Children are likely to function at the age of their language.ĭiagnosing preschool-aged children with ADHD can be incredibly difficult. It is not chronological age but language age that is most important. However, this tantrum may be age appropriate for a 3-year-old. This child may be challenged when trying to communicate his or her needs and resultantly acts out or has a tantrum in a similar fashion as a child with ADHD. It is the internal monologue that keeps our attention directed appropriately. It is important for the pediatrician to remember the link between language age and behavior.Ī 5-year-old child with a language delay who speaks at a 3-year-old level will generally have the attention span of a 3-year-old. 3Īlthough the pediatrician is well aware of the “terrible 2s,” not every child aged younger than 4 years with impulsivity, decreased attention span, tantrums, and high levels of activity goes on to develop ADHD. 2 However, 388,000 children aged 2 to 5 years have been diagnosed with ADHD despite there being no guidelines for a diagnosis before age 4 years. The American Academy of Pediatrics (AAP) guidelines for the diagnosis of ADHD were expanded to include children aged 4 to 5 years in 2011. However, if these same symptoms are assessed at a 4½- to 5-year-old level, they may be much more appropriate. What many clinicians are not explicitly taught, however, is that the DSM-5 (and earlier editions) requires the critical diagnostic requirement that ADHD symptoms must be assessed at the “appropriate developmental age” and NOT the chronologic age.Īssessing a 7-year-old with a language age of a 4½-to-5-year-old (the lower end of the typical range) likely results in a diagnosis of ADHD because the child’s behaviors, attention, and activity level are inappropriate for a 7-year-old child. Additionally, the DSM-5 also recognizes the presence of ADHD in adults, and requires 5 symptoms of the inattentive subtype or the hyperactive-impulsive subtype for diagnosis.
Whereas most pediatricians understand the diagnostic criteria, the DSM-5 expanded the age of symptom onset from prior to age 6 years to prior to age 12 years, in recognition of the later presentation of inattentive symptoms.
Hyperfocus adhd manual#
The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) 1 requires 6 or more symptoms of hyperactivity or inattention in children aged younger than 17 years and 5 or more in adolescents aged older than 17 years. This article will review the diagnostic criteria for ADHD and discuss 6 pitfalls that may face the treating pediatrician.Īs the pediatrician commonly experiences in practice, ADHD has 2 main types: inattentive and hyperactive. Pediatricians need to be not only cognizant of the diagnostic criteria, clinical mimics, comorbidities, and complications of ADHD, but also be comfortable with managing a whole host of complications and other issues, such as stimulant abuse and diversion, that can be very subtle.
Attention-deficit/hyperactivity disorder (ADHD) and its comorbid conditions represent a significant problem to the children in a pediatric practice.
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