diagnosing kids: recent publications

The American Psychiatric Association’s Diagnostic and Statistical Manual is the enduring authority for healthcare providers who diagnose and treat mental health conditions. Its origins date back to the 1800s1 and, though it continues to serve an important role for patients and clinicians, the DSM is not without significant problems.

Depression and anxiety disorders occur with attention deficit hyperactivity disorder (ADHD) at significant rates. While figures vary across studies, it’s estimated that 18% of adults with ADHD also have major depressive disorder, and about half of adults with ADHD have anxiety.1 What explains these high comorbidity rates?Many factors may explain the overlap, and one of them I can’t stress enough: ADHD does not happen in a vacuum, and its effects are far more impairing when the condition goes undiagnosed, untreated, or improperly treated.Undiagnosed and/or untreated ADHD makes children, teens, and adults who are otherwise bright and competent feel severely inadequate.

Not available December 5? Don’t worry. Register now and we’ll send you the replay link to watch at your convenience.Attention problems may signal ADHD — or another condition entirely.Some children and adolescents experience a unique type of attention problem with symptoms including excessive daydreaming, staring or zoning out, being lost in one’s thoughts, sleepiness, and peer relationship challenges.

For many years, ADHD was believed to impact only males — and the research reflects that. It wasn’t until 1993 that NIH-funded clinical studies on ADHD were required to include women. We’ve come a long way, but missed ADHD symptoms and underdiagnosis are still common among females with the condition.“Because of stigma as well as thoughts related to gender role presentations, ADHD symptoms in females can be thought of as more likely due to anxiety or depression,” says Dave Anderson, Ph.D., of the Child Mind Institute, in the video above.

I was in the early stages of my own ADHD advocacy journey when ADDitude came on the scene 25 years ago. Since then, the conversation around ADHD in communities of color has evolved, but many beliefs have remained unchanged.Far too many people of color still believe that our children are over-diagnosed and over-medicated for ADHD.

The science of ADHD is evolving and, with it, so is our understanding of the condition. Over the past 25 years, research has blossomed as institutions share data sets to combine and test earlier findings, says Dave Anderson, Ph.D., of the Child Mind Institute.The use of fMRI brain scans in ADHD research has helped scientists spot abnormalities in underlying neural networks and circuitries.

October 3, 2023Approximately 25 years ago, when ADDitude published its first newsletter, the diagnosis of ADHD was based on criteria published in the Diagnostic and Statistical Manual of Mental Disorders, Version III-C. The DSM-IV diagnostic criteria adopted two years later were the most scientifically validated to date.Its 18 symptoms were evenly divided into two lists: problems with inattention vs. problems with hyperactivity-impulsivity.

The physical hyperactivity so often associated with attention deficit hyperactivity disorder (ADHD) — jumping on the couch, barreling across the playground, or talking without a pause for 10 minutes straight — is far from universal. In fact, this external symptom occurs in only one quarter of children and 5 percent of adults with the condition.

In the arc of science, 25 years isn’t a long time. Yet, in the realm of attention deficit hyperactivity disorder (ADHD), the last quarter century has been pivotal, yielding myriad advances in our understanding of the condition.

You won’t find DESR in the DSM-V, but in this webinar Russell Barkley, Ph.D., makes a compelling argument for why it should be included in the diagnostic criteria for ADHD. Patients and professionals agree that difficulty with emotional control is a core facet of ADHD. Using historical concepts and research in the fields of neuroanatomy, neuropsychology, and psychology, Barkley highlights the relationship between ADHD and emotional control difficulties.

September 26, 2023Children of immigrant parents are less likely to be diagnosed with ADHD, according to a U.S. nationwide study published in the Journal of Attention Disorders,1 which found the ADHD diagnosis rate was lower for children with one or more immigrant caregivers than it was for children with U.S.-born caregivers.Using data from the National Survey of Children’s Health (NSCH), 109,881 children aged 3 to 17 were assigned to one of three groups based on caregiver nativity: U.S.-born (71.94%), non-U.S.-born (18.99%), or both (9.07%).The more time foreign-born caregivers spent in the U.S., the more likely their child was to receive an ADHD diagnosis.

Nail biting is a common behavior that typically begins in childhood. For most children, nail biting is a harmless habit.

Not available October 3? Don’t worry. Register now and we’ll send you the replay link to watch at your convenience.African Americans and other individuals of color are less likely to get an accurate ADHD diagnosis and proper treatment.

