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Controversy – difficult to diagnose
ADHD can be difficult to diagnose, especially in early childhood when limited attentional skills and high levels of energy are common
Controversy – Weak diagnosis reliability
diagnosis relies primarily on observations and input from parents, school personnel, and others knowledgeable about the child’s behaviors
Controversy – Overlooked Factors
it is necessary to determine if the behaviors are:

– typical for the child’s age, gender, and overall level of development;
– a normal temperamental variant involving higher than average energy and impulsivity; or
– an actual disorder involving significantly atypical behaviors that interfere with day-to-day functioning in multiple settings.

Controversy – misunderstanding
Hyperactive is a confusing term because it is frequently used to describe all highly energetic children
Controversy – Often misdiagnosed
family physicians often make ADHD diagnoses and prescribe medication when symptoms of inattention, hyperactivity, and impulsivity do not meet DSM diagnostic criteria resulting in increased likelihood of substance abuse
Controversy – inconsistency of symptoms
some children with ADHD, for example, seem unusually active in the classroom, but may not differ from peers during play activities. Other characteristics, however, might be apparent in these settings.
Controversy – Treatment
Treatment trends at an early age using medication throughout the day have resulted in increased lifetime medication exposure which account for the continued increases in stimulant medication use in the United States
Controversy – Misuse of Medication
frequency of misuse and diversion (i.e., giving, selling, or trading) of prescribed short-acting stimulant medications
Controversy – Methylphenidate (Ritalin) Consumption
the United States accounts for a large percentage of the use of this medication worldwide. From 2000-2009 the amount of methylphenidate consumed more than doubled both in the United States and worldwide
Attention-deficit/hyperactivity disorder (ADHD)
is characterized by attentional problems and/or impulsive, hyperactive behaviors that are atypical for the child’s age and developmental level and that significantly interfere with social, academic, or occupational activities. An ADHD diagnosis requires that symptoms begin before age twelve and persist for at least six months. Those with ADHD can have problems involving:
(1) inattention;
(2) hyperactivity and impulsivity; or
(3) a combination of these characteristics.
Symptoms of hyperactivity and impulsivity
involve a combination of excessive movement and tendencies to act without considering the consequences
Characteristics of ADHD – Inattention
Poor attention to detail
Difficulty sustaining attention
Does not seem to listen
Poor follow-through Excessively loud
Difficulty organizing tasks
Avoids sustained mental effort
Loses objects
Easily distracted
Forgetful
Characteristics of ADHD Hyperactivity and Impulsivity
Fidgets
Restless
Moves excessively
Talks excessively
Blurts out answers
Difficulty waiting for a turn
Interrupts or intrudes on others
Impatient
Diagnosis of ADHD
– Six or more symptoms of inattention that have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level
– Six or more symptoms of hyperactivity-impulsivity
– Some symptoms were present before age 7 years
– The child must display symptoms in two or more settings
ADHD Prevalence
• According to DSM-IV prevalence is estimated at 3% to 5%
• Other estimates range from 5% to 20% rambunctious

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