658 CHAPTER 14
In addition, symptoms of impulsivity can lead to increased risk of harm. As shown in
Figure 14.3, as the child heads into adulthood, hyperactive and impulsive symptoms
tend to decrease but not disappear. Symptoms of inattention, however, do not tend
to decrease as much (Biederman, Mick, & Faraone, 2000). Additional facts about
ADHD are presented in Table 14.15.Distinguishing Between Attention-Defi cit/Hyperactivity
Disorder and Other Disorders
Some symptoms of ADHD overlap with those of other disorders. For instance, the
hyperactive and impulsive symptoms of ADHD may appear similar to those of
hypomania or mania (bipolar disorder, Chapter 6) or to anxiety symptoms (such
as those that may arise with anxiety disorders, Chapter 7). In addition, symptoms
of inattention may overlap with some of the symptoms of dissociative disorders
(Chapter 8). Moreover, symptoms of substance-related disorders (Chapter 9) and per-
sonality disorders (Chapter 13) may overlap with both inattention and hyperactive/
impulsive symptoms.
However, two factors distinguish ADHD from the other disorders: (1) child-
hood onset, and (2) the relatively large number of symptoms of inattention and/
or hyperactivity/impulsivity necessary for the diagnosis. But even these two fac-
tors may not allow a clinician to distinguish disruptive behaviors that arise from
hyperactivity or impulsivity from disruptive behaviors that arise from defi ance
associated with oppositional defi ant disorder or conduct disorder. The extremely
high comorbidity between ADHD and oppositional defi ant disorder or conduct
disorder requires clinicians to assess carefully the reason for a child’s persistent
disruptive behavior. A general rule of thumb is that individuals with ADHD and
not oppositional defi ant disorder or conduct disorder do not intentionally violate
the rights of others. For instance, Javier didn’t hurt others physically, nor had his
parents or teachers noticed any signifi cant lying or stealing. Moreover, his disrup-
tive behaviors in the classroom did not seem willful; rather, it seemed as though he
couldn’t help himself when he jumped out of his seat. And when he stood 5 inches
from his classmates’ faces while talking to them, he seemed happy and excited, not
threatening. However, many children are diagnosed with both conduct disorder
and ADHD, indicating that they intentionally violate rules and are also impulsive and
hyperactive or have problems with attention.Figure 14.3g43100Percent reduction806040200
6–8 9–11 12–14
Age(a) Hyperactivity6 15–17 18–2014.3 • Reduction in ADHD Symptoms From Childhood to Adulthood By adulthood,
the symptoms of (a) hyperactivity and (b) impulsivity diminish more in people with ADHD than do the
symptoms of (c) inattention (Biederman, Mick, & Faraone, 2000). In syndromatic remission, symptoms
improve and no longer meet diagnostic criteria; in symptomatic remission, symptoms improve but
diagnostic criteria are still met (Biederman et al., 2000).100Percent reduction806040200
6–8 9–11 12–14
Age(b) Impulsivity6 15–17 18–20100Percent red
uction
806040200
6–8 9–11 12–14
Age(c) Inattention6 15–17 18–20Syndromatic remission
Symptomatic remission
Full recovery