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87-459: The Autism Diagnostic Interview-Revised (ADI-R), a companion instrument, is a structured interview conducted with the parents of the referred individual to cover the subject's full developmental history. The ADI-R has lower sensitivity but similar specificity to the ADOS. The ADI-R and ADOS are both considered gold standard diagnostic tests for autism. However, neither of these tests are required by

174-470: A dysfunctional family or a poor educational system , rather than any true presence of ADHD in the individual. In other cases, it may be explained by increasing academic expectations, with a diagnosis being a method for parents in some countries to obtain extra financial and educational support for their child. Behaviours typical of ADHD occur more commonly in children who have experienced violence and emotional abuse. Current models of ADHD suggest that it

261-528: A mental age of at least 24 months and measures behavior in the areas of reciprocal social interaction, communication and language, and patterns of behavior. The Autism Diagnostic Interview and the Autism Diagnostic Observation Schedule are both considered gold standard tests for autism. Useful for diagnosing autism, planning treatment, and distinguishing autism from other developmental disorders. The interview covers

348-481: A meta-analysis of 16 studies examining the relative risk of traffic collisions for drivers with ADHD, finding an overall relative risk estimate of 1.36 without controlling for exposure, a relative risk estimate of 1.29 when controlling for publication bias , a relative risk estimate of 1.23 when controlling for exposure, and a relative risk estimate of 1.86 for ADHD drivers with oppositional defiant disorder and/or conduct disorder comorbidities . In April 2018,

435-476: A better understanding of autism spectrum disorder and the factors that lead to a diagnosis . The first section of the interview is used to assess the quality of social interaction and includes questions about emotional sharing, offering and seeking comfort, social smiling, and responding to other children. The communication and language behavioral section investigates stereotyped utterances, pronoun reversal , and social usage of language. Stereotyped utterances are

522-436: A cause that can be understood mechanistically and treated in a novel way. The sensory overload is treatable with oral potassium gluconate . Research does not support popular beliefs that ADHD is caused by eating too much refined sugar, watching too much television, bad parenting, poverty or family chaos; however, they might worsen ADHD symptoms in certain people. In some cases, an inappropriate diagnosis of ADHD may reflect

609-539: A concurrent diagnosis of ASD) scored in the autism spectrum range on the ADOS total score. False positives have also been found in school-age subjects who have high anxiety or trauma-related disorders; in these cases, the ADOS-2 scores related to repetitive and restrictive behaviors (RRB) are usually lower than typical for ASD. A 2018 Cochrane systematic review included 12 studies of ADOS diagnostic accuracy in pre-school children (Modules 1 and 2). The summary sensitivity

696-862: A diagnosis in individuals with a mental age of at least 18 months.This would enable clinicians to use the interview to differentiate autism from other disorders which can appear in early childhood. The main goals in revising the ADI were to make the interview more efficient, shorter, and more appropriate for younger children. The majority of the revisions made involved the organization of the interview. The questions were divided into five distinct sections and early and current behavior were consolidated in each section. Research led to some modifications of specific interview questions. Modifications included both making some questions focus more on autism-specific aspects of behaviors and making other questions more generalized to improve efficiency. Also, some additional questions were added to

783-564: A distinct attention disorder occurring in 30–50% of ADHD cases as a comorbidity, regardless of the presentation; a subset of cases diagnosed with ADHD-PIP have been found to have CDS instead. Individuals with ADHD are three times more likely to be diagnosed with an eating disorder compared to those without ADHD; conversely, individuals with eating disorders are two times more likely to have ADHD than those without eating disorders. ADHD, trauma , and adverse childhood experiences are also comorbid, which could in part be potentially explained by

870-417: A frequency of 1 in 40000. There is evidence that adults with schizophrenia demonstrate an increased incidence of autistic features compared to the general population, resulting in higher ADOS scores, though schizophrenia patients also experience positive symptoms of psychosis (e.g. hallucinations, delusions, formal thought disorders). A 2016 study found that 21% of children with a diagnosis of ADHD (and without

