Attention-Deficit/Hyperactivity Disorder: Considerations during Assessment

Introduction

According to the Center for Disease Control (CDC; 2005), an estimated 4.4 million children between the ages of 4 and 17 have been diagnosed with attention-deficit/hyperactivity disorder (ADHD). Based on 2003 data, the CDC (2005) also reported that 7.8% of school-aged children had an AD/HD diagnosis by their parents. National prevalence rates of ADHD reported within the medical arena (Brown et al., 2001) range from 4% to 12% of the elementary school population with higher rates of the disorder among males and with higher rates reported from school settings than community settings; also reported was that 2.5 million youth ages 4-17 were receiving medication treatment for the disorder. The U.S. Department of Education asserts that children with ADHD should be considered disabled and eligible to receive special education services (Olfson, Gameroff, Marcus, & Jensen, 2003). Other behavioral, emotional, and learning problems significantly co-occur with ADHD (Brown et al.), meaning speech-language pathologists (SLPs) will most certainly find children with ADHD referred to them for evaluation. The purpose of this article is to highlight the complex interaction of attention, cognition, and language in individuals with ADHD and to urge examiners to be cautious in interpreting the results of assessment of individuals with ADHD.

ADHD Diagnosis

The Diagnostic and Statistical Manual for Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2004) is used by mental health professionals to diagnose ADHD, along with other disorders. The DSM-IV categorizes the diagnosis of ADHD into three distinct categories:

1. inattention,
2. hyperactivity, and
3. impulsivity.

There must be six or more symptoms of inattention or six or more symptoms of hyperactivity/impulsivity present in order to obtain a diagnosis of ADHD. Symptoms must be present for at least six months and cause a disruption in development or be inappropriate for the child's developmental level.

According to the Center for Disease Control (2005), symptoms of inattention include:

1. trouble maintaining attention to play tasks,
2. difficulty listening,
3. difficulty following directions,
4. forgetfulness and high distractibility,
5. avoidance of mentally challenging tasks, and
6. inability to organize effectively.

There are nine total symptoms related to inattention. Individuals with ADHD may exhibit symptoms of hyperactivity and impulsivity, which include:

1. fidgeting,
2. yelling answers to questions before completion,
3. talking excessively,
4. being unable to remain seated, and
5. having difficulty waiting one's turn, among others.

According to the DSM-IV-TR (American Psychiatric Association, 2004), aside from the necessity of six of the above-mentioned symptoms being present for a diagnosis of ADHD, children must also meet four additional criteria. First, some of the symptoms of impairment in functioning must have been present before the child is seven years old. Second, the impairments must be exhibited in more than one setting to assure that it is not due to an environmental cause. Third, the impairments must be displayed in a manner that significantly impact the child's function in social, school, or work environments. Finally, the child's symptoms do not occur during the course of another mental disorder.