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Old 12-17-12, 05:32 PM
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Dsm iv tr

DSM V is supposed to come out in May 2013..... hurry up

for anyone who was wondering what the DSM had to say

Disorders: attention deficit and disruptive behavior
Deficit disorder attention deficit / hyperactivity
Diagnostic Features
The essential feature of Attention Deficit Disorder / Hyperactivity Disorder is a persistent mode of inattention and / or hyperactivity / impulsivity, more frequent and severe than is typically observed in individuals with a similar level of development (Criterion A).
It requires a minimum number of symptoms of hyperactivity / impulsivity or inattention leading to functional impairment were present before age 7 years, although in many cases the diagnosis is worn for several years after their appearance, especially in the case of subjects of the predominant type inat-tention (Criterion B).

Functional impairment associated with symptoms should be manifested in at least two different types of environments (eg., Home and school or work) (Criterion C).

There must be clear evidence the symptoms interfere with social functioning, academic or professional
1. In ICD-10, F84.1 Atypical autism is encoded (note).

100 Disorders usually first diagnosed in infancy ...
corresponds to the level of development of the subject (Criterion D).

The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or of another Psychotic Disorder and is not better explained by another cated mental disorder (eg., mood disorder, anxiety disorder, dissociative disorder, or personality disorder) (Criterion F).

Inattention may manifest itself in the context of academic, professional or social. Subjects with attention deficit / hyperactivity may prove unable to pay attention to details or make careless mistakes in school-lar homework or other tasks (Criterion Ala).

Their work is often messy and performed carelessly or forethought. Subjects often struggle to sustain their attention at work or play, they find it difficult to go through things (Criterion Alb).

Often, they seem to have their minds elsewhere and not to listen or not to hear what is said (Criterion Alc).

They frequently changing business, starting a task from another, turning again to a third, without any finish. Often, they do not do what they are told or do not comply with the guidelines, they can not complete their homework, their chores or other tasks (Criterion Ald).

But the inability to complete a task can not be considered as a criterion for Attention Deficit / hype-ractivité if it is linked to a lack of attention, as opposed to other possible reasons (eg. an inability to understand instructions, provocation). Subjects often struggle to organize their work or activities (Criterion Ael).

Tasks that require sustained mental effort are experienced as unpleasant and taken into aversion. Thus, subjects avoid or dislike activities that require sustained implementation and intellectual effort, or those that require the organization and concentration (eg., Homework or other writings) (Criterion garlic).

Avoidance must be due to attentional difficulties of the subject and not a primary attitude of opposition, although such an attitude can subse-quently develop. I2 way of working is often disorganized and scattered the necessary instruments, crippled, abused or damaged (Criterion Alg).

Subjects with Attention Deficit / Hyperactivity easily distracted by unimportant things and frequently interrupt what they are doing to look at noise or minor events that most people usually ignore (eg., the horn of a car, a conversation below) (Criterion Al h).

They often forgetful clans everyday life (eg., Miss appointments, forget to bring your lunch) (Criterion Ale).

In social relationships, inattention may manifest frequent changes of conversa-tion about by an inability to listen to others or to follow a conversation, and by the failure details or rules of games or clans other activities.

Hyperactivity may be manifested by the "restless" or writhing in her seat (Criterion A221), inability to sit still when he should (Criterion A2b), by the fact of running or climbing everywhere, situations in which it is inappropriate (Criterion A2c), difficulties to keep quiet in games or leisure activities (Criterion A2d), by being always "on the go" or "driven by a motor" (Criterion Ale) and talk excessively (Criterion A2f).

Hyperactivity may vary with age and level of development of the subject, and we must be very careful to diagnose in young children. Very young and preschool children with Attention Deficit / Hyperactivity Disorder differ from normally active children because they are constantly moving and interested in all at once, they darken from right to left are already out before they put on their coats,

Disorder: attention deficit / hyperactivity disorder 101

jump or climb on furniture, run around the house and in the community, Ont difficult to participate in group activities where we must remain quiet (eg., listening to a story). Children of school age have the like behaviors but generally less frequent and less severe than those of smaller ones. They have trouble sitting still, get up frequently squirm or balan percent of their seats. They touch everything, clapping, stir constantly legs or feet. They often get up during the meal, in the middle of a television program, or for homework, they talk excessively, they make too much noise during quiet activities. In adolescents and adults, symptoms of hype-ractivité take the form (a feeling of nervousness and difficulty engaging in quiet activities and sedentary.