957-415: A high heritability of 74%, meaning that 74% of the presence of ADHD in the population is due to genetic factors. There are multiple gene variants which each slightly increase the likelihood of a person having ADHD; it is polygenic and thus arises through the accumulation of many genetic risks each having a very small effect. The siblings of children with ADHD are three to four times more likely to develop

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1044-891: A line at where normal levels of inattention, hyperactivity, and impulsivity end and significant levels requiring interventions begin. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and its text revision ( DSM-5-TR ), symptoms must be present for six months or more to a degree that is much greater than others of the same age . This requires at least six symptoms of either inattention or hyperactivity/impulsivity for those under 17 and at least five symptoms for those 17 years or older. The symptoms must be present in at least two settings (e.g., social, school, work, or home), and must directly interfere with or reduce quality of functioning. Additionally, several symptoms must have been present before age 12. The DSM-5 's required age of onset of symptoms

1131-452: A major genetic mutation. There is no biologically distinct adult-onset ADHD except for when ADHD occurs after traumatic brain injury. Inattention, hyperactivity (restlessness in adults), disruptive behaviour, and impulsivity are common in ADHD. Academic difficulties are frequent, as are problems with relationships. The signs and symptoms can be difficult to define, as it is hard to draw

1218-408: A meta-analysis reviewing 40 voxel-based morphometry studies and 59 functional magnetic resonance imaging studies comparing subjects with IGD or ADHD to control groups that found that IGD and ADHD subjects had disorder-differentiating structural neuroimage alterations in the putamen and orbitofrontal cortex (OFC) respectively, and functional alterations in the precuneus for IGD subjects and in

1305-666: A neurological condition characterised by recurrent seizures. There are well established associations between ADHD and obesity, asthma and sleep disorders, and an association with celiac disease. Children with ADHD have a higher risk for migraine headaches, but have no increased risk of tension-type headaches. Children with ADHD may also experience headaches as a result of medication. A 2021 review reported that several neurometabolic disorders caused by inborn errors of metabolism converge on common neurochemical mechanisms that interfere with biological mechanisms also considered central in ADHD pathophysiology and treatment. This highlights

1392-537: A new Toddler Module (T) for assessing children aged 12 to 30 months. The scoring algorithm was also revised to align with the recent changes in the DSM-5 diagnostic criteria. While the ADOS-G had separate sections for social and communication behaviors, the ADOS-2 combined these into a single domain to represent social affect, and added a new domain to assess restrictive and repetitive behaviors (RRB). The ADOS consists of

1479-519: A number of differences between ADHD and control brains. Mirroring what is known from structural findings, fMRI studies have showed evidence for a higher connectivity between subcortical and cortical regions, such as between the caudate and prefrontal cortex. The degree of hyperconnectivity between these regions correlated with the severity of inattention or hyperactivity Hemispheric lateralization processes have also been postulated as being implicated in ADHD, but empiric results showed contrasting evidence on

1566-436: A number of genes are involved, many of which directly affect brain functioning and neurotransmission. Those involved with dopamine include DAT , DRD4 , DRD5 , TAAR1 , MAOA , COMT , and DBH. Other genes associated with ADHD include SERT , HTR1B , SNAP25 , GRIN2A , ADRA2A , TPH2 , and BDNF . A common variant of a gene called latrophilin 3 is estimated to be responsible for about 9% of cases and when this variant

1653-745: A proportionally greater decrease in the volume in the left-sided prefrontal cortex. The posterior parietal cortex also shows thinning in individuals with ADHD compared to controls. Other brain structures in the prefrontal-striatal-cerebellar and prefrontal-striatal-thalamic circuits have also been found to differ between people with and without ADHD. The subcortical volumes of the accumbens , amygdala , caudate , hippocampus , and putamen appears smaller in individuals with ADHD compared with controls. Structural MRI studies have also revealed differences in white matter, with marked differences in inter-hemispheric asymmetry between ADHD and typically developing youths. Functional MRI (fMRI) studies have revealed

