1% of Europeon kids are classified ADHD as opposed to 6% of American kids.
Attention-Deficit Hyperactivity Disorder
European Description
The ICD-10 Classification of Mental and Behavioural Disorders
World Health Organization
Contents
F90 Hyperkinetic Disorders
F90.0 Disturbance Of Activity And Attention
F90.1 Hyperkinetic Conduct Disorder
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F90 Hyperkinetic Disorders
This group of disorders is characterized by: early onset; a combination of overactive, poorly modulated behaviour with marked inattention and lack of persistent task involvement; and pervasiveness over situations and persistence over time of these behavioural characteristics.
It is widely thought that constitutional abnormalities play a crucial role in the genesis of these disorders, but knowledge on specific etiology is lacking at present. In recent years the use of the diagnostic term “attention deficit disorder” for these syndromes has been promoted. It has not been used here because it implies a knowledge of psychological processes that is not yet available, and it suggests the inclusion of anxious, preoccupied, or “dreamy” apathetic children whose problems are probably different. However, it is clear that, from the point of view of behaviour, problems of inattention constitute a central feature of these hyperkinetic syndromes.
Hyperkinetic disorders always arise early in development (usually in the first 5 years of life). Their chief characteristics are lack of persistence in activities that require cognitive involvement, and a tendency to move from one activity to another without completing any one, together with disorganized, ill-regulated, and excessive activity. These problems usually persist through school years and even into adult life, but many affected individuals show a gradual improvement in activity and attention.
Several other abnormalities may be associated with these disorders. Hyperkinetic children are often reckless and impulsive, prone to accidents, and find themselves in disciplinary trouble because of unthinking (rather than deliberately defiant) breaches of rules. Their relationships with adults are often socially disinhibited, with a lack of normal caution and reserve; they are unpopular with other children and may become isolated. Cognitive impairment is common, and specific delays in motor and language development are disproportionately frequent.
Secondary complications include dissocial behaviour and low self-esteem. There is accordingly considerable overlap between hyperkinesis and other patterns of disruptive behaviour such as “unsocialized conduct disorder”. Nevertheless, current evidence favours the separation of a group in which hyperkinesis is the main problem.
Hyperkinetic disorders are several times more frequent in boys than in girls. Associated reading difficulties (and/or other scholastic problems) are common.
Diagnostic Guidelines
The cardinal features are impaired attention and overactivity: both are necessary for the diagnosis and should be evident in more than one situation (e.g. home, classroom, clinic).
Impaired attention is manifested by prematurely breaking off from tasks and leaving activities unfinished. The children change frequently from one activity to another, seemingly losing interest in one task because they become diverted to another (although laboratory studies do not generally show an unusual degree of sensory or perceptual distractibility). These deficits in persistence and attention should be diagnosed only if they are excessive for the child’s age and IQ.
Overactivity implies excessive restlessness, especially in situations requiring relative calm. It may, depending upon the situation, involve the child running and jumping around, getting up from a seat when he or she was supposed to remain seated, excessive talkativeness and noisiness, or fidgeting and wriggling. The standard for judgement should be that the activity is excessive in the context of what is expected in the situation and by comparison with other children of the same age and IQ. This behavioural feature is most evident in structured, organized situations that require a high degree of behavioural self-control.
The associated features are not sufficient for the diagnosis or even necessary, but help to sustain it. Disinhibition in social relationships, recklessness in situations involving some danger, and impulsive flouting of social rules (as shown by intruding on or interrupting others’ activities, prematurely answering questions before they have been completed, or difficulty in waiting turns) are all characteristic of children with this disorder.
Learning disorders and motor clumsiness occur with undue frequency, and should be noted separately when present; they should not, however, be part of the actual diagnosis of hyperkinetic disorder.
Symptoms of conduct disorder are neither exclusion nor inclusion criteria for the main diagnosis, but their presence or absence constitutes the basis for the main subdivision of the disorder (see below).
The characteristic behaviour problems should be of early onset (before age 6 years) and long duration. However, before the age of school entry, hyperactivity is difficult to recognize because of the wide normal variation: only extreme levels should lead to a diagnosis in preschool children.
