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Expanding our Thinking About ADHD Diagnostic Criteria

This is in response to the article citing comparisons between boys and girls diagnosed (Oct., 2002) with AD/HD:

“These statistics don’t represent how many girls have ADHD, but rather how many girls with AD/HD were diagnosed with AD/HD at the time of the survey, during which time DSM-IV criteria were presumably used to make these diagnoses. These findings suggest that more attention is now being paid to girls’ learning problems.”

Funny that AD/HD should be called “learning problems,” as if that’s all ADD is.

But to my major point: I agree the diagnostic criteria have got to be changed to coincide with the symptoms girls have which persist for years to the extent that we are being diagnosed in adulthood, without doubt from our doctors (many of them) and a part of the diagnostic interview pertains specifically to childhood patterns!!

This is ironic, and tragic.

The current criteria are adequate, if people are able to expand their definitions a little. For example, the seven-year old girl who NEVR STOPS TALKING can be said to be exhibiting both hyperactivity (verbal) and impulsivity (no brakes on her mouth).

The same child who is nearly mute when asked a question yet writes like a dream on paper (so she can’t be called LD) can be interpreted as having a lot of trouble sorting through stimuli, knowing when is the moment to answer, which part of the question posed to the class is the salient one, and what was the question anyway, the birds were chirping outside right then.

The child who cannot NOT attend to everything that’s going on, and who is told, when she describes how others are talking to HER, to “just ignore them,” should be observed for whether she can, in fact, ignore anything at all.

Executive function, not specifically part of the DSM criteria, but widely asked about in adult diagnostic interviews (but not in children’s) can be seen to vary and be quite poor in children with AD/HD. I personally observed my 4-year-old grandson sift through a box of cards looking for a specific one, finally find it, and set it aside, returning all the others to the box before using the one he sought. My then eight-year-old daughter (with AD/HD) who has had much more instruction, examples to follow, and specific teaching in comparison to my grandson would not be that organized typically. If she did carefully set a card aside and replace the other cards, it would be with great difficulty, thinking it through, not in that automatic way her (non-AD/HD) nephew did it.

Poor modulation of affect, also not in the DSM, but notoriously problematic for 100 percent of adult AD/HD patients, can be observed in children with AD/HD soon after they reach school age. Whoever it was who said a kid need not be referred for any kind of ADD evaluation until he (yes, “he” was the pronoun used) had annoyed three people probably didn’t include the child himself as one of the three, which wipes out altogether the subjective experience of ADD which is often most troubling, ESPECIALLY FOR GIRLS.

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