1740-503: A rate of 21% in those with ADHD, affects social skills, ability to communicate, behaviour, and interests. Learning disabilities have been found to occur in about 20–30% of children with ADHD. Learning disabilities can include developmental speech and language disorders, and academic skills disorders. ADHD, however, is not considered a learning disability, but it very frequently causes academic difficulties. Intellectual disabilities and Tourette's syndrome are also common. ADHD

1827-527: A scoring algorithm classifies the individual with autism, autism spectrum disorder, or non-spectrum. The toddler module algorithm yields a "range of concern" rather than a definite classification. The toddler module is appropriate for children 12–30 months who use little to no phrase speech and are able to walk independently. This module consists of eleven primary activities: Module 1 is appropriate for children 31 months and older who use little or no phrase speech. This module consists of ten activities: Module 2

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1914-636: A series of structured and semi-structured tasks that generally takes 30-60 minutes to administer. During this time, the examiner provides a series of opportunities for the subject to show social and communication behaviors relevant to the diagnosis of autism. Each subject is administered activities from the module that corresponds to their developmental and language level. The ADOS should not be used for formal diagnosis with individuals who are blind , deaf , or otherwise seriously impaired by sensory or motor disorders, such as cerebral palsy or muscular dystrophy . Following task administration and observation coding,

2001-496: A side effect of medications used to treat ADHD. In children with ADHD, insomnia is the most common sleep disorder with behavioural therapy being the preferred treatment. Problems with sleep initiation are common among individuals with ADHD but often they will be deep sleepers and have significant difficulty getting up in the morning. Melatonin is sometimes used in children who have sleep onset insomnia. Restless legs syndrome has been found to be more common in those with ADHD and

2088-526: A statistically small relationship between children's media use and ADHD-related behaviours exists. In November 2018, Cyberpsychology published a systematic review and meta-analysis of 5 studies that found evidence for a relationship between problematic smartphone use and impulsivity traits. In October 2020, the Journal of Behavioral Addictions published a systematic review and meta-analysis of 40 studies with 33,650 post-secondary student subjects that found

2175-579: A symptom of ADHD for that person. In DSM-5, subtypes were discarded and reclassified as presentations of the disorder that change over time. The individual may also meet the criteria for hyperactivity-impulsivity, but the inattentive symptoms are predominant. The individual may also meet the criteria for inattention, but the hyperactive-impulsive symptoms are predominant. Girls and women with ADHD tend to display fewer hyperactivity and impulsivity symptoms but more symptoms of inattention and distractibility. Symptoms are expressed differently and more subtly as

2262-538: A systematic review of 11 studies where the data from all but one study suggested that heightened screen time for children is associated with attention problems. In July 2022, the Journal of Behavioral Addictions published a meta-analysis of 14 studies comprising 2,488 subjects aged 6 to 18 years that found significantly more severe problematic internet use in subjects diagnosed with ADHD to control groups. Systematic reviews in 2017 and 2020 found strong evidence that ADHD

2349-504: A weak-to-moderate positive association between mobile phone addiction and impulsivity. In January 2021, the Journal of Psychiatric Research published a systematic review of 29 studies including 56,650 subjects that found that ADHD symptoms were consistently associated with gaming disorder and more frequent associations between inattention and gaming disorder than other ADHD scales. In July 2021, Frontiers in Psychiatry published

2436-438: Is 12 years. However, research indicates the age of onset should not be interpreted as a prerequisite for diagnosis given contextual exceptions. ADHD is divided into three primary presentations: The table "Symptoms" lists the symptoms for ADHD-I and ADHD-HI from two major classification systems. Symptoms which can be better explained by another psychiatric or medical condition which an individual has are not considered to be

