ebook_ADHD2019

The World Federation of ADHD Guide 49 CLINICALASSESSMENTACCORDING TO DEVELOPMENTAL STAGE The developmental aspect of ADHD must be taken into account when characte- rizing clinical presentation. The validity of ADHD among preschoolers has been an area of particular controversy in the literature. Although there is increasing evidence that ADHD constitutes a valid diagnosis even before the age of 6, there are several challenges in making a diagnosis during this developmental period. For example, the difficul- ties associated with making observations across multiple settings for children not attending preschool – and subsequent lack of information about pervasiveness. In addition, hyperactivity and impulsivity are much more prominent at this stage and inattention might not be so evident due to there being less environmental demands on the child. Thus, it is not surprising that ADHD predominantly hype- ractive/impulsive presentation is the most frequent presentation in preschoolers. Several studies have however shown that currently available criteria reliably iden- tify ADHD in children as young as 3 years old and that these individuals have clinically significant impairment across all relationships and settings. 14 While the combination of inattentive and hyperactive/impulsive symptoms is the most common presentation in clinical samples during school age, inattentive symptoms are more prominent in non-referred samples. Whether this represents an effect of sample origin or gender (e.g., more boys are usually brought to asses- sment and they present more combined symptoms while girls present more pro- nounced inattentive symptoms) is still controversial. Another important aspect is that ADHD in school age children is associated with very high rates of comorbid disorders including learning disorders. Up to 70% of the cases in clinical sam- ples present with one or more comorbid conditions. 2,14 When assessing ADHD in school age children, it is important to remember that ADHD symptoms might not be seen during the appointment, since the child is in a very artificial environ- ment with few people in the room, in a situation where performance anxiety might mean that he/she does not portray his/her typical behavior. In addition, school age children with ADHD might focus well during one-to-one activities, especially when highly motivated or the situation is either novel or associated with frequent rewards. Thus, parents frequently report that they doubt the diagnosis since their son/daughter can stay for hours playing videogame or in social media. The expla- nation of this apparent paradox to families is essential in the process of ADHD psychoeducation (see chapter on “Talking with families”). Research has also documented the validity of ADHD diagnosis among older adolescents and young adults. Despite the observed age-dependent decline in ADHD symptoms, a substantial proportion of individuals continue to present cli-