Not available September 28? Don’t worry. Register now and we’ll send you the replay link to watch at your convenience.ADHD is likely influenced by both genetics and the environment, starting before birth.

Not available September 20? Don’t worry. Register now and we’ll send you the replay link to watch at your convenience.Given the prevalence of ADHD, every educator should assume they’ll be teaching at least one student with ADHD (diagnosed or not) — likely many more.

Q: “I’m currently in all advanced classes, but I still struggle with remembering due dates, procrastinating, zoning out when my mind wanders, and losing points due to silly mistakes. Whenever I bring up my ADHD-related behaviors (forgetfulness, fidgeting, constant daydreaming, losing interest in personal projects when the novelty wears off, being contrary, etc.), my parents act like I’m exaggerating.

Not available August 23? Don’t worry. Register now and we’ll send you the replay link to watch at your convenience.The exact causes of ADHD are not yet known. ADHD is believed to be highly heritable —researchers have made strides in recent years identifying genes involved in the disorder — but it is also understood that ADHD may be influenced by non-inherited risk factors, such as trauma and stress.

Worried about your child’s gaming habits and behaviors?Gaming addiction — known as “gaming disorder” and (conceptualized as) “internet gaming disorder” in the ICD-11 and the DSM-5, respectively — affects about 3% of people worldwide.1 Among people with ADHD, that percentage trends higher, according to research.23Like other forms of addiction, gaming addiction can affect functioning in multiple areas of life, from academic performance to friendships to finances. Gaming addiction is treatable; help exists in the form of support groups, talk therapy, and treatment centers dedicated to problematic or disordered screen use.If you are concerned about your child’s behaviors around gaming, answer the questions below and share the results with a licensed mental health professional.This self-test was adapted from criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and in the International Classification of Diseases 11th Revision. It is designed to screen for the possibility of gaming disorder, and it is intended for personal use only.

Anxiety is the brain's helpful and essential internal alarm system that activates our fight, flight, or freeze response. Typically, anxiety is triggered when a child feels vulnerable, in danger of being embarrassed, or in trouble. In children with generalized anxiety disorder (GAD), these feelings or worry don’t always have a logical source and they are typically persistent, crippling, and way out of proportion.It's not uncommon for generalized anxiety disorder (GAD) to be mistaken for ADHD symptoms in children. When a child’s attention is consumed by her vigilance and fearfulness, she may be unable to redirect her attention to anything else.

Q: “How should clinicians understand a patient’s experience with trauma and adverse events in relation to conditions that are often associated with trauma, like borderline personality disorder (BPD) and attention deficit hyperactivity disorder (ADHD)? How should clinicians take traumatic events into consideration when evaluating and treating these patients?”With ADHD, we know that individuals have a higher risk for various kinds of trauma.1 We also know that the signs of trauma — like inattention and emotional dysregulation — can overlap with the signs of ADHD. Attention issues, for example, can be due to intrusive thoughts about a traumatic event.

Not available August 1? Don’t worry. Register now and we’ll send you the replay link to watch at your convenience.Temple Grandin, Ph.D., a prominent author, scientist, and esteemed professor at Colorado State University, will talk about her journey growing up with autism in an era when children were routinely institutionalized following a diagnosis — and what helped her to follow her passions to world renown.

Q: “My son has attention deficit hyperactivity disorder (ADHD), though we are starting to think that he is showing signs of borderline personality disorder (BPD), too. Can BPD even be diagnosed in teenagers? If so, what does BPD look like in teens? How can we differentiate BPD symptoms from ADHD?”As noted in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), children and adolescents may be diagnosed with a personality disorder (excluding antisocial personality disorder) in the “relatively unusual” cases in which the individual’s maladaptive personality traits are “pervasive, persistent, and unlikely to be limited to a particular developmental stage or another mental disorder.” Additionally, a child or teen must have shown symptoms for at least one year to merit a diagnosis for a personality disorder.So while it’s possible for children and teens to be diagnosed with BPD, it’s also true that some medical circles may think that child and adolescent patients are far too young for a BPD diagnosis.

Not available July 13? Don’t worry. Register now and we’ll send you the replay link to watch at your convenience.ADHD is routinely under-diagnosed in African-American children due to myriad factors, including structural inequalities in medical care and schools across the U.S.

