Additional Requirements for the Diagnosis of ADD/ADHD
1. The symptoms must be to a degree that is "maladaptive and inconsistent with development level."
This part is highly subjective. Remember: Just because a behavior appears to be maladaptive, it doesn't necessarily mean a child actually has some sort of brain defect, as proved by Thomas Edison's remarkable career after being kicked out of school for his divergent thinking traits. Gifted students may also display behavior that is "maladaptive" but they certainly do not have a disorder or brain defect. Parents and professionals alike should not only judge the child's behavior, but also their own expectations of conformity and convenience. Because children become less impulsive as they get older, a child who is naturally more impulsive than others will appear to be "developmentally behind."
2. "Some impairment from the symptoms is present in two or more settings." If a child is only having problems in school, then the DSM IV criteria have not been met. The wording, however, is so vague that just about anything can be considered impairment by someone who is looking for it. If you report that it is difficult to get your child to clean up his room, or that you have a lot of trouble getting him to do his homework, this may be taken as a sign of "some impairment," when both traits are very normal for divergent thinkers. An astute parent, however, can make a solid argument against an ADD diagnosis if he or she has not had significant problems with the child outside of school.
3. "There must be clear evidence of clinically significant impairment in social, academic or occupational functioning."
There are some children who really do have severe dysfunction. But if a bright but bored student gets only C's, is that "clinically significant impairment"? Many would argue yes. Others would argue no. It is this ambiguity that can lead to high levels of diagnoses. In Greenwich, Connecticut, one of the wealthiest cities in the U.S., 30% of all school kids have been diagnosed with some type of learning disability, qualifying them for additional school resources like one-on-one tutors.
4. "The symptoms are not better accounted for by another mental disorder." Depression and anxiety are often overlooked in kids, but they can mimic many of the traits of ADD. Inability to concentrate can be severe in kids or adults with depression and anxiety. Sometimes kids are being bullied in school and don't want to tell anyone, so they may become depressed or anxious and can appear to have ADD without hyperactivity.
5. The symptoms that cause impairment must have been present before the age of 7. If your sweet child never had a problem until his third grade teacher insisted he be tested for ADD because he won't sit still, then the DSM IV criteria have not been met. However, in "real life" there are people who acquire ADD as a result of brain trauma.