What are the diagnostic criteria for diagnosis?

Some factors that seem to be associated with the occurrence of ADD or ADHD – many are impressionistic and controversial, and much more research is needed to clarify their relevance. They can be interpreted somewhat like pieces of evidence - the more there are, the firmer the diagnosis becomes. Most of these characteristics are associated with a greater than chance likelihood of the syndrome, but no ADHD child has all these indicators, and many occur in non-ADHD children.

Foetal Indicators:

• Apparent hyperactivity in the womb. About one-third of ADHD children are hyperactive while still unborn. Mother’s report the child kicks and turns and punches or bruises her ribs. This increased activity is especially pronounced when the expectant mother is sitting or lying down.
• Poor maternal health.
• Mother under 20 years of age.
• First pregnancy.
• Elevated blood pressure during pregnancy.
• Convulsions in the mother during latter stages of pregnancy or during childbirth.
• Maternal alcohol abuse.
• Heavy maternal smoking.
• Drug abuse.
• Birth Indicators:
• Extreme prolonged lack of oxygen at birth.
• Labour lasting longer than eighteen hours.
• Birth injuries.
• Congenital problems or physical malformations.
• Foetal alcohol syndrome. This syndrome include low birth weight, small head size, birth defects, withdrawal symptoms, and mental retardation. When the expectant mother consumes a large amount of ethyl alcohol, she can cause foetal damage. The actual amount needed to harm the nervous system and period of pregnancy in which the developing child is most sensitive to this insult are yet unknown.
• Prematurely. Studies of low birth weight babies suggest a relationship between prenatal factors and the syndrome. In one study, prematurely was found to be associated with hyperactivity at age seven. In another study, the ADHD rate was 18 % in low birth weight children and 6.5 % in full birth children.
• Low placental weight.
• Breech presentation.
• Inflammation of the outermost of the two membranes enveloping the unborn child.
• Early Infancy Indicators:
• Inadequate sleep.
• Irritability.
• Excessive crying and colic.
• Feeding problems such as difficulty nursing or accepting a formula and differing appetite levels.
• Health problems such as allergies, colds, asthma, upper respiratory infections, and fluid in the ears.
• Poor bonding. The baby is not cuddly and responsive and is restless and difficult to manage during

such routine activities as bathing, nappy changing, or feeding.

Late Infancy Indicators:

• Unusual crib behaviour such as foot thumping, excessive rocking, head banging, and climbing out of the crib.
• Rapid or delayed development of physical skills such as crawling, sitting, standing, walking, and running.
• Delayed or rapid development of verbal skills, such as saying the first word prior to ten months or after sixteen months of age.
• Low adaptability to change.
• Sleep difficulties including getting to sleep, staying asleep, obtaining restful sleep, and arising refreshed and pleasant in the morning.
• Toddlerhood Indicators:
• Aggressive: pushes, shoves, pinches, kicks, bites and grabs toys and can't play cooperatively for a sustained period.
• Destructive: breaks, throws, and tears apart things, toys, and clothing because of anger, curiosity, or wear-and-tear from high activity level.
• Overactive: acts as if driven by a mainspring that is wound to tightly, resulting in non-stop movements and an inability to sit quietly for more than a few minutes.
• Incorrigible: under responsive to parental correction, unconcerned when threatened with punishment, and requiring constant attention, reminding and restraining.
• Reckless: accident prone, careless with common dangers such as traffic, and susceptible to accidental poisoning.

Pre-school Indicators:

• Stomach problems . By the time they are five years old, hyperactive children on the average have had more serious gastrointestinal complains resulting in contact with physicians than their peers.
• Lack of coordination in large or small muscle group activities. The child tends to produce sloppy and messy seatwork at preschool or kindergarten.
• Off task behaviour . These children wander away from their tables at school and do other than what the teacher is instructing the class to do, thus requiring an excessive amount of attention and supervision.
• Over activity. They won't sit still and pay attention, won't sit for story time, are out of their seats too often, talk out of turn, and make inappropriate and disrespectful comments to classmates and the teacher.
• Intrusiveness: Hyperactive children are almost universally unpopular throughout their childhood and adolescence. They bother other children by talking to them, touching them, or intruding on their projects and play, as well as by inappropriately seeking attention, such as by clowning. This trend starts shortly after they learn to walk and begin interacting with other children and becomes a lifelong problem of getting along in groups and a secondary problem of self-esteem.
• Aggressiveness. These children are aggressive toward classmates and can't play cooperatively. They take their classmates toys and hit, kick, and make them cry.
• Distractibility. These children appear to have too short an attention span when compared to other children of the same age.
• Parent-child conflict . Patterns of family disruption, such as nag-yell-spank cycles, become established. The parents perceive the child as a negative influence on the family.

Age 6-13:

It must be remembered that not every child has ALL the symptoms. An ADD/ADHD child must manifest with at least six symptoms out of each category in ALL situations. Children without this disorder may also manifest from
time to time with some of these symptoms

Diagnostic criteria as per the dsm iv (Statistical Manual for mental disorders)

Attention deficit disorder:

• Often fails to give close attention to details or makes careless mistakes
• Often has difficulty sustaining attention in tasks or activities
• Often does not seem to listen when spoken to directly
• Often does not follow through on instructions
• Often has difficulty organizing tasks and activities
• Often avoids tasks that require sustained attention
• Often loses things necessary for tasks
• Easily distracted by extraneous stimuli
• Is forgetful in daily activities

Attention deficit hyperactivity disorder:

• Often fidgets with hands or feet or squirms in seat
• Often leaves seat in classroom or other situations
• Often runs or climbs excessively in situations where it is inappropriate to do so
• Often has difficulty playing quietly
• Is often "on the go" or often acts as if "driven by a motor"
• Often talks excessively
• Often blurts out answers before questions have been completed
• Often has difficulty awaiting turn
• Often interrupts or intrudes on others
• Often engages in dangerous activities