have suffered brain damage in utero or at birth. Researchers today agree that ADHD is usually not caused by brain damage. It is also not associated with cognitive disability (a low intellectual ability).
Studies conducted among chimpanzees and other primates (Dr Russell A. Barkley, 1995) have produced interesting results. When the frontal lobes of the brains of the primates were manipulated or injured they manifested behaviour that corresponds with ADHD symptoms. The animals became more hyperactive and had difficulty with concentration and impulse control. Many other studies confirm that the frontal area of the brain is underdeveloped in ADHD sufferers. One of the most common treatments for ADHD using neurofeedback therapy involves inhibiting the activity of excessively slow brainwaves (theta waves) that often occur in underdeveloped frontal lobes.
The social behaviour of ADHD sufferers often seems immature. Neurological tests often show that the electrical activity in the brain of ADHD sufferers looks like that of a younger person. In neurofeedback therapy,