The most widely accepted criteria for making the diagnosis of ADD is contained in the Diagnostic and Statistical Manual (DSM) published by the American Psychiatric Association. In the Manual, two types of ADD are identified, inattentive and hyperactive. Often they occur together (ADHD), especially in children. But as children with ADHD grow into adolescence and adulthood, hyperactive symptoms usually fade, and most adults with ADD have attention deficit disorder without hyperactivity.
The DSM requires that six of the nine following inattentive symptoms are present for a person to qualify for the diagnosis of inattentive ADD :
- fails to give close attention to details or makes careless mistakes
- has difficulty keeping up attention on tasks
- does not seem to listen when spoken to directly
- doesn’t follow through or fails to finish tasks
- has difficulty organizing tasks
- doesn’t do well with tasks that require sustained mental effort
- loses things
- is easily distracted
- is forgetful
The six symptoms must…
- be present often
- have been present for at least six months
- cause significant problems in functioning
Problems Making the Diagnosis
Given these criteria, it might seem easy to make the diagnosis of ADD. But it is sometimes hard to be sure exactly what it means that a symptom is “often” present. The spouse may say that he often fails to complete tasks while he may say that he usually does complete them. A similar problem is trying to decide exactly what is meant by “significant impairment”. And what if a person has only five of the symptoms but those five cause significant problems in functioning?
It is important to keep in mind the purpose of making the diagnosis. If it is for a research study it is very important that all the people who are included in the study meet the same standard requirements for the diagnosis. But if the diagnosis is for the purpose of selecting a treatment or deciding whether accommodations at school are useful, then the clinician might make the diagnosis even with fewer than six symptoms present because many patients with fewer symptoms respond well to treatment with stimulants or benefit from special ADD-type accommodations at school or work.
For clinicians, the most important aspect of a diagnosis may be what is suggests for a patient’s treatment. For example, if a person has the symptoms of ADD and has no other condition that might account for them, medications and other treatments (coaching, family or couples therapy) should be considered.
But even if the diagnosis is certain, the clinician will still have other issues to deal with:
- there are a number of medical problems that may interfere with the treatment of ADD, such as hypo-thyroidism. These need to be evaluated and treated.
- there may be other disorders that share a number of symptoms with ADD like depression, anxiety, bipolar disorder, and Alzheimers. Which disorder should be treated first?
- there are medical problems, for example heart rhythm disorders, that are made worse by treatments that help ADD, that is stimulants .
- the patient with ADD may have other medical or psychological conditions that need to be addressed and treated before the ADD will respond to treatment, for example certain sleep disorders like sleep apnea or narcolepsy.
So making the diagnosis of ADD is one part of the assessment of a patient who may have ADD, but judgment and experience is needed to decide what to do once the diagnosis is made.