Attention-Deficit Hyperactivity Disorder is a deficit in attention, hyperactivity and impulsivity that is generally first diagnosed in children during elementary school. According some ADHD researchers, however, parents often retrospectively report seeing symptoms much earlier. Clinical psychologists, social workers, pediatricians and school counselors are the professionals who usually diagnose ADHD. They use a set form of diagnostic criteria that delineates three types--ADHD, combined type; ADHD, predominately inattentive type; ADHD, predominately hyperactive-impulsive type.
ADHD, Combined Type
The combined type of ADHD involves equal inattentive and hyperactive-impulsive symptoms. Research shows that children with this type of ADHD differ significantly with children diagnosed with the predominately inattentive type. They are generally more aggressive and oppositional, experience more peer rejection, and often have an additional Oppositional Defiant or Conduct Disorder. In addition, these children have higher rates of speech and language problems and under academic achievement compared to children with the predominately inattentive type of ADHD. Children diagnosed with the combined type of ADHD must have six inattentive symptoms and six hyperactive and/or impulsive symptoms that have persisted for over six months. Inattentive symptoms involve not listening when spoken to directly, reluctantly engaging in tasks that require sustained attention, losing items necessary for specific activities and not following instructions. Children displaying hyperactivity may fidget in their seats, talk excessively and run and climb when it is inappropriate. Lastly, children with impulsive symptoms may have difficulty waiting their turn, blurt out answers and intrude on others' conversations. As with all three forms of ADHD, symptoms must cause significant impairment in academic, social or occupational functioning. In addition, symptoms must be developmentally inappropriate, observed before age 7 and occur in two settings---usually school and home.
ADHD, Inattentive Type
Girls and older children with ADHD are more likely diagnosed with the predominately inattentive type. This is often because research shows that girls are less likely to display excessive hyperactive and impulsive symptoms. Pre-adolescents and adolescents with the inattentive type may have not been diagnosed until this period because this type of ADHD does not generally manifest with classroom disruptions. Children with the inattentive type are usually described as daydreamy, passive, apathetic, shy and withdrawn. They are also more likely struggling with depression, anxiety and social withdrawal. Like those with combined type, inattentive-type children often have additional learning disabilities and academic difficulties. To receive a diagnosis of inattentive type, children must have six inattentive symptoms. These must cause significant interference in daily functioning, are developmentally inappropriate and observed before age 7. In addition, the behaviors must occur in two settings.
ADHD, Hyperactive-Impulsive Type
There is less research on the predominately hyperactive-impulsive type of ADHD. Some theorists believe it is an early form of the combined type that is observed in young children before sustained attention is required. A few studies do suggest that these children are often later diagnosed with the combined type. In the predominately hyperactive-impulsive type, hyperactivity and impulsivity overshadow inattentive behaviors. Like with the inattentive type, six hyperactive-impulsive symptoms must be present for at least six months. Symptoms must significantly interfere with daily life and are not developmentally appropriate, as with the other two types. The symptoms must also begin before age 7 and occur in two settings.
References
- Diagnostic and Statistical Manual for Mental Disorders 4th Edition Text Revision, 2000
- Developmental Issues in the Clinical Treatment of Children,1999
- Child Psychopathology 2nd Edition, 2003
