Attention-Deficit/ Hyperactivity Disorder (ADHD)

A. A Persisten pattern of inattention and/or hyperactivity-impulsivity that

interferes with functioning or development, as characterised by (1) and or
(2):
1. Inattention: 6 or More of the following, which have persisted for At Least 6
Months to a degree that is inconsistent with developmental level and that
negatively impacts directly on social and academic/occupational activities:
a. Often fails to give close attention to details or makes careless mistakes
in schoolwork, at work, or during other activities (e.g., overlooks or misses
details, work is innaccurate).
b. Often has difficulty sustaining attention in tasks or play activities (e.g.,
has difficulty remaining focussed during lectures, conversations, or lengthy
reading).
c. Often does not seem to listen when spoken to directly (e.g., mind seems
elsewhere, even in the absence of any obvious distraction)/
d. Often does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly
loses focus and is easily sidetracked).
e. Often has difficulty organising tasks and activities (e.g., difficulty
managing sequential tasks; difficulty keeping materials and belongings in
order; messy, disorganised work; has poor time management; fails to meet
deadlines).
f. Often avoids, dislikes, or is reluctant to engage in tasks that require
sustained mental effort (e.g., schoolwork or homework; for older
adolescents and adults, preparing reports, completing forms, reviewing
lengthy papers).
g. Often loses things necessary for tasks or activities (e.g., school materials,
pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile
telephones).

h. Is often easily distracted by extraneous stimuli (for older adolescents and

adults, may include unrelated thoughts)
i. Is often forgetful in daily activities (e.g., doing chores, running errands;
for older adolescents and adults, returning calls, paying bills, keeping
appointments).
2. Hyperactivity and Impulsivity: 6 or More of the following, which have
persisted for At Least 6 Months to a degree that is inconsistent with
developmental level and that negatively impacts directly on social and
academic/occupational activities:
*NOTE* The symptoms are not solely a manifestation of oppositional
behaviour, defiance, hostility, or a failure to understand tasks or instructions.
For older adolescents and adults (age 17+), at least 5 symptoms are required.
a. Often fidgets with or taps hands or feet or squirms in seat.
b. Often leaves seat in situations when remaining seated is expected (e.g.,
leaves his or her place in the classroom, in the office or other workplace, or
in other situations that require remaining in place).
c. Often runs about or climbs in situations where is it innapporopriate
(Note: in adolescents or adults, may be limited to feeling restless).
d. Often unable to play or engage in leisure activities quietly.
e. Is often on the go, acting as if driven by a motor (e.g., is unable to be
or uncomfortable being still for extended time, as in restaurants, meetings;
may be experienced by others as being restless or difficult to keep up with).
f. Often talks excessively.
g. Often blurts out an answer before a question has been completed (e.g.,
completes peoples sentences; cannot wait for turn in conversation).
h. Often has difficulty waiting their turn (e.g., butts into conversations,
games, or activities; may start using other peoples things without asking or
receiving permission; for adolescents and adults, may intrude into or take
over what others are doing).

B. Several inattentive or hyperactive-impulsive symptoms were present prior to

age 12 years.
C. Several inattentive or hyperactive-impulsive symptoms are present in 2 or
More settings (e.g., at home, school, or work; with friends or relatives; in other
activities).
D. There is clear evidence that the symptoms interfere with, or reduce the
quality of, social, academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of schizophrenia or
another psychotic disorder and are not better explained by another mental
disorder (e.g., mood disorder, anxiety disorder, dissociative disorder,
personality disorder, substance intoxication or withdrawal).

Risk and Prognostic Factors

- Temperament: Reduced behavioural inhibition, effortful control/
constraint, negative emotionality, elevated novelty seeking.
-Environmental: Very low birth weight, smoking during pregnancy,
diet, history of abuse, neglect, multiple foster placements, neurotoxin
exposure, infections, alcohol exposure in utero, environmental
toxicants. Family interaction patterns in early childhood dont cause
ADHD but may influence course or contribute to secondary
development of conduct problems.
-Genetic and physiological: Strong heritability (strongest risk with firstdegree relatives). Symptoms may be influenced by visual and hearing
impairments, metabolic abnormalities, sleep disorders, nutritional
deficiencies and epilepsy. Minor physical abnormalities may be mildly
elevated. Subtle motor delays and other neurological soft signs may
occur.

