Assessing Attention-Deficit Hyperactivity Disorder

Screening Question

When you were young, did you have problems with hyperactivity or with paying attention in school?

ATTENTION-DEFICIT HYPERACTIVITY DISORDER

Patients must meet either criterion 1 or criterion 2 (must have six of nine disorganization/inattention symptoms or six of nine impulsivity/hyperactivity symptoms) plus criteria 3 and 4 (Table 30.1):

Organization/inattention

Organization problems
- Can’t organize tasks
- Loses things needed for tasks
- Has problems finishing tasks
Attention problems
- Poor focus
- Easily distracted
- Doesn’t listen
- Forgets easily
- Makes careless mistakes
- Avoids tasks requiring concentration

Impulsivity/hyperactivity symptoms

Talks too much
Blurts out answers
Interrupts others
Can’t play quietly

Movement excess

Fidgets and squirms
Leaves seat
Is restless
Is on the go
Can’t wait for his turn

TABLE 30.1. DSM-IV-TR criteria for attention-deficit hyperactivity disorder

Mnemonic: You’ll need a MOAT around the classroom for the hyperactive child.
	Movement excess (hyperactivity).
	Organization problems (difficulty finishing tasks).
	Attention problems.
	Talking impulsively.
Adapted from American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text revision. Washington, DC: American Psychiatric Association.

Some symptoms must have been present before age 7.
Symptoms occur in two or more settings, such as school (or work) and at home.

ADHD is one of those disorders, such as panic disorder, that involve a long list of criteria, making it impractical to memorize each one. To make matters more confusing, many of the criteria are so similar as to be redundant (e.g., is there really a difference between “often fails to pay close attention” and “often has difficulty sustaining attention”?). Therefore, as was true for panic disorder, the most rational approach is to clump criteria into meaningful clusters by using a mnemonic, in this case MOAT.

To meet the criteria, your patient must have six of nine symptoms of inattention/disorganization or six of nine symptoms of hyperactivity/impulsivity.

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