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ADHD & ADD DSM-IV Diagnosis

May 10th 2010


Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder are diagnosed by psychiatrists and psychologists with the DSM-IV criteria, which are only behaviour related and have no physiological or neurological criteria whatsoever. This is clearly stated in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision).

There are no laboratory tests, neurological assessments, or attentional assessments that have been established as diagnostic in the clinical assessment of Attention-Deficit/Hyperactivity Disorder.”

(DSM-IV-TR page 88)


The DSM-IV also states regarding the word disorder:

The problem raised by the term mental disorders has been much clearer than its solution, and, unfortunately, the term persists in the title of DSM-IV because we have not found an appropriate substitute. . . Mental disorders have also been defined by a variety of concepts (e.g., distress, dysfunction, dyscontrol, disadvantage, disability, inflexibility, irrationality, syndromal pattern, etiology and statistical deviation). Each is a useful indicator for a mental disorder, but none is equivalent to the concept, a different situations call for different definitions.”

(Introduction page xxxi)


Diagnostic Criteria


Diagnostic criteria for Attention-Deficit/Hyperactivity Disorder:


A. Either (1) o r (2):


(1) six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Inattention


(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities


(b) often has difficulty sustaining attention in tasks or play activities


(c) often does not seem to listen when spoken to directly


(d) often does not follow through on instructions and fails to finish schoolwork. Chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)


(e) often has difficulty organizing tasks and activities


(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)


(g) often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books, or tools)


(h) is often easily distracted by extraneous stimuli


(i) is often forgetful in daily activities


(2) six (or more) of the following symptoms of hyperactivity-Impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Hyperactivity


(a) oft en fidgets with hands or feet or squirms in seat


(b) often leaves seat in classroom or in other situations in which remaining

seated is expected


(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)


(d) often has difficulty playing or engaging in leisure activities quietly


(e) is often “on the go” or often acts as if “driven by a motor”


(f) often talks excessively.


Impulsivity


(g) often blurts out answers before questions ha ve been completed


(h) often has difficulty awaiting turn


(i) often interrupts or intrudes on others (e.g., butts into conversations or games)

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.


C. Some impairment from the symptoms is present in two or more settings (e.g. at school [or work] and at home).


D. There must be dear evidence of clinically significant impairment in social, academic, or occupational functioning.


E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia. or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, DissociativeDisorder, or a Personality Disorder).


Code based on type:


314.01 Attention-Deficit/Hyperactivity Disorder, Combined Type: if both Criteria A1 and A2 are met for the past 6 months


314.00 Attention Deficit/Hyperactivity Disorder. PredominantlyInattentive Type: if Criterion A1 is met but Criterion A2 is not met for the past 6 months


314.01 Attention Deficit/Hyperactivity Disorder, PredominantlyHyperactive-Impulsive Type: if Criterion A2 is met but Criterion A1 is not met for the past 6 months


Coding note: For individuals (especially adolescents and adults) who currently have symptoms that no longer meet full criteria, “In Partial Remission” should be specified.


314.9 Attention-Deficit/Hyperactivity Disorder Not Otherwise Specified


This category is for disorders with prominent symptoms of inattention or hyperactivity-impulsivity that do not meet criteria for Attention-Deficit/ Hyperactivity Disorder.


Examples include


1. Individuals whose symptoms and impairment meet the criteria for Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type but whose age at onset is 7 years or after


2. Individuals with clinically significant impairment who present with inattention and whose symptom pattern does not meet the full criteria for the disorder, but have a behavioral pattern marked by sluggishness, daydreaming, and hypoactivity


Is ADHD a Mental Disorder?


Although the ADHD diagnosis is defined in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) making it appear scientific, it is not purely scientific as the criteria used are subjective. What is perceived as excessive, but still in the “normal” range in one culture is perceived as “odd” in another culture.


To put the issue of DSM-IV (the current version) and ADHD in perspective, according to the DSM-III, homosexuality was a diagnosable mental disorder until 1974. The same pattern of justification applied to homosexuality until 34 years ago is behind today’s ADHD diagnosis. Homosexuality can be called a sin, an inclination, a preference, an orientation, or a lifestyle, but never a disease.


What are the DSM-IV criteria based on? The committee of the DSM-IV meets in a committee room and by a show of hands, vote into existence the disorder of the day, and give it a code number in the DSM. That is how we get so many psychiatric disorders.


Did Leonardo da Vinci, Galileo, Isaac Newton, Einstein, The Wright Brothers, Thomas Edison, Beethoven, Mozart and Abraham Lincoln, all of whom showed signs of ADHD, suffer from a “mental disorder”?





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