Attention-Deficit Hyperactivity Disorder DSM-5 314.01 (ICD-10-CM Multiple Codes)
DSM-5 Category: Neurodevelopmental Disorders
Attention-deficit hyperactivity disorder (ADHD) is a disorder with its onset in early childhood, and is characterized by symptoms of hyperactivity, inattention, and impulsivity that interfere with daily and occupational functioning. DSM-5 has updated its criteria for ADHD to encompass the full life span experience of an individual with the disorder. Early diagnosis of ADHD, when early interventions can have the greatest effect, is being given greater attention in the psychological literature. Nonetheless, some individuals may not receive a proper diagnosis until adulthood. The new DSM-5 criteria seeks to improve the accuracy of the diagnosis of ADHD across all age groups. Accordingly, DSM-5 has reclassified ADHD from “Disorders Usually First Diagnosed in Infancy, Childhood or Adolescence” to “Neurodevelopmental Disorders.” The worldwide estimate of ADHD prevalence in children is 5% (Cortese et al., 2012). About half of those with childhood ADHD will still have symptoms in adulthood.
Symptoms of Attention-Deficit Hyperactivity Disorder
ADHD symptoms fall into two primary categories: (1) inattention and (2) hyperactivity / impulsivity. Inattention symptoms may include a short attention span and lack of response to verbal or gestural cues. Hyperactive symptoms may manifest themselves in the display of lot of excess motoric activity energy, rapid speech, fidgeting, etc. He/she may also have problems remaining seated, particularly during childhood years. Impulsive actions often demonstrate a disconnect between executive functioning and actions. Co-morbid disorders often associated with ADHD would include autism spectrum disorder, and a number of mood and anxiety disorders.
For a diagnosis of ADHD under DSM-5, a person must display at least six symptoms, whereas those over the age of 17 years must present with five symptoms from both categories (Inattention and Hyperactivity-Impulsivity). In addition, symptoms must persist for at least six months, and also be inconsistent with one’s developmental level (APA, 2013). Seen below, are examples of behavioral and cognitive symptoms from both categories referenced earlier.
Inattention – Does not pay close attention to details, difficulty sustaining attention, does not listen when spoken to directly, does not follow instructions/finish schoolwork, difficulty organizing tasks/activities, avoids sustained mental effort, loses important things, easily distracted, forgetful
Hyperactivity-Impulsivity – Fidgets/squirms, leaves seat, runs about/climbs, difficulty playing quietly, often ‘on the go,’ talks excessively, blurts out answers before questions completed, difficulty waiting one’s turn, interrupts or intrudes on others
For a diagnosis under DSM-5, several of these symptoms must be present before the age of 12, and must also be present across two or more settings (e.g., home and school). Clinical impairment must be shown in social, academic or occupational functioning. These symptoms cannot co-occur exclusively with other psychiatric or mental disorders.
A diagnosis of ADHD can be predominately inattention, predominately hyperactive/impulsive or a combination of both.
Therapy and Treatment for Attention-Deficit Hyperactivity Disorder
The heavy reliance on medication, specifically anti-depressants and psychostimulants, in the treatment of ADHD has raised concerns over side effects and addiction. Pharmacotherapy is a frequently recommended treatment because it produces improvements in core ADHD symptoms, including hyperactivity, inattention and impulsivity. A major concern is the risk of children becoming overly dependent on medication. However, brain imaging studies have identified long-term improvements in core symptoms. A survey of brain imaging studies on persons with ADHD revealed structural deficits (i.e., reduced volume of specific neurochemicals in areas of the basal ganglia and anterior cingulate cortex) in the brains of those who presented with a diagnosis of ADHD. Proper medication has been extremely effective in altering the levels of neurochemicals responsible for sustained attention (Frodl & Skokauskas, 2011).
Behavioral interventions, on other hand, have proven more effective in treating overall behavioral functioning, as opposed to the primary symptoms of ADHD. Behavioral therapies used in the treatment of ADHD focus primarily on one’s symptoms (Becker, Chorpita, & Daleiden, 2011). The major challenge in the life of many persons with ADHD relates to impairments in daily functioning. While medication can improve the attention span of a child, behavioral therapy can teach the individual how to sustain attention, block out distractions, and improve basic social skills.
Over 60% of those with ADHD are believed to use complementary and alternative medicine (CAM) (Searight, Robertson, Smith, Perkins, & Searight, 2012). The type of CAM therapy used depends partly on the underlying cause of ADHD. A wide variety of causes attributed to the development of ADHD would include dietary, environmental, and genetic vulnerabilities. Chelation therapy, for example, is a treatment that supports the belief that ADHD is caused by heavy metals ingested by the body. Dietary modifications are proving to be effective. Omega-3 fatty acids have provided modest efficacy in the treatment of ADHD. The effect of essential fatty acids on the central nervous system can alter serotonin and dopamine neurotransmission. They are recommended for use alongside traditional pharmacotherapy interventions (Bloch & Qawasmi, 2011).
Living With Attention-Deficit Hyperactivity Disorder
Persons with ADHD have difficulties in communication, social and occupational functioning. Brain imaging studies have found dysfunction related to hypo activation in areas of the brain involving high-level cognitive functioning, including executive function, attention and sensorimotor functions (Cortese et al., 2012). Executive functioning is involved in organizing, regulation, control and planning. Many people with ADHD carry on normal lives, complete higher education and are often very successful across a variety of professions. However, if left untreated, they may also be more disorganized, lack concentration to finish a task, display impulsivity via several risk-taking behaviors, and are prone to mood swings. Persons who have met the DSM-5 criteria for ADHD most likely require some level of therapy to improve their daily functioning. In other cases, if left untreated, a person’s ability to process information across cognitive domains may be so significantly impaired that they result in deficits which impair basic tasks, and thus one’s quality of life. He/she, for example, may not be able to keep a job due to the inability to show up for work on time and meet deadlines.
Currently, behavioral therapies are widely used to help a person with ADHD improve functioning across several social-interpersonal domains. Families, caregivers and educators need to learn effective strategies regarding how to best interact with those who evidence a diagnosis of ADHD. The primary focus needs to be on first educating the individual with ADHD to better understand their condition, and to realize that, in many cases, their primary symptoms can actually prove to be an asset as they approach adulthood. Indeed, they should be given a list of people who possessed this diagnosis, and went on to become extremely successful with their careers in later life. This list would include past Presidents of the United States, as well as those who started their businesses which later found themselves featured in Fortune 500 publications.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Becker, K. D., Chorpita, B. F., & Daleiden, E. L. (2011). Improvement in symptoms versus functioning: How do our best treatments measure up?. Administration and Policy in Mental Health and Mental Health Services Research, 38(6), 440-458.
Bloch, M. H., & Qawasmi, A. (2011). Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 50(10), 991-1000.
Cortese, S., Kelly, C., Chabernaud, C., Proal, E., Di Martino, A., Milham, M. P., & Castellanos, F. X. (2012). Toward systems neuroscience of ADHD: a meta-analysis of 55 fMRI studies. American Journal of Psychiatry, 169(10), 1038-1055.
Frodl, T., & Skokauskas, N. (2012). Meta‐analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects. Acta Psychiatrica Scandinavica, 125(2), 114-126.
Searight, H. R., Robertson, K., Smith, T., Perkins, S., & Searight, B. K. (2012). Complementary and Alternative Therapies for Pediatric Attention Deficit Hyperactivity Disorder: A Descriptive Review. ISRN psychiatry, 2012.
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