The increase in age for onset of ADHD symptoms was undertaken in DSM-V in recognition of the fact that a significant number of individuals do not show overt symptoms until the demands of the environment exceed the ability of the person's brain to adjust to them. It is not uncommon, for example. for children entering secondary school to begin to experience significant attention and concentration deficits. This is often because the intense work load they face is something their brain cannot process adequately. Many parents have noticed this phenomenon and there are a great many teachers who notice the same.
DSM-V has come into use in the last several months. After years of on-going investigation the criteria for a number of mental health conditions have changed, some of them drastically, other only slightly. There is a small change in wording in the DSM about ADHD and it revolves around the issue of severity of signs and symptoms. The criteria now state that they must "negatively impact on social and academic/occupational activities". Additionally, the impact of these symptoms must be present in more than one setting. This mean that if a child or adolescent is adjusting well at home but poorly in school it points to a school or curriculum related problem. Likely, if the individual is performing poorly in the home and not in school it points to a family problem.
ADHD, like a number of conditions is often assessed wtih a degree of clinical judgement involved. However, having said that, it is imperative to gather evidence based data, to support one's clinical position. This is why the use of rating scales, a careful history, observation of the individual when possible and other forms of scientifically validated data must be used in the assessment process.
- David J Carey, Consulting Psychologist and advisor to HADD Ireland