2523-721: Is a companion instrument by the same core authors. It is a semi-structured set of observations and is conducted in an office setting as a series of activities involving the referred individual and a psychologist or other trained and licensed examiner. Attention deficit hyperactivity disorder Attention deficit hyperactivity disorder ( ADHD ) is a neurodevelopmental disorder characterized by executive dysfunction occasioning symptoms of inattention , hyperactivity, impulsivity and emotional dysregulation that are excessive and pervasive, impairing in multiple contexts, and developmentally-inappropriate . ADHD symptoms arise from executive dysfunction, and emotional dysregulation

2610-449: Is an increased risk of a missed ADHD diagnosis, possibly because of compensatory strategies in said individuals. Studies of adults suggest that negative differences in intelligence are not meaningful and may be explained by associated health problems. In children, ADHD occurs with other disorders about two-thirds of the time. Other neurodevelopmental conditions are common comorbidities. Autism spectrum disorder (ASD), co-occurring at

2697-645: Is appropriate for children six years old or younger who speak in phrases but have not yet developed fluent verbal language. This module consists of fourteen activities: Module 3 is appropriate for children or young adolescents who are verbally fluent. This module consists of fourteen activities: Module 4 is appropriate for older adolescents and adults. While similar to module 3, module 4 relies more heavily on questions and verbal responses rather than non-verbal actions observed during play. This module consists of ten to fifteen activities. Activities marked by an asterisk are optional: The social communication difficulties that

Autism Diagnostic Observation Schedule - Misplaced Pages Continue

2784-423: Is associated with functional impairments in some of the brain's neurotransmitter systems , particularly those involving dopamine and norepinephrine . The dopamine and norepinephrine pathways that originate in the ventral tegmental area and locus coeruleus project to diverse regions of the brain and govern a variety of cognitive processes. The dopamine pathways and norepinephrine pathways which project to

2871-528: Is associated with increased suicide risk across all age groups, as well as growing evidence that an ADHD diagnosis in childhood or adolescence represents a significant future suicidal risk factor. Potential causes include ADHD's association with functional impairment, negative social, educational and occupational outcomes, and financial distress. A 2019 meta-analysis indicated a significant association between ADHD and suicidal spectrum behaviours (suicidal attempts, ideations, plans, and completed suicides); across

2958-450: Is associated with other neurodevelopmental and mental disorders as well as non-psychiatric disorders, which can cause additional impairment. While people with ADHD often struggle to initiate work and persist on tasks with delayed consequences, this may not be evident in contexts they find intrinsically interesting and immediately rewarding, potentiating hyperfocus (a more colloquial term) or perseverative responding. This mental state

3045-400: Is both linked to novelty seeking and ADHD. The genes GFOD1 and CDH13 show strong genetic associations with ADHD. CDH13's association with ASD, schizophrenia , bipolar disorder, and depression make it an interesting candidate causative gene. Another candidate causative gene that has been identified is ADGRL3 . In zebrafish , knockout of this gene causes a loss of dopaminergic function in

3132-443: Is characterised by aggression, destruction of property, deceitfulness, theft and violations of rules. Adolescents with ADHD who also have CD are more likely to develop antisocial personality disorder in adulthood. Brain imaging supports that CD and ADHD are separate conditions: conduct disorder was shown to reduce the size of one's temporal lobe and limbic system , and increase the size of one's orbitofrontal cortex , whereas ADHD

3219-427: Is completed, the interviewer determines a rating score for each question based on their evaluation of the caregiver's response. A total score is then calculated for each of the interview's content areas. When applying the algorithm, a score of 3 drops to 2 and a score of 7, 8, or 9 drops to 0 because these scores do not indicate autistic behaviors and, therefore, should not be factored into the totals. In order to create

3306-511: Is controversial due to the differences between people with ADHD and the difficulty determining the influence of symptoms, such as distractibility, on lower scores rather than intellectual capacity. In studies of ADHD, higher IQs may be over-represented because many studies exclude individuals who have lower IQs despite those with ADHD scoring on average nine points lower on standardised intelligence measures. However, other studies contradict this, saying that in individuals with high intelligence, there