Diagnosis of hyperkinetic disorder can still be made in adult life. The grounds are the same, but attention and activity must be judged with reference to developmentally appropriate norms. When hyperkinesis was present in childhood, but has disappeared and been succeeded by another condition, such as dissocial personality disorder or substance abuse, the current condition rather than the earlier one is coded.
Differential Diagnosis
Mixed disorders are common, and pervasive developmental disorders take precedence when they are present. The major problems in diagnosis lie in differentiation from conduct disorder: when its criteria are met, hyperkinetic disorder is diagnosed with priority over conduct disorder. However, milder degrees of overactivity and inattention are common in conduct disorder. When features of both hyperactivity and conduct disorder are present, and the hyperactivity is pervasive and severe, “hyperkinetic conduct disorder” (F90.1) should be the diagnosis.
A further problem stems from the fact that overactivity and inattention, of a rather different kind from that which is characteristic of a hyperkinetic disorder, may arise as a symptom of anxiety or depressive disorders. Thus, the restlessness that is typically part of an agitated depressive disorder should not lead to a diagnosis of a hyperkinetic disorder. Equally, the restlessness that is often part of severe anxiety should not lead to the diagnosis of a hyperkinetic disorder. If the criteria for one of the anxiety disorders are met, this should take precedence over hyperkinetic disorder unless there is evidence, apart from the restlessness associated with anxiety, for the additional presence of a hyperkinetic disorder. Similarly, if the criteria for a mood disorder are met, hyperkinetic disorder should not be diagnosed in addition simply because concentration is impaired and there is psychomotor agitation. The double diagnosis should be made only when symptoms that are not simply part of the mood disturbance clearly indicate the separate presence of a hyperkinetic disorder.
Acute onset of hyperactive behaviour in a child of school age is more probably due to some type of reactive disorder (psychogenic or organic), manic state, schizophrenia, or neurological disease (e.g. rheumatic fever).
Excludes:
* anxiety disorders
* mood (affective) disorders
* pervasive developmental disorders
* schizophrenia
F90.0 Disturbance Of Activity And Attention
There is continuing uncertainty over the most satisfactory subdivision of hyperkinetic disorders. However, follow-up studies show that the outcome in adolescence and adult life is much influenced by whether or not there is associated aggression, delinquency, or dissocial behaviour. Accordingly, the main subdivision is made according to the presence or absence of these associated features. The code used should be F90.0 when the overall criteria for hyperkinetic disorder (F90.-) are met but those for F91.- (conduct disorders) are not.
Includes:
* attention deficit disorder or syndrome with hyperactivity
* attention deficit hyperactivity disorder
Excludes:
* hyperkinetic disorder associate with conduct disorder (F90.1)
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F90.1 Hyperkinetic Conduct Disorder
This coding should be used when both the overall criteria for hyperkinetic disorders (F90.-) and the overall criteria for conduct disorders (F91.-) are met.
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ICD-10 by World Health Organization.
Internet Mental Health (www.mentalhealth.com) copyright © 1995-2003 by Phillip W. Long, M.D.
The American Academy of Pediatrics
For more specific diagnosing information see the clinical guideline link in the article.
“Below is a news release of a policy published in the May issue of Pediatrics, the peer-reviewed scientific journal of the American Academy of Pediatrics (AAP).
For Release: May 1, 2000, 5:00 p.m. (ET)
CHICAGO - The American Academy of Pediatrics (AAP) released new recommendations today for the assessment of school-age children with attention-deficit/hyperactivity disorder (ADHD).
Research in various community and practice settings shows that between 4 and 12 percent of all school-age children may have ADHD, making it the most common childhood neurobehavioral disorder. Children with ADHD may experience significant functional problems such as school difficulties, academic underachievement, troublesome relationships with family members and peers, and behavioral problems.
In recent years, there has been growing interest in ADHD as well as concerns about possible over diagnosis. In surveys among pediatricians and family physicians across the country, wide variations were found in diagnostic criteria and treatment methods for ADHD.