Does your child bristle against limits? Challenge your authority? Resist even reasonable requests? Yes, youthful rebellion travels in lockstep with adolescence, but don’t dismiss your teen’s oppositionality as hormones alone. “No” could be your child’s way of expressing a wide range of emotions they can’t otherwise articulate.

Not available May 24? Don’t worry. Register now and we’ll send you the replay link to watch at your convenience.Adults with ADHD are up to six times more likely than are their neurotypical peers to have Major Depressive Disorder (MDD), which is characterized by extreme sadness, loss of interest, and mania. Not only is MDD more prevalent in adults with ADHD, but the disorder can have an outsized effect on women and girls who have both conditions.

Our understanding of ADHD has leapfrogged forward over the last generation. No longer considered a diagnosis just for hyper little boys, ADHD is recognized (at last!) as a lifelong condition that cannot be outgrown.

Not available May 4? Don’t worry. Register now and we’ll send you the replay link to watch at your convenience.Trichotillomania (i.e. hair pulling) and dermatillomania (i.e.

The evaluation process for attention deficit hyperactivity disorder (ADHD) in children stands apart from most other conditions’ diagnostic procedures in a few ways — most notably, in how much it demands from parents.Clinicians rely on caregivers to describe their child’s symptoms, behaviors, and experiences to make the diagnosis. What’s more, parents are responsible for administering treatment, monitoring symptoms, and driving ongoing treatment decisions.

Q: “My son does not take responsibility for his decisions; everything is someone else’s fault and he blames others. His teachers have pretty much given up on him because when he knows that he needs to put in the time and effort to do well in school, he says he will do his work, but then he doesn’t do it and comes up with excuses.

Grouchy. Moody. Easily frustrated and annoyed.

Is ADHD caused by birth trauma? Do prenatal complications increase a child’s risk for ADHD? What role do exposures during pregnancy and infancy play in the development of ADHD? These are all important — and difficult-to-answer — questions about the causes of ADHD that parents ask frequently.From lead exposure and maternal stress during pregnancy to low birth weight, the list of prenatal and perinatal risk factors associated with ADHD seems to grow longer and longer with ongoing research. But there is much left to learn.

Not available March 21? Don’t worry. Register now and we’ll send you the replay link to watch at your convenience.Over its lifetime, ADHD has been a lightning rod for controversy and for heated debates over its increasing diagnostic rates, its pharmacological treatment, and its links to factors like screen use and social media.

February 16, 2023Researchers have “refined the genetic architecture of ADHD” after identifying 27 variations in genetic code that are most present in people with the attention deficit hyperactivity disorder. A Danish-led international genome-wide association study (GWAS) published in Nature highlighted these and 76 probable risk genes — including “brain-expressed genes” involved in development and genes known to influence other psychiatric disorders.

December 11, 2019White teachers are more likely to attribute a Black boy’s behavior to attention deficit hyperactivity disorder (ADHD) and to rate those behaviors as severe than are Black parents, according to a new study published in the Journal of Abnormal Child Psychology1. The study, conducted by researchers at the University of Massachusetts, demonstrated that White teachers are more likely to ascribe Black boys’ behavior to ADHD and to assign them higher scores on the Vanderbilt Assessment Scale for ADHD than are Black parents.

When grappling with eating disorders, we typically think about the disturbing effects on young girls and women.But as many as one in three individuals with an eating disorder is male. About 10 million males in the United States will struggle with an eating disorder in their lifetime, according to the National Eating Disorders Association.Watching sculpted male actors on the big screen and seeing fitness magazine covers of muscular men with six-pack abs, boys and young men risk developing body dissatisfaction and body image disorders like bigorexia.

Avoidant restrictive food intake disorder (ARFID) is an eating disorder often characterized as “extreme picky eating.” Food avoidance or restriction in ARFID can be due to any of the following:1Unlike other eating disorders, like anorexia nervosa and bulimia nervosa, the eating behaviors seen in ARFID are not associated with concerns about body weight or shape. Children with ARFID may struggle to meet nutritional and/or energy needs, and they may be dependent on nutritional supplements for functioning.ARFID often co-occurs with autism, anxiety, and attention deficit hyperactivity disorder (ADHD).2 Some symptoms of autism, like rigid eating behaviors and sensory sensitivity, overlap with ARFID.If you suspect that your child has symptoms of ARFID, answer the questions below and share the results with your child’s pediatrician or a licensed mental health professional who is experienced in diagnosing and treating ARFID.If you or a loved one are suffering from an eating disorder, contact the National Eating Disorder Association (NEDA) for support, resources, and treatment options. Call or text NEDA at 800-931-2237 or visit www.nationaleatingdisorders.org to reach a NEDA volunteer.This self-test was adapted in part from the Nine Item ARFID Screen (NIAS) and incorporates findings from research on ARFID.