3393-806: Is generally understood to be a common symptom of ADHD. People with ADHD of all ages are more likely to have problems with social skills , such as social interaction and forming and maintaining friendships. This is true for all presentations. About half of children and adolescents with ADHD experience social rejection by their peers compared to 10–15% of non-ADHD children and adolescents. People with attention deficits are prone to having difficulty processing verbal and nonverbal language which can negatively affect social interaction. They may also drift off during conversations, miss social cues, and have trouble learning social skills. Difficulties managing anger are more common in children with ADHD, as are delays in speech, language and motor development. Poorer handwriting

3480-707: Is more common in children with ADHD. Poor handwriting can be a symptom of ADHD in itself due to decreased attentiveness. When this is a pervasive problem, it may also be attributable to dyslexia or dysgraphia . There is significant overlap in the symptomatologies of ADHD, dyslexia, and dysgraphia, and 3 in 10 people diagnosed with dyslexia experience co-occurring ADHD. Although it causes significant difficulty, many children with ADHD have an attention span equal to or greater than that of other children for tasks and subjects they find interesting. Certain studies have found that people with ADHD tend to have lower scores on intelligence quotient (IQ) tests. The significance of this

3567-576: Is no clear data on whether there is a direct relationship between ADHD and suicidality, or whether ADHD increases suicide risk through comorbidities. ADHD arises from brain maldevelopment especially in the prefrontal executive networks that can arise either from genetic factors (different gene variants and mutations for building and regulating such networks) or from acquired disruptions to the development of these networks and regions; involved in executive functioning and self-regulation. Their reduced size, functional connectivity, and activation contribute to

Autism Diagnostic Observation Schedule - Misplaced Pages Continue

3654-432: Is often comorbid with disruptive, impulse control, and conduct disorders. Oppositional defiant disorder (ODD) occurs in about 25% of children with an inattentive presentation and 50% of those with a combined presentation. It is characterised by angry or irritable mood, argumentative or defiant behaviour and vindictiveness which are age-inappropriate. Conduct disorder (CD) occurs in about 25% of adolescents with ADHD. It

3741-468: Is often considered a core symptom. Impairments resulting from deficits in self-regulation such as time management , inhibition , and sustained attention can include poor professional performance, relationship difficulties, and numerous health risks, collectively predisposing to a diminished quality of life and a direct average reduction in life expectancy of 13 years. The disorder costs society hundreds of billions of US dollars each year, worldwide. It

3828-427: Is often due to iron deficiency anemia . However, restless legs can simply be a part of ADHD and requires careful assessment to differentiate between the two disorders. Delayed sleep phase disorder is also a common comorbidity. Individuals with ADHD are at increased risk of substance use disorders . This is most commonly seen with alcohol or cannabis . The reason for this may be an altered reward pathway in

3915-494: Is often hard to disengage from and is related to risks such as for internet addiction and types of offending behaviour. ADHD represents the extreme lower end of the continuous dimensional trait (bell curve) of executive functioning and self-regulation, which is supported by twin, brain imaging and molecular genetic studies. The precise causes of ADHD are unknown in most individual cases. Meta-analyses of studies of twins, families and molecular genetics have shown that

4002-443: Is present, people are particularly responsive to stimulant medication. The 7 repeat variant of dopamine receptor D4 (DRD4–7R) causes increased inhibitory effects induced by dopamine and is associated with ADHD. The DRD4 receptor is a G protein-coupled receptor that inhibits adenylyl cyclase . The DRD4–7R mutation results in a wide range of behavioural phenotypes , including ADHD symptoms reflecting split attention. The DRD4 gene

