Intrinsic Motivation and Magical Unicorns

The art and science of time management.

Do I "Wiki-Meet" Diagnostic Criteria for ADHD?

Accurate diagnosis of ADHD is more than simply counting symptoms.

If I were to pull out my copy of the DSM-IV-TR (you do know I carry one around in my back pocket, right?) and rattled off the diagnostic criteria for many of the disorders listed there, you probably would not recognize your friends or family, or yourself. Many mental health and developmental disorders have unusual signs and symptoms which are pathognomonic, or specific to that condition.

On the other hand, some disorders are made up of symptoms which are not altogether odd or bizarre. For example, if I were to pull out the DSM and tick off the symptoms of inattention, distractibility, and disorganization which are listed as features of ADHD, you might well begin to identify these challenges in your own day to day experience at school or work.

ADHD "Lookalikes"

The symptoms of ADHD are not "specific"—in fact many conditions mimic the clinical presentation of ADD/ADHD, such as:

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  • head injury
  • sleep disorder
  • sensory integration issues
  • substance abuse, or early withdrawal from certain substances
  • autistic spectrum developmental disorders
  • anxiety, including trauma-related anxiety disorders
  • depression

Whether it's a checklist I use in my clinical practice, or a list of symptoms at Wikipedia, counting to 6 does not a diagnosis make. A checklist is a great way to start a conversation, however. The challenge for clinicians who make the ADHD diagnosis, then, is to clarify who "Wiki-meets" criteria and which individuals, in fact, demonstrate the specific disorder intended by the diagnostic term Attention Deficit Hyperactivity Disorder.

"Wiki-meeting" Criteria
I use the term "Wiki-meets" to refer to the process of going online, or watching a television program, or reading an article in Cosmopolitan or Men's Fitness, and seeing a clear picture of oneself in the ADHD symptoms listed there.

But the diagnosis is best made by a skilled clinician with a grasp of the nuances of symptom overlap among various diagnostic conditions—a clinician who is able to distinguish these various conditions from the broad range of "normal," and who is able to determine the range of "typical" reactions to life and classroom stressors from those clinical presentations which in fact suggest a brain-based developmental disorder.

If you think someone in your family demonstrates symptoms of ADHD or a related disorder, you might consider a conversation (a "diagnostic interview") with just such a clinician. If you've been through such an assessment process yourself, or if you're a clinician who regularly makes these difficult diagnostic decisions, I'd love to share with my readers your tips for the intake and assessment process. 


David D. Nowell, Ph.D., is a neuropsychologist interested in motivation, focus, and fully-engaged living.


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