58 Chapter 5
Assessment of symptoms
1 Attention is primarily assessed from how long the child or adolescent
persists when engaged in a range of tasks including playing alone,
reading, drawing, or playing with a friend. Some parents say their
children can persist for fairly long periods when playing alone or with
others – but closer enquiry makes it clear that they have a brief attention
span, switching frequently from one play activity to another. Since even
ADHD individuals are often able to watch TV or play computer games
for long periods, persistence with these tasks is not a very discriminating
measure of attention.
2 Motor activity is assessed from:
(a)how long the individual can stay seated during the previously
mentioned tasks;
(b) what proportion of the time they are fidgeting;
(c) how often they wander off on family outings or at the supermarket.
3 Impulsiveness is assessed using questions such as: Does he often blurt
out an answer before he has heard the question properly? Is it hard
for her to wait her turn? Does he often butt in on other people’s
conversations or games?
Additional features commonly associated
with ADHD
1 Defiant, aggressive, and antisocial behavioursare often sufficiently marked
to warrant the diagnosis of a disruptive behavioural disorder as well
(see Chapter 6). Child and adolescent psychiatrists using DSM-IV will
diagnose ADHD alongside either an oppositional-defiant disorder or a
conduct disorder; child and adolescent psychiatrists using ICD-10 will
use the combined diagnosis of ‘hyperkinetic conduct disorder’.
2 Problems with social relationships. Children and adolescents with ADHD
are often socially disinhibited with adults, being over-familiar and
cheeky. Peer rejection is common, partly in response to their disrup-
tiveness and impulsive disregard for rules and turns. Individuals with
ADHD are easily led or dared into all sorts of mischief.
3 IQ under 100in many but certainly not all affected individuals.
4 Specific learning problems(for example, with reading or spelling), even
when IQ is taken into account.
5 Coordination problemsand neurodevelopmental immaturities (‘soft neu-
rological signs’).
6 A history of specificdevelopmental delay, for example, in language acqui-
sition
7 Deficient emotional self-regulation(DESR) in a subgroup, with excessive
emotional reactions to everyday occurrences.