Application of DSM Criteria For Diagnosing ADD/ADHD

Attention Deficit Disorder (ADD) as added to the Diagnostic and Statistical Manual (DSM) by The American Psychological Association (APA) in its 1980 edition. The U.S. Centers for Disease Control (CDC), the International Statistical Classification of Diseases and Related Health Problems (ICD-10), has since then strived towards further developing the criteria used to diagnose children and adults for ADD/ADHD.

DSM-IV Criteria:

I. Either A or B:

A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:

1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2 Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Often forgetful in daily activities.

B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:

Hyperactivity:

1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often "on the go" or often acts as if "driven by a motor".
6. Often talks excessively.

Impulsiveness:

1. Often blurts out answers before questions have been finished.
2. Often has trouble waiting one's turn.
3. Often interrupts or intrudes on others.

II. Some symptoms that cause impairment were present before age 7 years.
III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
IV. There must be clear evidence of significant impairment in social, school, or work functioning.
V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Although the criteria listed is accepted as fact proven by research findings, it cannot be denies that is still very subjective. It can be misinterpreted even if there is display of symptom.

There is still no legitimacy in testing methods used to identify ADD/ADHD.

Why is this so?

The fact is that the criteria for identifying ADD/ADHD were created as part of a movement to combat poor behavior in schools. Part of a diagnosis-of-the-moment trend, an ADD/ADHD diagnosis signaled a maximum tolerance point on the part of education professionals, and a need to explain why children had become far more difficult to handle than in previous decades. Just like other mental and developmental disorders were being over diagnosed according to the "popularity" of the disorder at any given moment, a diagnosis of ADD/ADHD had become the go-to explanation for uncontrolled behavior in children and an inability to focus in adults.*

This is not to say that ADD/ADHD, and other disorders, do not exist and that they are not very real, and very treatable, disorders. It does mean, however, that such disorders are significantly over-diagnosed and are more likely due to factors that do not warrant prescription drug treatment as a solution.

There is room for argument when it comes to using the DSM criteria to predict or diagnose ADD/ADHD. Criteria IA, IB, II, III, and IV is still considered subjective to the observation of teachers, caretakers, parents, or physicians, different from requirements of criteria V which is by far more appealing.

Criteria V does not guarantee an accurate diagnosis of ADD/ADHD, even if it is the only DSM-IV-R's attempt at being objective. This are the reasons why:
1. Many individuals are never actually "tested". They are diagnosed, and medicated, based solely on the observations of others.
2. Criteria V necessitate individuals that does not show symptoms of ADD/ADHD possibly have other diagnosable disorder but they are rarely tested for other disorder apart from ADD/ADHD therefore it is still not completely thorough in identifying the correct disorder.
3. The fact the individuals are usually diagnosed based on trial -and-error basis is questionable. Even if symptoms subside after taking medication, there is still no hard prove that the individual is suffering from ADD/ADHD.

DSM criteria is still a very weak form of diagnosis for ADD/ADHD and medical treatment administered from it lays on shaky grounds.

Diagnosis of disorders such as schizophrenia, dyslexia, and Tourette's faces same issues as ADD/ADHD.