Impulsivity is characterized by impatience, a difficulty to wait before responding, the subject's response before blurting male that the matter has been fully raised (Criterion A2g), a difficulty awaiting turn ( A2h criterion), and a frequent tendency to interrupt others or to impose his presence, a point which creates problems in social situations, school or work (Criterion A2i).

Others may complain about not being able to get a word. Typically, individuals with Attention Deficit / Hyperactivity make comments when they do not ask, do not listen to instructions, enta-ing the conversation indiscriminately, interrupt others all the time , impose their presence, cutting off the hands of other objects, to affect it should not, and make the clown around them. Impulsivity may lead to accidents (eg., Knock over objects, hitting people, getting a pot burner-down) and lead the subject to engage in potentially dangerous activities, without considering possible consequences ( p. former., climb repeatedly in an unstable position, make skateboarding on extremely rough terrain).

Attentional and behavioral manifestations of the disorder usually appear in multiple contexts: at home, at school, at work and in social gatherings. To have a diagnostic value, these events should cause discomfort in at least two different types of environments (Criterion C). It is very unusual that a subject has the same level cle dysfunction in all environments or the same environment at all times.

Typically, the symptoms worsen in situations that require attention or sustained intellectual effort, or those who lack intrinsic (or the attractiveness of novelty (eg., Listen to teachers, do school work, listen or read long documents, work with monotonous and repetitive tasks). however, the clinical manifestations may be minimal or absent when the subject is repeated rewards for good behavior, he is under strict supervision, in a new environment, or absorbed through activities particularly interesting nents, or in situations head-to-head (eg., in the clinician's office).
Symptoms tend to occur when the subject is in a group situation (eg., daycare, classroom or at work). Clinicians should gather information from multiple sources (eg., parents, teachers) and learn about the behavior of child in a variety of situations within each environment (eg., when he does his homework and eats).

102 Disorders usually first diagnosed in infancy ...

SUB-types
Although, in most subjects, symptoms of inattention and symptoms of hyperactivity / impulsiyité coexist in some one or other mode of conduct is predominant. It is the nature of the predominant symptoms during the last 6 months to determine the clinical subtype (for current diagnosis).

F90.0 [314.01] Attention deficit / hyperactivity disorder, combined type. This subtype should be used if six symptoms of inattention (or more) and six symptoms of hyperactivity / impulsivity (or more) have been present for at least six months. Most children and adolescents with attention deficit / hyperactivity present the mixed type. We do not know if it is the same in adults with the disorder.

F90.0 [314.00] Attention Deficit / Hyperactivity Disorder, Predominantly Inattentive Type. This subtype should be used if six symptoms of inat-tention (or more), but fewer than six symptoms of hyperactivity / impulsivity have been present for at least six months. Hyperactivity may however be a significant feature in many of these cases, while other cases are marked by inattention.

F90.0 [314.01] Attention deficit / hyperactivity disorder, predominantly hyperactive-impulsive type. This subtype should be used if six symptoms of hyperactivity / impulsivity (or more), but fewer than six symptoms of inattention have been present for at least six months. In such cases, inattention may still represent a significant clinical trait

Registration procedures
Subjects who, in the early course of the disorder, corresponded to a diagnosis of predominantly inattentive type or predominantly hyperactive-impulsive, can meet later in diagnosis of mixed type, and vice versa. Subtype appro-priate (for current diagnosis) will be chosen according to predominant symptoms in the past 6 months. If all criteria are no longer met but persistent symptoms tent clinically significant, the appropriate diagnosis is: Attention deficit / hyperactivity disorder, in partial remission. When symptoms do not meet all the diagnostic criteria for the disorder, and that it is not known whether these criteria have all been met, the diagnosis should be: Attention deficit / hyperactivity disorder, unspecified.

