What's New In ADHD?

     There are standard guidelines that all caregivers use to make the diagnosis of Attention Deficit/ Hyperactivity Disorder. These guidelines are published in a manual called the “Diagnostic and Statistical Manual of Mental Disorders” (DSM). In 2013, a new, 5^th edition of the DSM was published.

     At first, there was criticism that the new manual loosened the criterion for making the diagnosis of ADHD. The concern came from a commonly-stated fear that ADHD is already over-diagnosed and over-treated. But the new diagnostic guidelines are only minimally different from the previous guidelines. The same questions are asked about inattention, hyperactivity and impulsivity – the main symptoms used to diagnose ADHD. With the old guidelines, we asked if any of these symptoms were present before age 7. The new guidelines liberalize that slightly by saying “before age 12”. They also require that “several” of the symptoms are present in more than one setting – school, home, or other settings outside the home. The only change that made the diagnosis of ADHD “easier” was that less criterion were required to make the diagnosis of ADHD in adults.  This makes sense because some of the ADHD symptoms are different in adults –for example, there is less hyperactivity.

     Because the diagnosis of ADHD is still made from a child’s history rather than using a “test”, it is important that caregivers have clearly outlined diagnostic criteria. Having standard guidelines that we all can refer to helps to ease parents’ concerns about over-diagnosis. It is important for parents to have confidence in a caregiver’s diagnosis of ADHD because untreated ADHD can result in to school failure, depression, drug abuse and suicide.

     Other recent studies have repeated the previously known facts that ADHD is not a dietary deficiency, food allergy or simply “a behavior problem.” Agreement was also reached that there is no connection between the use of ADHD medication and sudden death in children from heart problems (another commonly stated fear). The American Academy of Pediatrics recommends that any child with ADHD have a thorough medical history review which includes the family cardiac history, but it does not recommend that caregivers obtain an electrocardiogram (EEG) in a child before starting ADHD medication.

     There is one new test that might make the diagnosis of ADHD easier. In 2013, the FDA approved for marketing a specialized measurement of brain waves called the Neuropsychiatric EEG-Based Assessment System. This is a test that measures certain types of brain waves that seem to be more common in children with ADHD. Whether or not this test will finally offer a “more scientific” way of making the diagnosis of ADHD remains to be seen.