In case you were wondering, it has taken me hours of distraction to write this stupid little post, and I’m not even done yet. This hasn’t been fun. This is officially a molasses day. They come and go. This one’s here with a vengeance. (It’s weird to talk about it in this way–in kind of a public confessional. But whatever. It is what it is.)
I’m tempted to post it as is just to get it over with and get on with my day, but instead, I want to finish. The deal I’m making with myself is that I’m going to keep trying until 1:00pm, and once there, I’m just slapping up whatever I’ve got.
So, you’ve taken a gander at part I and feel that the things you’ve seen might fit for you or someone you know. Now what?
Well, first let’s cover the remaining criteria.
Okay, the symptoms that cause impairment need to have been present before seven years of age, right? But that’s not all. In addition to that, it’s necessary that they be present in two or more settings (e.g. work or school or home.) This prevents somebody from assuming their child had ADHD-I when, in reality, the symptoms are the result of a poor relationship with a teacher, or some other factor not related to inattention. Also, the symptoms need to show clear evidence of “significant clinical impairment” in social, academic or occupational functioning.
What is significant clinical impairment? you ask. Well, that’s a really good question, and I think it’s probably the most subjective part of diagnosis. Here are a couple of articles about “clinical impairment” that might be helpful.
The role of impairment in making a diagnosis of ADHD This article makes a case for the symptoms of ADHD-I as being significantly impairing, even if they don’t compare in quality to the impairments of other subtypes (see the final portion of the second paragraph).
This article addresses some of the possible changes in the DSM-V regarding the issue of significant clinical impairment.
My take on all of this is the following: if you meet the diagnostic criteria in the different quadrants of functioning, this means that something “not right” is happening. Clearly, you are impaired, otherwise you wouldn’t notice a problem. So, I tend to agree with the camp that finds this requirement a little bit redundant, even though I do recognize the importance of what they are trying to accomplish in having included it.
Furthermore, technically one might say that I am not “clinically impaired” because over the course of decades I have come up with coping mechanisms that allow me to conform to mainstream ideals for the most part. Does this mean I am not impaired? No. It means that I have, through years of practice, learned how to compensate for my impairment. And such a view doesn’t take into account the many moments in which my defenses fail, and I end up looking like a five-year-old amongst peers and colleagues.
Anyway, the point is (as demonstrated by the first article I shared), significant impairment might simply mean “I want to pay attention as I write a blog post, but I can’t.” (It’s now 2:41, btw. No joke.)
Okay, I’m done. Those are the criteria. Oh, also make sure these symptoms don’t actually stem from another disorder whose criteria fit better (like a mood disorder, or an anxiety disorder), and make sure that the symptoms don’t occur exclusively during the course of schizophrenia, a pervasive developmental disorder, or a psychotic disorder. (You would be seeing other symptoms that alarmed you besides the ones outlined in these posts were any of these things the case. If you have any specific questions about this, feel free to ask, and I’ll do my best to clarify.)
Blah blah blah wrap up tidily blah blah blah.