Characteristics and associated disorders
Characteristics and mental characteristics associated associés.Les vary according to age and stage of development of the subject, which may include: low frustration tolerance, temper tantrums, authoritarianism, stubbornness, a frequent insistence and that excessive demands are met, lability of mood, demoralization, dysphoria, negative reactions from others and low self-esteem.
School performance are often very bad-vaises and devalued significantly, which usually results in conflicts with family and school authorities.
The lack of application to tasks that require sustained effort is often interpreted by others as evidence of laziness, a refusal of responsibility or oppositional behavior. Family relationships

Disorder: attention deficit / hyperactivity disorder 103
are often filled with resentment and antagonism, especially as changes in the subject's symptoms often others believe that the misconduct was deliberate. There is often a family disharmony and negative parent-child interactions. These negative interactions often decrease with successful treatment.

On average, subjects with attention deficit / hyperactivity disorder succeed in school subjects less than their peers and have a lower rate of career success. In addition, the intellectual level, as measured by individual IQ tests cies, is several points lower in children with this disorder compared to their peers. Meanwhile, there is a great variability Qi subjects with Attention Deficit / Hyperactivity Disorder can demonstrate an intellectual development above average or even highly gifted. In its severe form, the disorder is very disabling, affecting social adjustment, family and school. The three subtypes are associated with a significant disability.

The lack of academic achievement and school problems tend to be most important types dominated by inattention (inattentive type and combined type), whereas peer rejection and, to a lesser extent, injuries accidents are more common in type marked by hyperactivity and impulsivity (Type Predominantly Hyperactive-Impulsive Type, and Combined). Children with the inattentive type pre-dominant tend to be socially passive and seem neglected, rather than rejected by their peers.

A substantial proportion (about half) of children referred in consultation for Attention Deficit / Hyperactivity Disorder also have oppositional defiant disorder or conduct disorder. The percentages of co-occurrence of Attention Deficit / Hyperactivity Behaviors such other per-disruptors are higher than other mental disorders, and this co-occurrence is more likely in two subtypes marked by the hyperactivity-impulsivity (Types predominantly hyperactive-impulsive, and combined).

In children with attention deficit / hyperactivity disorder, other disorders possibly associated NEET comprise the Mood Disorders, Anxiety Disorders, Disorders of learning and communication disorders. Although an Attention Deficit / Hyperactivity Disorder is present in at least 50% of children referred for consultation Syndrome Tourette, most children with Attention Deficit / Hyperactivity Disorder are not Gilles de Tourette. When the heavens disorders coexist, the beginning of Attention Deficit / Hyperactivity Syndrome often precedes that of Gilles de la Tourette.

There may be a history of abuse or lack of care in childhood, family placement multiple exposure to neurotoxic substances (eg., Poisoning), infectious diseases (eg., Encephalitis) ,-euse drug exposure in utero, or mental retardation. Although a low birth weight may sometimes be associated with Attention Deficit / Hyperactivity Disorder, most children who had a low birth weight did not develop Attention deficit / hyperactivity disorder, and most children with Attention Deficit / Hyperactivity Disorder do not have a history of tooth low birth weight. Supplementary examinations.

No further examination or any neurological examination or any evaluation of attention can be considered to have diagnostic value for attention deficit disorder / hyperactivity. Some neuropsychological tests requiring a sustained intellectual effort proved abnormal pain in subjects with the disorder compared to peers, but these tests have not proven their usefulness in determining whether a particular topic

104 Disorders usually first diagnosed in infancy ...
Disorder present. We do not yet know the fundamental cognitive deficits responsible for these group differences. Clinical examination and general medical conditions associated with it. On clinical examination, there are no specific signs associated with the diagnosis of Attention Deficit / Hyperactivity Disorder, although minor physical anomalies (eg., Hvperté-lorisme, ogival palate, low-set ears) could be observed with greater frequency than in the general population. Physi-cal injury by accident also seem to occur more frequently.

