Human growth and development, with the requisite learning of skills and master of cognitive and psychosocial tasks, unfolds in endlessly fascinating, complex patterns. If the child is to develop a healthy personality, then he or she must learn how to test reality, regulate impulses, stabilize moods, integrate feelings and actions, focus attention, and plan. (Wright, 1999)

Diagnostic Features

Attention-Deficit/Hyperactivity Disorder (ADHD) often referred to erroneously as ADD, is presented in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) (American Psychological Association [APA], 1994, pp. 78-85) as a disorder usually first diagnosed in infancy, childhood, or adolescence. The diagnostic criteria are enumerated as follows:

1. Either (1) or (2):
   1. six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
      Inattention
      1. often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
      2. often has difficulty sustaining attention in tasks or play activities
      3. often does not seem to listen when spoken to directly
      4. often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
      5. often has difficulty organizing tasks and activities
      6. often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
      7. often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
      8. is often easily distracted by extraneous stimuli
      9. is often forgetful in daily activities
   2. six (or more) 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
      1. often fidgets with hands or feet or squirms in seat
      2. often leaves seat in classroom or in other situations in which remaining seated is expected
      3. 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)
      4. often has difficulty playing or engaging in leisure activities quietly
      5. is often "on the go" or often acts as if "driven by a motor"
      6. often talks excessively
      Impulsivity
      1. often blurts out answers before questions have been completed
      2. often has difficulty awaiting turn
      3. often interrupts or intrudes on others (e.g. butts into conversations or games)
2. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.
3. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).
4. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning
5. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

The DSM-IV (1994, p. 85) also defines four diagnostic categories of ADHD, based upon the impairments present. If Criteria A1 and A2 are met (inattention and hyperactivity-impulsivity), ADHD, Combined Type is appropriate. If Criteria A1 is met (inattention), ADHD, Predominately Inattentive Type is appropriate. And if Criteria A2 is met (hyperactivity-impulsivity), ADHD, Predominately Hyperactive-Impulsive Type is appropriate. The fourth category is defined as ADHD, Not Otherwise Specified (NOS), and is utilized for those who have "disorders with prominent symptoms of inattention or hyperactivity-impulsivity that do not meet the criteria for Attention Deficit/Hyperactivity Disorder." The diagnosis of "In Partial Remission" can also be appended if a previous diagnosis has been made, but the individual no longer meets the full criteria. Additionally, persons who have any of the subtype diagnoses, may go on to have that subtype changed (e.g. from Predominately Inattentive type to Combined type).

Important to the view of the development of person with ADHD, is the description given by Hutchins (1994), in which he describes the dichotomous symptoms of persons with and without hyperactivity-impulsivity:

And by Zgonc's Study (as cited in Price, 1999)

Cultural Considerations

In his comprehensive review of literature (approaching 100 references), Reid (1995) presents the data currently available regarding current standardized testing. It appears that in the United States, African-American Students are over-represented, and Hispanic students under-represented with respect to the ADHD diagnosis. Reid also suggests there is a higher rate of diagnosis among those with a low socioeconomic status, among whom minorities are over-represented. However, there is no firm evidence on which to base a conclusion, as the studies which have been done show conflicting results. In fact, no variations were noted by ethnic or socioeconomic status in a later study (Bussing, Schoenberg, Rogers, Zima, & Angus, 1998).

However, Reid (1995) was able to show that inter-rater reliability was a factor among cultures when children were tested within their own country, such as China (with a low mean score) versus New Zealand and South London (with higher mean scores). With this data in mind, he cautions against the use of simple standardized testing without clinical judgment in the schools until more studies are done, as fully one-third of the school population is expected to be minority by the year 2000.