Category: ADHD Health

ADHD DSM-5 Diagnosis

DSM-5 stands for Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. ADD (Attention Deficit Disorder) and ADHD (Attention Deficit Hyperactivity Disorder) are diagnosed by psychiatrists and psychologists with the DSM-5 criteria, which are descriptions of behavior patterns. There is nothing in the manual linked to physiological or neurological criteria. The DSM-IV-TR manual (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision) states this clearly:

There are no laboratory tests, neurological assessments, or attentional assessments that have been established as diagnostic in the clinical assessment of Attention-Deficit/Hyperactivity Disorder.”

(DSM-IV-TR page 88)

This attitude is still valid in the DSM-5. As stated in the DSM-5 page 61:

No biological marker is diagnostic for ADHD. As a group, compared with peers, children with ADHD display increased slow wave electroencephalograms, reduced total brain volume on magnetic resonance imaging, and possibly a delay in posterior to anterior cortical maturation, but these findings are not diagnostic..”

DSM-5 page 61

ADD/ADHD is a complex set of conditions. The DSM-5 defines ADHD by a set of symptoms as a single disorder. This tends to give the impression that ADHD is a single disorder with a one-size-fits-all stimulant solution.

This is not true, however, as ADD/ADHD is complex. Consensus science tends to lag behind innovative science. At the Amen Clinics, Dr. Daniel Amen has analyzed tens of thousands of ADD brain scans from over 100 different countries. He has found seven different types of brain patterns with ADD/ADHD symptoms. By correlating symptoms with brain activity, he can prescribe targeted treatment for each individual. The DSM-5 speaks about “ADD presentations” which are vague, while the Amen Clinic scans are specific for each individual brain.

There is a free online ADD/ADHD test at the Amen Clinics site.

The three main changes in the DSM-5 from the previous version, the DSM-IV, are:

  • Regarding teens and adults the onset is no longer 7-years-old, but by the age of 12. Teens and adults can now be easier diagnosed. While children still should have six or more symptoms of the disorder. In older teens and adults the DSM-5 states they should have at least five symptoms.
  • A diagnosis with ADHD and autism spectrum disorder can now coexist.
  • The different “types” of ADHD/ADD are now called “presentations.”

DSM-5 ADD/ADHD Diagnostic Criteria

Diagnostic criteria according to the DSM-5 for Attention-Deficit Hyperactivity Disorder are as follows:

A. Either (1) or (1) and (2):

(1) At least six of the following symptoms of inattention have persisted for at least 6 months to a degree that negatively impacts directly on social and academic/occupational activities, and is inconsistent with developmental level:

Inattention:

(a) Often fails to give close attention to details or makes careless mistakes in school work, work, or other activities.

(b) Often has difficulty sustaining attention in tasks or play activities.

(c) Often does not seem to listen when spoken to directly.

(d) Often does not follow through on instructions and fails to finish school work, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).

(e) Often has difficulty organizing tasks and activities.

(f) Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).

(g) Often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books, or tools).

(h) Is often easily distracted by stimuli unrelated to the subject or activity being dealt with. For older adolescents and adults, may include unrelated thoughts.

(i) Is often forgetful in daily activities, such as doing chores, running errands; for older adolescents and adults, returning calls, paying bills and keeping appointments.

(2) At least six of the following symptoms of hyperactivity-Impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Hyperactivity:

(a) Often fidgets with or taps hands or feet or squirms in seat.

(b) Often leaves seat in classroom, office meetings or in other situations in which remaining seated is expected.

(c) Often runs about or climbs excessively in situations in which it is inappropriate. In adolescents or adults, may be limited to subjective feelings of restlessness.

(d) Often has difficulty playing or engaging in leisure activities quietly.

(e) Is often “on the go” or often acts as if “driven by a motor.”

(f) Often talks excessively.

Impulsivity:

(g) Often blurts out an answer before a question has been completed, or completes people’s sentences and cannot wait for turn in conversation.

(h) Often has difficulty awaiting turn.

(i) Often interrupts or intrudes on others (e.g., butts into conversations, games or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).

B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.

C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).

D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication, or withdrawal).

Attention Deficit Presentations

Combined Presentation: if both Criteria (1) and (2) are met for the past 6 months.

Predominantly Inattentive Presentation: if Criterion (1) is met but Criterion (2) is not met for the past 6 months.

Predominantly Hyperactive-Impulsive Presentation: if Criterion (2) is met but Criterion (1) is not met for the past 6 months.

Attention Deficit Severity

Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and symptoms result in only minor functional impairments.

Moderate: Symptoms or functional impairment between “mild” and “severe” are present.

Severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present, or the symptoms result in marked impairment in social or occupational functioning.

Vitamin B6 ADHD and Calm Minds

Vitamin B6 calms the nervous system, helps the body to produce neurotransmitters and so balance the neurotransmitter systems transmitting messages through it. No wonder then that numerous studies have connected this vitamin with ADD (Attention Deficit Disorder) and ADHD (Attention Deficit Hyperactivity Disorder).

ADD/ADHD is generally considered a neurological disorder where a person is easily distracted, unable to focus on a specific task, daydream in ADD and fidget and feel restless in ADHD.

Saying something is a neurological disorder is not helpful unless one also says, what has caused this neurological problem. Treating symptoms, but not whatever it is that causes the symptoms is not a cure, but an excuse to sell medicine.

ADHD medication calms children according to one view, but dampens their spark and makes them compliant according to the alternative view, by describing the same effect from different viewpoints. If ADD/ADHD people have a deficiency in the neurotransmitter dopamine, then the logical question a doctor should ask is: “Why?”

The cause of the deficiency should be addressed as naturally as possible and not artificially boosted for a few hours with potent synthetic drugs. If ADHD is caused by a dopamine deficiency, get the body to produce the dopamine by itself. ADHD is not a Ritalin deficiency. ADHD is a complex set of conditions that are still not well understood, but share a common set of symptoms. The individual’s metabolism of vitamins and minerals is one link in this story. One study found that vitamin B6 was as or a little more effective than methylphenidate, one of the stimulant drugs used to treat ADHD. The products containing methylphenidate are Ritalin, Concerta, Focalin, and the Daytrana patch.

People who are hyperactive and/or have attention deficit have a different metabolism than the majority of the population and therefore need supplements to help compensate for this deficit. It is not so much a disorder, but more like being different. The link between metabolism and ADHD has largely been ignored in research, but the fact remains that with the right amount of magnesium and B6 in the body, people with ADHD can think clearer and concentrate better.

Children with ADHD (that’s the age group mostly studied) generally have lower vitamin B6 and magnesium levels than the average child. These two nutrients are linked, and for best effect, with ADD/ADHD both should be taken. Taking these two supplements eases hyperactive behavior and increases focus and attention, being able to think clearer and concentrate better.

ADHD medication as directed on the dopamine neurotransmitter system as a lack of dopamine causes ADHD-like symptoms. Vitamin B6 is needed for the formation of dopamine. If there is a vitamin B6 deficiency, then the body’s dopamine production suffers. ADHD stimulant drugs will mask this deficiency artificially, while a vitamin B6 supplement will help the brain produce dopamine naturally.

Dopamine is formed when the enzymes in the brain react with L-DOPA, but this process is first activated by a co-enzyme, which is vitamin B6.

For ADD and ADHD, magnesium should be taken together with vitamin B-6. This vitamin improves the absorption of minerals including magnesium into cells. Zinc is also usually low in attention deficit and hyperactive people, and a supplement like the product ZMA from NOW is ideal as it contains these elements and vitamins in the right proportions for ADHD and is designed to maximize absorption. It is a synergistic combination of zinc and magnesium with vitamin B6 without sugar, yeast, gluten, soy, milk, egg, shellfish, or preservatives. For treating ADD and ADHD the recommended doses vary but is in the region of:

Magnesium: 3 mg to 6 mg per pound bodyweight and day.

Vitamin B-6: 0.3 mg per pound bodyweight and day.

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You can experiment, starting with these dosages, as your need is very individual depending on your metabolism. There is no risk of overdosing on vitamin B6 at this level of dosage in healthy people. (See !!! NOTE below on magnesium overdosage.)

If you do get a benefit from this, then you need to keep taking this supplement. I do and I treat my B6-magnesium supplements as food. We all have our personal metabolism, that is why there is no universal weight loss diet, in spite of what the adverts try to make us believe.

Vitamin B6 plays an essential role for normal brain development and is essential in the synthesis of brain chemicals, converting amino acids into neurotransmitters in the brain. It also is necessary keep a healthy balance between the neurotransmitter systems. Vitamin B6 helps to produce: acetylcholine, dopamine, gamma-aminobutyric acid (GABA), norepinephrine and serotonin as well as and the allergy regulator histamine. This vitamin is also an important antioxidant.

!!! NOTE on magnesium overdosage:

For most healthy people large doses of magnesium appear safe, so magnesium from food and a reasonable addition of supplement will not lead to an overdose. The first sign of taking too much magnesium is the laxative effect. Many laxative products contain magnesium compounds for this effect.

Stimulant medication taken for ADHD increases the absorption of magnesium, therefore if you do take this medication be aware of this effect.

A deficiency in magnesium is less pleasant, it results in nausea, fatigue, muscle weakness, irritability, depression, loss of appetite, cramps, abnormal heart rhythm, and in women an increased premenstrual stress.

!!! NOTE If you have kidney problems: You should not take magnesium supplements. Your doctor should prescribe medication to counter magnesium deficiency. Although people with kidney disorders may have low magnesium levels, they risk complications from a high magnesium intake and should use medication instead of supplements.

ADHD Social Construct Theory

In the ADHD Social Construct Theory, the idea is that ADD (Attention Deficit Disorder) and ADHD (Attention Deficit Hyperactivity Disorder) are generally speaking, not biological or psychiatric disorders, but can be better explained by environmental causes or even the personality type of the person. For example, an ADD person can be an introvert, while a hyperactive person is an extrovert.

This theory suggests that the observed behaviors are not abnormal, but normal behavior for a part of the human race. However, extreme overreactions are caused by environmental factors. Among these factors are cramped living conditions with inadequate play space, the United States’ classroom environment together with the increased educational burden being expected from children today, and the stress parents are under, making it more difficult to be in tune with their children like parents are in Africa are able to do.

As an example: a young child sitting quiet and still for three-quarters of an hour at a time, listening to something they are told to learn, but which they do not find interesting, is unnatural behavior. This is a new phenomenon in human history.

ADHD was not a problem of note until after the Industrial Revolution. The social changes in western society created environments and situations where this behavior became problematic. Certain children who are boredom intolerant are likely to react against this unnatural environment by either “tuning out” (ADD) or becoming restless and a disturbance (ADHD). Learn more about the history of ADHD at http://adhd-health.com/the-history-of-adhd/

Different cultures have different expectations of behavior and are more or less tolerant of active children. In United States’ schools, an attitude of intolerance towards children behaving in a manner similar to that described as ADHD has developed.

In other cultures that are more tolerant see the same behavior as just an “active child.” Some may even perceive the behavior as healthy. This is especially so where these people do not live in high rise apartments, but in smaller communities in more natural environments, where the children can run free.

Parenting styles vary, even within the Western cultural sphere. The parenting styles in Northern Europe are generally more child-centered than in the United States. Dutch parents, for example, are generally more aware of their children’s arousal and self-regulation, than the average parent in the United States, and they take care of their children get sufficient sleep, and are not overstimulated.

Schools in different countries have different attitudes, which facilitate the accommodation of different children or restrict all children into the same regimen. Canada is ahead of the United States in this regard, having a more flexible attitude. Many European schools have alternative seating styles and even allow for movement in class, with the spread of COVID-19 many schools are closed, and when they open they maintain social distance, and teachers are encouraged to go for RAT Tests.

There are studies that show that the rate of ADHD-like behavior is fairly consistent in children all over the world. However, the rate children are diagnosed varies greatly. In some cultures that behavior is not considered impairing the children. In the United States parents, especially when pressured from schools, are encouraged to look for medical treatment, usually stimulant drugs.

Within western society, there are definite differences even in the diagnosis. In Europe, the ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision) is used instead of the United States’ DSM-IV (Diagnostic and Statistical Manual of Mental Disorders 4th Edition). The ICD-10 has a different level of diagnosis of ADD and ADHD, resulting in 3 to 4 times fewer diagnoses than in the United States with the DSM-IV.

The proponents of the ADHD Social Construct Theory argue that while biological factors do play a large role in difficulties sitting still or concentrating on schoolwork in some children, the real problem is that the school systems, have failed to integrate these children with the social expectations that the schools have on them.

Some theories will explain some aspects of ADHD, while other theories show other sides of the condition. There is no single explanation. ADHD is complex. Trying to simplify it is not science, but wishful thinking. ADHD is very individual, in both cause, symptoms, and treatment. One theory might explain one individual’s ADHD, while another theory explains another person’s ADD, and a third person may find their explanation in parts from three theories. in this context the ADHD Social Construct Theory should be given more consideration than it is at present.