ADHD in children
or Hyperactive Culture?)
DSM III-R Criteria for
Attention-deficit Hyperactivity Disorder
314.01 Attention-deficit Hyperactivity Disorder (ADHD)
The essential features of this disorder are developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity. People with the disorder generally display some disturbance in each of these areas, but to varying degrees. Manifestations of the disorder usually appear in most situations, including at home, in school, at work, and in social situations, but to varying degrees. Some people, however, show signs of the disorder in only one setting, such as at home or at school. Symptoms typically worsen in situations requiring sustained attention, such as listening to a teacher in a classroom, attending meetings, or doing class assignments or chores at home. Signs of the disorder may be minimal or absent when the person is receiving frequent reinforcement or very strict control, or is in a novel setting or a one-to-one situation (e.g., being examined in the clinician's office, or interacting with a videogame.)
Impulsiveness is often demonstrated by blurting out answers to questions before they are completed, making comments out of turn, failing to await one's turn in group tasks, failing to heed directions fully before beginning to respond to assignments, interrupting the teacher during a lesson, and interrupting or talking to other children during quiet work periods. Hyperactivity may be evidenced by difficulty remaining seated, excessive jumping about, running in classroom, fidgeting, manipulating objects, and twisting and wiggling in one's seat. At home, inattention may be displayed in failure to follow through on others' requests and instructions and in frequent shifts from one uncompleted activity to another. Problems with impulsiveness are often expressed by interrupting or intruding on other family members and by accident-prone behavior, such as grabbing a hot pan from the stove or carelessly knocking over a pitcher. Hyperactivity may be evidenced by an inability to remain seated when expected to do so and by excessively noisy activities.
When children play games with their friends, it is difficult for them to follow the rules of the games or to listen to other children. Impulsiveness is frequently demonstrated by not being able to await one's turn in games, interrupting, grabbing objects (not with malevolent intent), and engaging in potentially dangerous activities without considering the possible consequences, e.g., riding a skateboard over extremely rough terrain. Hyperactivity may be shown by excessive talking and by an inability to play quietly and to regulate one's activity to conform to the demands of the game.
In preschool children, the most prominent features are generally signs of gross motor over-activity, such as excessive running or climbing. The child is often described as being on the go and "always having his motor running." You can observe inattention by watching those children shifting frequently from one activity to another. They say that, in older children and adolescents, the most prominent features tend to be excessive fidgeting and restlessness. In adolescents, impulsiveness is often displayed in social activities, such as initiating a diverting activity on the spur of the moment instead of attending to a previous commitment (e.g., joy riding instead of doing homework, or partying, daring games etc.)
Associated features. Associated features vary as a function of age, and include low self-esteem, mood lability, low frustration tolerance, and temper outbursts. Academic underachievement is characteristic of most children with this disorder. Non-localized, "soft," neurological signs and motor-perceptual dysfunctions (e.g., poor eye-hand coordination) may be present.
Age at onset. In approximately half...
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