Attention-Deficit/Hyperactivity Disorder

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Chapter 6 Attention-Deficit/Hyperactivity Disorder

PATHOPHYSIOLOGY

Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobiologic disorder characterized by problems in regulating activity (hyperactivity), inhibiting behavior (impulsivity), and attending to tasks (inattention). The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR), outlines specific observable behavioral symptoms in these three areas (Box 6-1). To meet the criteria for ADHD, symptoms must be present across settings. In other words, if the child is hyperactive at home but not at school, ADHD is not diagnosed.

Box 6-1 Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder

A. Either (1) or (2):

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or personality disorder).

Code based on type:

314.01: Attention-deficit/hyperactivity disorder, combined type: if both criteria A1 and A2 are met for the past 6 months

314.00: Attention-deficit/hyperactivity disorder, predominantly inattentive type: if criterion A1 is met but criterion A2 is not met for the past 6 months

314.01: Attention-deficit/hyperactivity disorder, predominantly hyperactive-impulsive type: if criterion A2 is met but criterion A1 is not met for the past 6 months

Coding Note: