ebook_ADHD2019

The World Federation of ADHD Guide 51 need for and the seeking out of, new stimuli, variety, excitement, and change. Con- crete examples are driving too fast, taking risks in traffic, taking risks in sexual con- tacts, creating a lot of arguments, seeking or creating an environment with a lot of excitement and variety, often changing position, job, or partner. It is conceivable that people who need excitement and sensation choose professions that meet this need; for example, journalism, free enterprise, or a job involving a lot of travel. 16 In ADHD, there is also a form of overconcentration or ‘hyperfocus’, where the extent to which somebody can be distracted is problematic. This phenomenon oc- curs above all during activities that the patient finds very interesting, such as using the computer or chatting on the internet. Then they can concentrate for hours on end in a very focused manner without a break. It is possible that it is mainly the dynamic ‘rewarding’ environment of the internet or the games that holds their attention and stimulates hyperfocus. ADHD can thus go hand in hand with both attention deficit and periodic overconcentration, and could therefore be viewed as an attention dysregulation (rather than deficit) disorder. With ADHD there is an inability to focus and to divide attention at the right moment. The problem is not that a patient with ADHD cannot concentrate but that they cannot deploy their ability to concentrate at the moment that it is needed. 16 THE ROLE OF INFORMATION SOURCES Extensive data document low levels of agreement between parents and teachers on ADHD symptomatology in children, 2 and divergent data exist on the agreement be- tween self-report and co-informant report on ADHD symptoms in adults. 4 Howe- ver, no guidance has been provided in any version of the DSM on how to combine data from different information sources during the diagnostic process, besides the more general suggestion in the text (not in the criteria) that assessment should be as comprehensive as possible, including data from teachers whenever possible. 14 Discrepancies between the different sources and accounts of the child are com- monplace. These may occur because the child behaves differently in different set- tings or is confronted with different impairments in different places, but they can also arise because different people with different views and perspectives and diffe- rent relationships with the child have provided their descriptions. 14 While research cannot yet inform us on how to combine data from different information sources and how to weight different perspectives, clinical wisdom indicates that: a the best estimate diagnostic approach should rely on a comprehensive asses- sment of all available sources; b some reporters might be in a better position than others to detect some types of symptoms.