May 19

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​Detecting Attention Deficits


Attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) is increasingly being acknowledged as the cause of problems with school, work, and relationships. Although many people speculate that it is overdiagnosed, it can just as easily go unrecognized. ADD is often difficult to detect in a one-on-one, novel situation in which people are motivated. Therefore, rating scales of how people operate in different settings are better indicators of problems than psychological tests. Six or more items marked “O” in the left column suggest ADD; six or more items in the right column suggests ADHD; and six plus items in each column suggest a combination of both.

ADD/ADHD Rating Scale

Directions: Mark items with an A (always) or O (often) to show rate of occurrence.

Inattention:

Hyperactivity:

Difficulty sustaining attention, completing tasks, without monitoring.

Skips from one activity (or topic) to another.

Easily distracted by extraneous stimuli.

Does not appear to be listening or following a conversation; daydreams.

Poor attention to instructions or directions.

Fails to pay attention to details, makes careless mistakes, rushes.

Avoids tasks that require sustained (mental) effort, easily bored, needs reminders.

Difficulty organizing tasks and belongings.

Forgetful, loses things, easily frustrated.

Fidgets with hands and feet, squirms in seat, grabs or touches excessively.

Difficulty sitting still or remaining seated.

Runs or climbs too much (children), or feels restless (adolescents and adults).

Louder than others; makes noises.

Always active, “on the go” or seems to be “driven by a motor.”

Talks excessively, excitable, easily upset.

Impulsivity:

Blurts out answer; ignores consequences.

Difficulty waiting or following a routine.

Interrupts or intrudes on others.

(Scale adapted from criteria for ADHD with permission from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Copyright 1994, American Psychiatric Association.)

HISTORY

In addition to rating scales, it is important to take a careful history. Family, friends, relatives, and school records are good sources of information. Mark all items that apply:

  • Symptoms of inattention or hyperactivity appeared before age seven and have persisted for more than 6 months. (Age of onset of symptoms: _______.)
  • Symptoms are present on a consistent basis, rather than appearing in cycles.
  • Other family members have had problems with __ attention, __ excessive activity, __ impulsivity, or __ underachievement. (Relationship: ______________________.)
  • The person was adopted. (ADD occurs more often among adopted people.)
  • There was use of __ alcohol, __ drugs, or __ nicotine during pregnancy.
  • There are problems __ falling asleep, __ staying asleep, or __ waking in the morning.
  • Symptoms cannot be explained by problems with __ allergies, __ asthma, __ breathing, __ blood sugar, __ anemia, __ seizures, __ thyroid, __ ear infections, or __ lead poisoning.
  • Medication or drugs containing stimulants or excessive caffeine are not being used.
  • Other problems (__ high stress, __ depression, __ anxiety, or __ nervous tics) are not factors

DETECTING ATTENTION PROBLEMS IN ADULTS

Difficulties with hyperactivity and attention used to be considered a disorder of childhood. It was believed that as young peoples’ brains matured, they grew out of it. More current estimates suggest that 30% to 70% of children with ADD will continue to have problems as adults. It may be that high numbers of adults have ADD, but they developed coping strategies to manage symptoms and even use them to their advantage. Researchers at the University of Utah2 suggest the following standards for adult ADD:
Core Measures (all three must be present)

  • Childhood evidence of ADD or ADHD with school problems, excitability, or temper.
  • Persistent motor activity: restlessness, difficulty settling down, “nervous” energy, pacing, drumming fingers, and feeling edgy or moving from one place to another.
  • Attention deficits: distractibility, difficulty staying on task, or forgetting or losing things.

Additional Measures (two out of five must be present)

  • Moodiness seen in sudden changes from excitement to discouragement, lasting from hours to days and not as extreme as people with mood disorders.
  • Hot temper or short-lived outbursts that may be frightening to self and others.
  • Reacts to stress with anxiety, anger, and depression.
  • Impulsive, hasty, or risky decisions about work and relationships.
  • Disorganization seen in going from one project to the next or leaving things unfinished, especially when school, parents or spouses are not present to provide structure.

Some writers are concerned that the Utah criteria fail to detect ADD without hyperactivity in adults. Although the ADD/ADHD Rating Scale and the Utah measures can identify problems, the following themes paint a clearer picture of the kind of difficulties adults with attention deficits can have:

Core Measures (both items must be present)

  • Other medical or emotional disorders do not explain the problem.
  • Childhood evidence of problems with attention, daydreaming or underachievement.

Additional Measures (nine or more items must be marked)

  • Procrastination due to reluctance to sustain effort on tasks lacking interest or novelty.
  • Difficulty prioritizing projects causing problems completing anything.
  • Speaking out without considering the timing or appropriateness of the remark.
  • Thrill seeking and searching for exciting, novel, or stimulating experiences.
  • Addictive tendencies with alcohol, cocaine, gambling, shopping, eating, overwork.
  • Avoidance of boredom or relaxation by involvement in projects or excitement.
  • High distractibility, “tuning out” while driving or reading, and losing one’s place.
  • Hyper focus on activities of interest and completely “tuning out” one’s surroundings.

  • High tolerance for chaos or disorder, which may allow for creativity.
  • Low tolerance for frustration in areas of disinterest.
  • Work problems such as relating to bosses, following the chain of command, managing paperwork, meeting deadlines, punctuality, or workaholism.
  • Impulsiveness with spending money, changing plans, or career decisions.
  • Excessive worry, particularly when not focused on novel or high-interest tasks.
  • Disassociation or difficulty staying with painful emotions unless they are immediate.
  • Low self-esteem, insecurity, and sense of underachievement in spite of accomplishments.

Reference

See Attention Deficit Hyperactivity Disorder in Adults by Paul Wender (Oxford University Press, 1995), pp. 241–243 for full description of criteria. Also see Driven to Distraction by Edward Hallowell and John Rately (Simon & Schuster, 1994). Starred items may indicate ADHD rather than ADD.

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