The new standardized AAP guidelines were
developed by a panel of medical, mental health and educational experts. The Agency for Healthcare Research and Quality provided significant research and background information for the new policy.
The new guidelines, designed for primary care physicians diagnosing ADHD in children age 6 to 12, include the following recommendations:
* ADHD evaluations should be initiated by the primary care clinician for children who show signs of school difficulties, academic underachievement, troublesome relationships with teachers, family members and peers, and other behavioral problems. Questions to parents, either directly or through a pre-visit questionnaire, regarding school and behavioral issues may help alert physicians to possible ADHD.
* In diagnosing ADHD, physicians should use DSM-IV criteria developed by the American Psychiatric Association. These guidelines require that ADHD symptoms be present in two or more of a child’s settings, and that the symptoms adversely affect the child’s academic or social functioning for at least six months.
* The assessment of ADHD should include information obtained directly from parents or caregivers, as well as a classroom teacher or other school professional, regarding the core symptoms of ADHD in various settings, the age of onset, duration of symptoms and degree of functional impairment.
* Evaluation of a child with ADHD should also include assessment for co-existing conditions: learning and language problems, aggression, disruptive behavior, depression or anxiety. As many as one-third of children diagnosed with ADHD also have a co-existing condition.
Other diagnostic tests, sometimes considered positive indicators for ADHD, have been reviewed and considered not effective. These tests include lead screening, tests for generalized resistance to thyroid hormone, and brain image studies.
Comprehensive ADHD treatment guidelines are also in development.
The American Academy of Pediatrics is an organization of 55,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.
© 2003 - American Academy of Pediatrics ”
http://www.aap.org/advocacy/archives/octadhd.htm
Re: ICD-10 (Europeon) criteria for ADHD vs DSM criteria
Quote:* 1. ADHD evaluations should be initiated by the primary care clinician for children who show signs of school difficulties, academic underachievement, troublesome relationships with teachers, family members and peers, and other behavioral problems. Questions to parents, either directly or through a pre-visit questionnaire, regarding school and behavioral issues may help alert physicians to possible ADHD.
* 2. In diagnosing ADHD, physicians should use DSM-IV criteria developed by the American Psychiatric Association. These guidelines require that ADHD symptoms be present in two or more of a child’s settings, and that the symptoms adversely affect the child’s academic or social functioning for at least six months.
*3. The assessment of ADHD should include information obtained directly from parents or caregivers, as well as a classroom teacher or other school professional, regarding the core symptoms of ADHD in various settings, the age of onset, duration of symptoms and degree of functional impairment.
*4. Evaluation of a child with ADHD should also include assessment for co-existing conditions: learning and language problems, aggression, disruptive behavior, depression or anxiety. As many as one-third of children diagnosed with ADHD also have a co-existing condition. Quote
The above is the crux of the problem. I will elaborate. 1. to automatically assume that these “symptoms” are indicative of anything is crazy especially a disorder that is alledgedly neurological. Those symptoms are more indicative of a conduct disorder brought on be bad parenting.
2. The DSM criteria does not describe a disorder it descibes the behavior of children. The APA is so aligned with the pharamceutical industry that their credibility should be suspect at best.
3. This one is a double edged sword first it relies on absurd diagnostic criteria then it relies on non proffesional to make a professional observation. There is also a financial incentive for schools to get as many students deemed disabled in order to get IDEA money.
4. Wow! The assumption/diagnosis has already been made and is now the “prime diagnosis” More double talk.
Objective criteria for ADHD does not exist in the DSM model. To my way of thinking the DSM criteria tries to set an unrealistic expectation for child behavior that would have them act like compliant little adults.
Kids were designed to misbehave. Correcting misbhavior and teaching children to conform to social norms is the job of the parent not a chemical.
