Diagnosing Add/adhd: The Real-life Application Of Dsm Criteria

The American Psychological Association (APA) added the condition of Attention Deficit Disorder (ADD) to the Diagnostic and Statistical Manual (DSM) in its 1980 edition. Since that time, the U.S. Centers for Disease Control (CDC), the International Statistical Classification of Diseases and Related Health Problems (ICD-10), and the American Academy of Pediatrics have supported, and worked to further develop, the criteria that are used to diagnose children and adults. The most recent criteria are as follows:

DSM-IV Criteria:
I. Either A or B:
A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:
1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2 Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesnt want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Often forgetful in daily activities.
B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:
Hyperactivity:
1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often on the go or often acts as if driven by a motor.
6. Often talks excessively.
Impulsiveness:
1. Often blurts out answers before questions have been finished.
2. Often has trouble waiting ones turn.
3. Often interrupts or intrudes on others.
II. Some symptoms that cause impairment were present before age 7 years.
III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
IV. There must be clear evidence of significant impairment in social, school, or work functioning.
V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

What can be said about the criteria is that it is proven by a significant amount of research therefore accepted as facts. Even so, a professional can still misinterpret the symptoms due it its subjectivity.

Today, the testing method used to identify ADD/ADHD still lacks validity.

Why is this?
The fact is that the criteria for identifying ADD/ADHD were created as part of a movement to combat poor behavior in schools. Part of a diagnosis-of-the-moment trend, an ADD/ADHD diagnosis signaled a maximum tolerance point on the part of education professionals, and a need to explain why children had become far more difficult to handle than in previous decades. Just like other mental and developmental disorders were being over diagnosed according to the popularity of the disorder at any given moment, a diagnosis of ADD/ADHD had become the go-to explanation for uncontrolled behavior in children and an inability to focus in adults.*

However, it is also incorrect to say that this is merely a disorder invented to pave an easy way out for some. ADD/ADHD is very real and like many other disorders is treatable. It is just that there have been many instances of over diagnose and more often than not, these cases requires no drugs to be prescribed.

There is room for argument when it comes to using the DSM criteria to predict or diagnose ADD/ADHD. Criteria IA, IB, II, III, and IV is still considered subjective to the observation of teachers, caretakers, parents, or physicians, different from requirements of criteria V which is by far more appealing.

Criteria V does not guarantee an accurate diagnosis of ADD/ADHD, even if it is the only DSM-IV-Rs attempt at being objective. This are the reasons why:
1. Tests are rarely carried out on individuals are they are often diagnosis based solely on observations.
2. Criteria V necessitate individuals that does not show symptoms of ADD/ADHD possibly have other diagnosable disorder but they are rarely tested for other disorder apart from ADD/ADHD therefore it is still not completely thorough in identifying the correct disorder.
3. Many individuals are diagnosed according to the trial-and-error method. If the individual displays signs of ADD/ADHD, they are medicated. If the medication quiets the signs, the individual must certainly have the disorder correct? Wrong!

DSM criteria is still a very weak form of diagnosis for ADD/ADHD and medical treatment administered from it lays on shaky grounds.

Schizophrenia, dyslexia, and Tourettes disorders have fair share of diagnosis issues such as the one clouding ADD/ADHD.