A 2e student’s high IQ often overshadows or camouflages their neurological or learning challenges — confusing teachers, parents, and clinicians alike. Twice-exceptional students perform above average in one or more subject areas, and below average in others. Accelerated intellectual growth and delayed social-emotional growth are common — and commonly contradictory — characteristics in 2e children.

January 19, 2023Virtual reality (VR) games may be used to accurately and objectively diagnose ADHD symptoms in children, according to a team of Finland-based researchers. Their newly developed VR game, Executive Performance in Everyday LIving (EPELI), performed better than standard behavioral tests in distinguishing children with ADHD from those without ADHD in a small study of 76 subjects.

Eating disorders disproportionately impact teens with attention deficit hyperactivity disorder (ADHD) 12 – and we don’t fully understand why. A growing body of research links ADHD to a higher incidence of anorexia nervosa, bulimia nervosa, and binge-eating disorder during puberty and adolescence – a time when a mix of factors, including social media use, can contribute to negative body image and low-self-esteem.

Eating disorders like anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) typically begin in adolescence, but they are increasingly seen in younger children.Researchers have linked the rise of eating disorders in children and teens to the pandemic and the ongoing youth mental health crisis, among other stressors.12Social media may also play a role in driving body image dissatisfaction and negative comparison among teens.3 What’s more, children and teens with conditions like anxiety, depression, and attention deficit hyperactivity disorder (ADHD) are at greater risk for developing eating disorders.4 ,5Eating disorders are complex but treatable conditions. Early detection greatly improves recovery and health outcomes.If you are concerned that your child is showing signs of an eating disorder like AN, BN, or BED, answer the questions below and share the results with your child’s pediatrician or a licensed mental health professional who is experienced in diagnosing and treating eating disorders.If you or a loved one are suffering from an eating disorder, contact the National Eating Disorder Association (NEDA) for support, resources, and treatment options. Call or text NEDA at 800-931-2237 or visit www.nationaleatingdisorders.org to reach a NEDA volunteer.This self-test was adapted from materials provided in “Identification and Management of Eating Disorders in Children and Adolescents” published by the American Academy of Pediatrics.

Persistent tic disorders, including Tourette’s disorder, affect about one in fifty children in the U.S. according to the latest research – more children than previously thought, and a figure that carries important implications for clinicians.1 What’s more, tic disorders are highly comorbid.

November 16, 2022The brains of autistic individuals experience widespread molecular changes across the cerebral cortex. The most differential changes occur in the primary visual cortex, according to a recent study published in Nature that analyzed 11 cortical areas of the brain.1 Most molecular profiling studies highlight changes limited to the frontal and temporal cortex.To further understand the brain pathology of autism spectrum disorder (ASD), researchers performed RNA-sequencing analysis on 112 post-mortem samples.

Not available December 14? Don’t worry. Register now and we’ll send you the replay link to watch at your convenience.Irritability, moodiness, temper tantrums, or other mood states commonly occur alongside ADHD in youth, but sometimes emotion regulation difficulties (ERD) indicate something more.

Not available October 27? Don’t worry. Register here and we’ll send the replay link to watch at your convenience.The pandemic has brought with it a troubling surge in eating disorders.

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If your child takes “defiant” to a whole new level, you probably feel at the end of your rope. Before you start pursuing treatment, however, it’s important to know exactly what you’re dealing with.

Perhaps the most broadly recognized learning disability, dyslexia is defined as a difficulty with spelling and word recognition. While some individuals with dyslexia do read words backwards, this condition manifests differently in different people; it is complex.

In the days and weeks following an ADHD diagnosis, many families enter a disorienting whirlwind of books, articles, videos, and next steps. In the midst of this ADHD education and understanding, one question inevitably arises: Who else needs to know?Some parents find that open and unbarred communication is essential for increasing acceptance and recognition of the disorder.