Very "Ball-like" post Re American Acad. Pediatrics
Now everybody, this post by Kenny is a prime example of a Ball-like post. Notice the automatic blame put on parents for bad behavior and not allowing for the posibility that ADHD exists. The author states that the symptoms used by physicians to diagnose ADHD are “more indicative of a conduct disorder brought on by bad parenting”. Honestly, we all have to admit that there are kids with ADHD symptoms that just have bad parents but it can’t explain away ADHD. If that were true then I would be using two different parenting styles in order to produce 1 child with ADHD and another without. Creative, well-informed parenting is a requirement for raising these children without and often even with medication but typical parenting doesn’t create the ADHD behavior issues. I personally think that the adults can worsen the ADHD bad hehaviors by villinizing the child rather than understanding and dealing with the ADHD.
The above posts
Let’s be honest - anyone who has parented more than one child will recognize that each child is unique. The fact is, some kids are just difficult. I will not pretend that we were perfect parents - far from it! But we did not abuse our oldest or neglect him in any way. He was just challenging from the start. He didn’t sleep well, he threw his food around, he got into everything, etc. Not because he was trying to be difficult - he just came that way. Our second child was quite the opposite - charming, sweet, sedate, thoughtful, patient - I called him our “mail order baby”. Why the difference? Beats me! But they are very different, not based on huge differences in parenting approach, but they came different.
So “bad parenting” did not create this situation with Patrick. I do believe that bad parenting CAN create these “ADHD” symptoms in some kids, but that is only one of many variables. And some kids would not become hyperactive no matter what you did to them. The folks on this board probably don’t fall into the “bad parenting” category, anyway - why would they be here seeking new strategies and approaches if they didn’t care about their kids? So “bad parenting” doesn’t explain much.
So the next question is, “does this mean there is something wrong with my ‘difficult’ child?” This is where most of the controversy lies. I would say “no” - I think of my children as representing normal variations in personality, just like some people have blue or green or brown eyes. Difference is not disease, to me. Even if there is evidence that these children’s brains work differently (which has by no means been definitively established), so what? We are all different in so many ways, it just figures that some of our brains will work differently.
The final question becomes, “What do I do about it?” Some of that depends on your answer to the above question. If you believe your child’s behavior indicates a medical illness, then you might seek medical treatment. Since I don’t, we didn’t. The challenge is to strategize for the long-term survival of your child. I have always believed that kids have strengths and challenges, and that our job is to teach them to build on their strengths to overcome the challenges. For these kids, the challenges revolve around dealing with the expectations of other people. There are tons of strategies to use, most of which do not require either the assumption that I am a bad parent, OR the assumption that there is something drastically wrong with my child medically. But others may freely disagree with me regarding their own situation. That’s just my view.
Some kids are tougher to raise than others. I’ve had both experiences. I want this forum to be about exploring all the available options. I am happy to see information posted regarding the risks involved with medications and regarding alternative approaches. But I don’t think insulting people will ever get us anywhere. I know that raising certain children is an incredible challenge - I have done it! And I know that improving parenting skills to a highly professional level is a requirement for these kids, regardless of what philosophical viewpoint you assume. So let’s skip the “ADHD is caused by bad parenting” stuff. Frankly, to me, it is just as unhelpful as “all kids must be medicated”. Neither attitude reflects reality. People have a right to see the information and make an informed choice. Let’s keep it to that level and stop insulting people that disagree with us.
–- Steve
Re: The above posts
[quote=”Steve”]. So let’s skip the “ADHD is caused by bad parenting” stuff. Frankly, to me, it is just as unhelpful as “all kids must be medicated”. Neither attitude reflects reality. People have a right to see the information and make an informed choice. Let’s keep it to that level and stop insulting people that disagree with us.
–- Steve[/quote]
Steve, you will find that these are the types of Post that “ball” has/will post and that was the reason most of the parents find them very Offensive and disturbing. We have been round this road before with him, and if you disprove his posts, he gets really offensive in his language and that is the reason why his posts were deleted. A lot of good parents have left the board and as this is now turning into an Anti-med and also anti-anything board with a “person” posting posts that have no scientific merit or any merit at all and only posts that are anti-med for personal gains, I have decided to not bother with this board anymore. There is no useful information to gain here by the “postings” of a lunatic on the evils of medications. Notice nobody is asking him any questions, and nobody has asked for any info on medication and yet he is posting all this “information” just to flood the board. By the way, he doesn’t even have any children, much less children with ADHD, so ask yourself why he is on this board. He has never answered the questions posed by many people about what his motives are here. He just keeps posting all the questionable information. If he so badly want this board. He can have it. We are all tired of the same rubbish he keeps posting, recycling the same old posts. The more you try to defend him, Steve, the more he is going post all this “bad parenting junk and there is no such thing as ADHD garbage,” to destroy this board. So I say welcome to you and goodbye. I don’t have time to waste here anymore, like I said before there is no useful information here or dialogue anymore..