Characteristics related to culture, age and gender

We know that attention deficit disorder / hyperactivity can occur in different cultures, variations in reported prevalence between Western countries from different clans probably more diagnostic practices that differences clans tables symptomatic.

The diagnosis is particularly difficult to establish in children less than 4 or 5 years, because their behavioral characteristics are more variables than older children and may include features similar to the symptoms of Attention Deficit / hyperactivity. In addition, symptoms of inattention-tion among children toddlers or preschoolers are not easy to observe, because it is rare that they demand an effort of attention often held. However, it is possible to capture the attention of young children in various situations (eg., A normal child of 2 or 3 years can sit with an adult flick picture books).

In contrast, young children with Attention Deficit / Hyperactivity move widely and are difficult to contain. To get a complete clinical in a young child, it may be useful to learn about a wide range of possible behaviors. Significant disruption was demonstrated in preschool children with Attention Deficit / hyperactivity. Among school-age children, the symptoms of inattention affect classroom work and school performance. Impulsive symptoms can also lead to violation of family rules, interpersonal and educational. The symptoms of Attention Deficit / Hyperactivity Disorder are typically at their peak during the elementary school years. When children acquire a more mature, the symptoms become less apparent.

At the end of childhood and early adolescence, signs of excessive motor activity (eg., Run and climb excessively, unable to sit still) become less frequent symptoms of hyperactivity may be limited to nervousness, or an inner sense of restlessness and inability to sit still. In adulthood, agitation can make it difficult to participate in sedentary activities, and lead to avoid occupations or leisure activities that do not move much (eg., Clerical ).

Adults, social dysfunction appears to occur more particularly in those with diagnoses simultaneously superimposed clans childhood. One must be careful when wearing the diagnosis of Attention Deficit / Hyperactivity Disorder in adults based solely on memories of it have been inattentive or hyperactive child, since the validity of such data retro- prospects is often problematic. Although it is not always possible to obtain information to support the diagnosis, the reliability of the latter can be improve the Viral relying on information from other sources and from corroborate (including previous school reports).

Disorder: attention deficit / hyperactivity disorder 105
The disorder is more common in boys than in girls, the report boy Cillevariant 2: 1-9: 1 by type (eg., The predomi-nant type inattention appears to have a less pronounced sex ratio ) and the host (eg., children are addressed in consultation more often boys).

Prevalence
The prevalence of attention deficit / hyperactivity disorder is estimated at 3-7% in school-age children. These rates vary depending on the nature of the population sampled and the method of evaluation. Data on prevalence in adolescence and adulthood are limited. The data suggest that the prevalence of attention deficit / hyperactivity disorder as defined by DSM-IV may be somewhat higher than the disorder as defined by DSM-III-R due to the inclusion of the Hyperactive-Impulsive Type predominantly inattentive type and (allegedly dia-gnostic Trouble: hyperactivity attention deficit not specified in the DSM-I11-R).

Evolution
Most parents begin to notice excessive motor activity with their child when he is still very young, often at the time of development of autonomous locomotion. But like many young children do not develop too active a later Attention deficit / hyperactivity disorder must be particularly careful to differentiate normal hyperactivity hyperactivity characteristic of Attention Deficit / Hyperactivity Disorder before making this diagnosis in a young child. The diagnosis is usually made during the years of primary school, when symptoms impair school adjustment. Some children with the predominantly inattentive type may not come to seek treatment at the end of childhood. In the majority of cases seen in the disorder remains relatively stable until early adolescence.

In most subjects, the symptoms (particularly motor hyperactivity) fade at the end of adolescence and adulthood, although a minority of patients continue to present the full clinical picture of the deficit attention / hyperactivity until mid-adulthood. Others guard RONT at this age that some symptoms then it will use the diagnostic series deficit attentiondlyperactivite in partial remission. This diagnosis applies to subjects who do not exhibit the full picture but some symptoms that persist in causing functional impairment.

