ADHD Diagnosis: Page #2

Proper ADHD diagnosis requires not only differentiation from other disruptive childhood disorders such as conduct disorder and oppositional defiant disorder, but also from a wide range of other psychiatric, developmental and medical conditions. Although there is a great amount of overlap between an ADHD diagnosis and a diagnosis for conduct disorder, it is now generally accepted that the two disorders can be differentiated despite the high degree of comorbidity (overlap of symptoms) both in terms of symptoms presentation and co-occurrence within specific individuals. ADHD is viewed as more of a cognitive/developmental disorder, with an earlier age of onset then conduct disorder. ADHD children also frequently show deficits on measures of attentional and cognitive functioning, and have increased motor activity and greater neurodevelopmental abnormalities. Conduct disordered children tend to be characterized by higher levels of aggression and greater degrees of family dysfunction then children with an ADHD diagnosis.

Many children with an ADHD diagnosis also present with symptoms of conduct disorder, and both should be diagnosed when this occurs. Coexisting ADHD and conduct disorder are consistently reported to be much more disabling than either disorder alone. These children frequently retain the difficulties experienced with these disorders and tend to show increased levels of aggressive behavior at an early age, and remain quite persistent over time. This may be in contrast to the more typical episodic course seen in children who have conduct disorder alone. Also, children with a comorbid ADHD diagnosis who also have conduct disorder, appear to have poorer long-term outcomes than either of these disorders diagnosed alone.

The relationship of a diagnosis of ADHD to oppositional defiant disorder is not as well studied. However, it does appear that among children with an ADHD diagnosis, those with the most hyperactive/impulsive behaviors are also at greater risk for developing oppositional defiant disorder. However, despite the high degree of comorbidity (overlapping symptoms) of these two disorders, it is frequently possible to distinguish between them by recognition of such oppositional defiant symptoms as "loses temper", "actively defies," and "swears," which are much less characteristics of children with an ADHD diagnosis. The onset of oppositional defiant disorder symptoms peak at approximately 8 years old and frequently show a declining course after that period of time. Hyperactive and attentional problems however, appear at a much earlier age and often persist, although the levels of inattentiveness and hyperactivity often decrease with age.

In order to have a proper ADHD diagnosis, you will need to differentiate between mood and anxiety disorders, learning disorders, mental retardation, pervasive developmental disorders, organic mental disorders, and psychotic disorders. All of these may present with some impairment of attention, as well as some level of hyperactive and impulsive behaviors. For an ADHD diagnosis according to the DSM-IV-TR, it needs to be defined whether the symptoms of attention/cognitive disorganization and impulsive/hyperactivity are not better accounted for by one of these other conditions. For example, differentiating ADHD from bipolar disorder may be confused by the low base rate of bipolar disorder and by it's variability in presentation. Even though there are frequently some similarities between the two disorders, there is little evidence to suggest that most children with externalizing symptoms are at risk for bipolar disorder. A family history of bipolar disorder is especially helpful in diagnosing this disorder in children. Also, a variety of medical conditions such as epilepsy, Tourette's disorder, thyroid disease, encephalopathy, and sensory impairments can present with symptoms similar to ADHD and must also be considered and ruled out. Many medications that are prescribed to children may also mimic the symptoms of a child with an ADHD diagnosis. Examples may include anticonvulsants such as Phenobarbital, antihistamines, decongestants, bronchodilators and systemic steroids.

Some information from DSM-IV-TR Mental Disorders Diagnosis, Etiology & Treatment

Additional Information and webpage by Paul Susic  MA Licensed Psychologist   Ph.D. Candidate  (Health and Geriatric Psychologist)  

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