00:01
When you see a patient with a potential
attention deficit hyperactivity disorder,
it’s important to
do a complete H&P.
00:08
And look for neurologic
and genetic problems.
00:11
So one issue is to rule out
conditions with similar symptoms,
which may co-exist with ADHD.
00:20
Examples are anxiety
disorders, depression,
patients with sleep disturbance
may present very similar to ADHD.
00:28
A good example was sleep apnea.
00:30
These children look like they have ADHD.
00:33
If they, for example, have their tonsils
removed and look better, that resolves.
00:37
Substance abuse.
00:39
Patients with oppositional
defiant disorder
may not really have a attention deficit
issues, they might just be misbehaving.
00:46
Patients with conduct disorder or
patients with true learning disorders.
00:51
Perhaps, the patient is having problems
reading because they have dyslexia,
not because they have
attention deficit problems.
00:58
So there are some DSM-V criteria for ADHD,
which I think are useful to review.
01:04
The DSM-V states that six or more
symptoms of inattention for children
up to the age of 16 or five or more for
adolescents 17 and older and adults
are needed to be able to
establish the diagnosis.
01:19
The symptoms of inattention need to have
been present for at least six months
and they are inappropriate
for developmental level.
01:27
So let’s go through the classic
symptoms of attention deficit.
01:32
Examples are often fails to
give close attention to details
or makes careless mistakes in schoolwork,
at work or with other activities.
01:41
Often has trouble holding attention
on tasks or play activities.
01:45
Often does not seem to listen
when spoken to directly.
01:49
Often does not follow
through on instructions
and fails to finish school work,
chores, or duties in the workplace.
01:55
In other words, loses focus
or becomes sidetracked.
01:59
Often has trouble organizing
tasks and activities.
02:01
Often avoids, dislike, or
is reluctant to do tasks
that require mental effort
over a long period of time,
such as schoolwork or homework.
02:10
Often loses things necessary
for tasks and activities
such as school materials,
pencils, books, et cetera.
02:17
These patients may become easily
distracted or forget daily activities.
02:23
So those are the criteria
for attention deficit.
02:26
But what about the
hyperactivity component.
02:30
The DSM-V states that for a diagnosis,
patients require six or more symptoms
of hyperactivity-impulsivity
for children up to age 16 or five or more
for adolescents 17 or older and adults.
02:43
These symptoms of hyperactivity-impulsivity
must have been present
for at least six months
just like for the attention
deficit symptoms.
02:52
So let’s go through the classic
symptoms of hyperactivity.
02:56
Often fidgets with or taps hands
or feet or squirms in the seat.
03:01
Often leaves seat in situations
when remaining seated is expected.
03:05
Often runs about or climbs in
situations where it is not appropriate
such as adolescents or adults may
be limited to feeling restless.
03:15
Also, they may be unable to play or take
part in leisure activities quietly.
03:20
They may be often on the go or
acting as if driven by a motor.
03:25
They may talk excessively.
03:27
They may blurt out an answer before
a question has been completed
or have trouble waiting their turn.
03:33
They may interrupt or intrude on others.
03:36
For instance, butting into
conversations or games.