Family aspects
It has been shown that Attention Deficit / Hyperactivity was more frequent among related facility first-degree biological children with the disorder than in the general population. A considerable amount of data demonstrates the strong influence of genetic factors on the degree of hyperactivity, impulsivity and (inattention mea-sured as dimensions. However, the family, school and peer influences are crucial and determine the extent of the discomfort and morbidity.'s studies suggest also an increased prevalence of mood disorders, in Anxiety disorders, disorders of learning, of substance-related disorder and anti Personality - social in families of subjects with attention deficit / hyperactivity disorder.
106 Disorders usually first diagnosed in infancy ...
Differential Diagnosis
In early childhood, it can be difficult to distinguish the symptoms of Attention Deficit / Hyperactivity age-appropriate behaviors in active children (eg., Running in all directions or make noise) .

Symptoms of inattention are common among children with low IQ placed in classes that do not match their intellectual capacities. read must be distinguished from similar symptoms in children with Attention Deficit / Hyperactivity Disorder. Patients with mental retardation, we must make additional diagnosis of attention deficit / hyperactivity disorder if symptoms of inattention or hyperactivity are excessive for the mental age of the child. One can also observe the classroom inattention in individuals of high intelligence placed in school environments insufficiently stimulating the Attention Deficit / Hyperactivity Disorder must also be distinguished from the difficulty to acquire behaviors intentional goal-directed among children living in environments inadequate, disorganized or chaotic.

Solid reconstruction of all symptoms, obtained from multiple sources of information (eg., Babysitters, grandparents, parents of classmates) can provide a set of observations about the child for inattention, hyperactivity, capacity for self-control, depending on their age and in different types of environments.
Some subjects with oppositional behavior may refuse to work or school task requiring personal application, simply not to comply with what they demand. It is necessary to differentiate these lines avoiding school activities observed in children with Attention Deficit / Hyperactivity Disorder. The fact that some of them develop secondary severally attitudes of opposition to such activities or devalue the importance, often to justify their failures, complicating the differential diagnosis.

The increase in motor activity that can occur in Attention Deficit / Hyperactivity Disorder must be distinguished from repetitive motor behavior characteristic of the disorder stereotyped movements. Stereotyped movements in the motor behavior is generally concentrated and fixed (eg., Body sway, self-biting), while the nervousness and agitation of Attention Deficit / Hyperactivity Disorder are typically generalized. In addition, subjects with stereo-typed movements are usually not too active, outside their stereotype, they may have decreased activity.
We must not make the diagnosis of Attention Deficit / Hyperactivity if another mental disorder may better explain the symptoms (eg., Mood Disorder [in particular Bipolar Disorder], anxiety disorder, dissociative disorder, personality disorder, personality change due to a general medical condition, substance-related disorder).

Typically, in these disorders, the symptoms of inattention begin after the age of seven, and special education before that age has not been marked by disruptive conduct or complaints insti-ers behavior for inattentive, hyperactive or impulsive. When a Mood Disorder or Anxiety Disorder coexists with Attention Deficit / Hyperactivity Disorder, wear both diagnoses. We do not diagnose Attention Deficit / Hyperactivity if symptoms of inattention and hyperactivity occur exclusively during a Pervasive Developmental Disorder or Psychotic Disorder. Symptoms of inattention, hyperactivity or impulsivity-related medications (eg., Bronchodilators, isoniazid, akathisia of neurolepti-
Disorder: attention deficit / hyperactivity disorder 107
fords) in children less than seven years should not make the diagnosis of Attention Deficit / Hyperactivity Disorder but the other related to a substance not specified.
Correspondence with the Research Diagnostic Criteria for ICD-10
Diagnostic criteria for research of C1M-10 are almost the same as the DSM-IV, the diagnostic algorithm, but is very different, with a definition of the much narrower in ICD-10.
While the diagnostic algorithm tick DSM-IV requires six symptoms of inattention or six symptoms of hyperactivity / impulsivity, diagnostic criteria for research of ICD-10 require at least six symptoms of inattention, the least three of hyperactivity and impulsivity at least one. Instead of defining subtypes depending on the nature of the predominant symptoms, ICD-10 allows specification according to the criteria of Conduct Disorder are also filled or not. In ICD-10, the disorder is called Disturbance of activity and attention in the heading of hyperkinetic disorders.
■ Diagnostic Criteria Trouble: Attention Deficit / Hyperactivity Disorder
A. The presence of either (1) or (2):
(1) six of the following symptoms of inattention (or more) have persisted for at least 6 months to a degree that is maladaptive and corresponds not to the level of child development:
Inattention
(A)
(B) (c) (d)
often fails to pay attention to details or makes careless mistakes in schoolwork, work or other activities Often has difficulty sustaining attention in tasks or play activities
often does not seem to listen when spoken to directly often do not comply with the instructions and fails to complete schoolwork, tasks domestic-professional duties (this is not due to behavior opposition, or an inability to understand instructions)
often has difficulty organizing tasks and activities (f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as work
(E)
schoolwork or homework)
(Continued)