DIFFERENTIALS

Why it looks similar

How to tell if its ADHD

ODD may resist work that ODD: Refuse to work because

requires self-application
they dont want to conform to
demands.
Characterised
by
Negativity, Hostility & Defiance.
ADHD: Aversion to work due to
difficulty
sustaining
effort,
forgetting, and impulsivity.
*ADHD may secondarily develop
oppositional attitudes towards
work though!
Intermittent
Explosive High levels of impulsivity
IED: Serious aggression, and no
Disorder
problems sustaining attention.
Its also rare in childhood.
*IED may be Dxd in presence of
ADHD
Other
ADHD: Increased motor SMD/ASD: Movements are fixed
Neurodevelopmental
activity
and repetitive
Disorders
Stereotypic
movement ADHD: Fidgetyness & restlesness
disorder
or
Autism: are generalised & not repetetive
Repetitive motor behaviour or stereotypic.
Tourettes: Tics may look Tourettes: Prolonged observation
like fidgeting
needed
to
distinguish
restlessness from tics
Specific
Learning SLD:
May
appear SLD: Inattentivenes does not
Disorder
inattentive
due
to impair beyond academic work.
disinterest, frustration, or
limited ability.
Intellectual Disability
ID: May display symptoms ID: Symptoms are not evident
of ADHD when placed in during non-academic tasks
settings inappropriate for *To Dx both, the inattention/
their intellectual abilities.
hyperactivity must be excessive
for Mental Age
Reactive
Attachment Social Disinhibition.
RAD: Do NOT have additional
Disorder
ADHD symptoms and have other
additional features (e.g., lack of
enduring friendships)
Anxiety Disorders
Inattention & restlesness
Anxiety:
inattention
&
Restlesness due to Worry &
Rumination
ADHD: NO worry & rumination.
Inattention due to attraction to
external stimuli, new activites,
or preocupation with enjoyable
ODD

activities.
Depressive Disorders
Inability to concentrate
Depression: Symptoms only
occur
within
depressive
episodes.
Bipolar Disorder
Increased activity, poor Bipolar: Features are episodic,
concentration & increased and must last 4+ days. Additional
impulsivity
manic features. Rare in preteens.
ADHD: May have emotional
lability but <4 days. Common in
kids and teens with excessive
anger & irritability.
Disruptive
Mood Irritability, intolerance to DMDD: Disorganised Attention
Dysregulation Disorder
frustration.
& Impulsiveness are not
essential features.
* DMDD often meeet criteria for
ADHD, which is Dxd seperately

Specific Learning Disorder

A. Difficulties learning and using academic skills, as indicated by the presence of
at least 1 of the following that have persisted for at least 6 Months, despite the
provision of interventions that target those difficulties:
1. Inaccurate or slow and effortful word reading (e.g., reads single words
aloud incorectly or slowly and hesitantly, frequently guesses words, has
difficulty sounding out words).
2. Difficulty understanding the meaning of what is read (e.g., may read
text accurately but not understand the sequence, relationships,
inferences, or deeper meanings of what is read).
3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or
consonants)
4. Difficulties with written expression (e.g., makes multiple grammatical or
punctuation errors within sentences; employs poor paragraph
organisation; written expression of ideas lacks clarity).
5. Difficulties mastering number sense, number facts, or calculation (e.g.,
has poor understanding of numbers, their magnitude, and relationships;
counts on fingers to add single digit numbers instead of recalling the math
fact as peers do; gets lost in the midst of arithmetic computation and may
switch procedures).
6. Difficulties wih mathematical reasoning (e.g., has severe difficulty
applying mathematical concepts, facts, or procedures to solve quantitative
problems).
B. The affected academic skills are substantially and quantifyably below those
expectecd for the individuals chronological age, and cause significant
interference with academic or occupational performance, or with activities of
daily living, as confirmed by individually administered standardised
achievement measures and comprehensive clinical assessment. For individuals
age 17 years and older, a documented history of impairing learning difficulties
may be substituted for the standardised assessment.

C. The learning difficulties begin during school-age years but may not become
fully manifest until the demands of those affected academic skills exceed the
individuals limited capacities (e.g., as in timed tests, reading or writing lengthy
complex reports for a tight deadline, excessively heavy academic loads).
D. The learning difficulties are not better accounted for by intellectual
disabilities, uncorrected visual or auditory acuity, other mental or neurological
disorders, psychosocial adversity, lack of proficiency in the language of
academic instruction, or inadequate educational assessment
*NOTE* The 4 diagnostic criteria are to be met based on a clinical synthesis of
the individuals history (developmental, medical, family, educational), school
reports, and psycho-educational assessment.
Specifiers:
Reading: -Word reading or accuracy
- Reading rate or fluency
- Reading comprehension
*Note: Dyslexia= Accurate or fluent word recognition
Decoding
Spelling
If this term is used, make sure to include any additional difficulties
too (e.g., reading comprehension)
Written Expression:

Mathematics:

-Spelling accuracy
- Grammar and punctuation accuracy
- Clarity or organisation of written expression

- Number sense
- Memorisation of arithmetic facts
- Accurate or fluent calculation
- Accurate math reasoning
*Note: Dyscalculia= Processing numerical information
Learning arithmetic facts
Accurate or fluent calculations
If this term is used, make sure to include any additional
difficulties too (e.g., reading comprehension)

Risk and Prognostic Factors

-Environmental: Very low birth weight, smoking during pregnancy,
diet, history of abuse, neglect, multiple foster placements, neurotoxin
exposure, infections, alcohol exposure in utero, environmental
toxicants. Family interaction patterns in early childhood dont cause
ADHD but may influence course or contribute to secondary
development of conduct problems.
-Genetic and physiological: Strong heritability (strongest risk with firstdegree relatives). Symptoms may be influenced by visual and hearing
impairments, metabolic abnormalities, sleep disorders, nutritional
deficiencies and epilepsy. Minor physical abnormalities may be mildly
elevated. Subtle motor delays and other neurological soft signs may
occur.