To Steve
Did I miss something? I didn’t think that your post was defending Ball. I thought it was a tactful suggestion for him to calm down the insults.
Re: ICD-10 (Europeon) criteria for ADHD vs DSM criteria
I think it is quite telling when a thread comparing ICD 10 and the DSM diagnostic criteria for ADHD gets mired in a discussion about Ball.
Steve, why do you suppose that is?
I think it is important to discuss the fact that DSM criteria identify 6 times as many ADHD kids than it’s Europeon and international counter-part the ICD 10.
Back to the topic. Could it have somthing to do with socialized medicine vs the greedy and heartless HMOs?
Ritalin is cheaper compred to therapy.
Re: ICD-10 (Europeon) criteria for ADHD vs DSM criteria
http://www.abelard.org/briefings/ritalin.htm
Research-based critique of DSM criteria for ADHD
Attention Deficit Hyperactivity Disorder: State of the Science. Best Practices
In Jensen PS, Cooper JR (Eds); Kingston NJ, Civic Research Institute, 2002.
Chapter 3: by William Carey, MD
I just ran across this by accident - it is a highly scientific and scholarly look at the ADHD diagnostic criteria in light of the author’s research into inheritable temperament differences. If anyone wants an unbiased, propaganda-free, non-blaming, reference-based look at ADHD as a diagnostic category, this is the link for you. There is a significant amount of scientific terminology, but it is still readable if you focus on the basic points he is making.
I highly recommend it for those who are skeptical about one-sided propaganda campaigns masquerading as science (which occur on both sides of the issue, in my observation). Dr. Carey fully acknowledges the challenges of raising such children, while calling on scientists to do a much better job defining their terms and including all of the available data before jumping to unsupported medical conclusions.
I also have a link: http://www.rdos.net/eng/
Unfortunately, it doesn’t link directly to the article. You have to go into the link “The Neanderthal Theory” (an extremely large document!) and scroll down about 2/3 of the way to the heading “Psychiatry and other theories”, then click on the link “Is ADHD a valid defect?”
Enjoy!
[color=darkred][/color][size=24][/size]This is[color=blue][/color]thr American DSM criteria fo ADHD.
[size=12][/size]I feel the DSM criteria is too broad and seems to fit all children.
Here it is…
Attention-Deficit Hyperactivity Disorder
American Description
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Diagnostic Criteria
Either (1) or (2):
six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
often has difficulty sustaining attention in tasks or play activities
often does not seem to listen when spoken to directly
often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
often has difficulty organizing tasks and activities
often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
is often easily distracted by extraneous stimuli
is often forgetful in daily activities
six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
Hyperactivity
often fidgets with hands or feet or squirms in seat
often leaves seat in classroom or in other situations in which remaining seated is expected
often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
often has difficulty playing or engaging in leisure activities quietly
is often “on the go” or often acts as if “driven by a motor”
often talks excessively
Impulsivity
often blurts out answers before questions have been completed
often has difficulty awaiting turn
often interrupts or intrudes on others (e.g., butts into conversations or games)
Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.
Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).
There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
Specify Type:
Attention-Deficit/Hyperactivity Disorder, Combined Type: if both Criteria A1 and A2 are met for the past 6 months
Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type: if Criterion A1 is met but Criterion A2 is not met for the past 6 months
Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type: if Criterion A2 is met but Criterion A1 is not met for the past 6 months
Note: For individuals (especially adolescents and adults) who currently have symptoms that no longer meet full criteria, “In Partial Remission” should be specified.