108 Disorders usually first diagnosed in infancy ...
❑ Trouble Diagnostic Criteria: Attention deficit / hyperactivity disorder (continued)
(G) often loses things necessary for tasks or activities (eg., Toys, school assignments, pencils, books, or tools)
(H) often easily distracted by extraneous stimuli
(I) often forgetful in daily life
(2) six of the following symptoms of hyperactivity-impulsivity (or more) have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level of the child:
Hyperactivity
(A) often fidgets with hands or feet or squirms in seat
(B) often leaves seat in classroom or in (the other situations where it is supposed to sit
(C) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, symptoms may be limited to subjective feelings of impatience motor)
(Cl) is often difficult to keep quiet in games or leisure activities
(E) is often "on the go" or often acts as if "driven by a motor."
(F) often talks excessively
Impulsiveness
(G) often blurts out answers to a question which is not yet fully laid
(H) often has difficulty awaiting turn (i) often interrupts or intrudes on others (eg.,
barged into conversations or games)
B. Some of the symptoms of hyperactivity-impulsivity or inattention caused by functional impairment were present before age 7 years.
C. Presence of a certain degree of functional impairment related to symptoms in two or more than two types (different environment (eg., School - or work - and at home).
D. There must be clear evidence of clinically significant impairment in social, academic or professional.
(Continued)

F90.9 [314.9] Trouble: attention deficit / hyperactivity disorder, unspecified 109
❑ Trouble Diagnostic Criteria: Attention deficit / hyperactivity disorder (continued)
E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or of another Psychotic Disorder and are not better accounted for by another mental disorder (eg., Thymic Trouble, Trouble anxiety disorder dissociating, or personality disorder).
Code by type: F90.0 [314.01] Attention Deficit / Hyperactivity Disorder, type
mixed if both criteria have Al and A2 are filled
for 6 months

F90.0 [314.00] Attention Deficit / Hyperactivity Disorder, type predominantly inat-tention, if for 6 months, Criterion Al is met but Criterion A2 not F90.0 [314.01] Attention Deficit / hyperactivity, type-hype-impulsivity predominant ractivité • if, for the last 6 months, but Criterion A2 is not met

Criterion Al
Coding note: For individuals (especially adolescents and adults) whose symptoms no longer meet all current diagnostic criteria, specify "partial remission."

F90.9 [314.9] Trouble: attention deficit / hyperactivity disorder, unspecified
This category is for disorders with obvious symptoms of inattention or hyperactivity / impulsivity that do not meet all the criteria for attention deficit disorder / hyperactivity.
1. Subjects with symptoms and discomfort meet the criteria for attention deficit / hyperactivity disorder, predominantly inattentive type, but the age of onset is greater than or equal to 7 years. 2. Subjects with clinically significant discomfort and inattention, including all symptoms do not meet criteria for the disorder, but whose behavior is characterized by laziness, daydreams and decreased activity.
__________________
Dx-ADHD combined, GAD, .....
Rx- Methylphenidate 30 mg ER (titrating)
Biotin-10,000mcg
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Last edited by sarek; 12-18-12 at 03:18 AM.. Reason: some paragraph breaks added
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