4089-541: The International Journal of Environmental Research and Public Health published a systematic review of 24 studies researching associations between internet gaming disorder (IGD) and various psychopathologies that found an 85% correlation between IGD and ADHD. In October 2018, PNAS USA published a systematic review of four decades of research on the relationship between children and adolescents' screen media use and ADHD-related behaviours and concluded that

4176-423: The DSM-5 for an autism diagnosis. The original ADOS was created by Catherine Lord , Michael Rutter , Pamela C. DiLavore and Susan Risi in 1989. The protocol consisted of 8 tasks meant to assess the individual’s social and communicative behaviors. Behaviors were rated on the following scale: Some ratings could also be assigned a rating of 7, indicating observed behaviors not otherwise specified. In response to

4263-478: The organophosphate insecticides chlorpyrifos and dialkyl phosphate is associated with an increased risk; however, the evidence is not conclusive. Exposure to tobacco smoke during pregnancy can cause problems with central nervous system development and can increase the risk of ADHD. Nicotine exposure during pregnancy may be an environmental risk. Extreme premature birth , very low birth weight , and extreme neglect, abuse, or social deprivation also increase

4350-439: The prefrontal cortex and striatum are directly responsible for modulating executive function (cognitive control of behaviour), motivation, reward perception, and motor function; these pathways are known to play a central role in the pathophysiology of ADHD. Larger models of ADHD with additional pathways have been proposed. In children with ADHD, there is a general reduction of volume in certain brain structures, with

4437-490: The rewards circuit (including the OFC, the anterior cingulate cortex , and striatum ) for both IGD and ADHD subjects. In March 2022, JAMA Psychiatry published a systematic review and meta-analysis of 87 studies with 159,425 subjects 12 years of age or younger that found a small but statistically significant correlation between screen time and ADHD symptoms in children. In April 2022, Developmental Neuropsychology published

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4524-431: The 5:1 male-to-female sex ratio in the epidemiology of ADHD suggests that ADHD may be the end of a continuum where males are overrepresented at the tails , citing clinical psychologist Simon Baron-Cohen 's suggestion for the sex ratio in the epidemiology of autism as an analogue. Natural selection has been acting against the genetic variants for ADHD over the course of at least 45,000 years, indicating that it

4611-423: The ADHD population, as have mood disorders (especially bipolar disorder and major depressive disorder ). Boys diagnosed with the combined ADHD subtype are more likely to have a mood disorder. Adults and children with ADHD sometimes also have bipolar disorder, which requires careful assessment to accurately diagnose and treat both conditions. Sleep disorders and ADHD commonly co-exist. They can also occur as

4698-493: The ADI-R is an investigator-based interview, the questions are very open-ended and the investigator is able to obtain all of the information required to determine a valid rating for each behavior. For this reason, parents and caretakers usually feel very comfortable when taking part in this interview because what they have to say about their children is valued by the interviewer. Also, taking part in this interview helps parents obtain

4785-498: The ADI-R is required for both conducting and scoring the interview. Training usually takes 2 or more months to complete depending on the person's clinical experience and interviewing skills. There are separate training procedures based on whether the ADI-R will be conducted for clinical or research purposes. To use the instrument as a clinician, there are training videos and workshops for administration and scoring. The ADI-R DVD Training Package offered by WPS provides clinical training in

4872-445: The ADI-R. Both inter-rater reliability and internal consistency were good across all behavioral areas investigated in the interview. The interview was also found to have adequate reliability across time. Research comparing ADI-R results of autistic children and children with other developmental disorders suggested that individual questions on the interview were slightly more valid when discriminating autism from intellectual disability than

4959-408: The ADOS and ADOS-2 seek to measure are not unique to ASD; there is a heightened risk of false positives in individuals with other psychological disorders. In particular, an increased false positive rate has been observed in adults with psychosis ; while case reports indicate that such false positives may also occur in cases of childhood-onset schizophrenia , which is an exceptionally rare entity with

5046-462: The ADOS-Generic (ADOS-G) to assess a broader developmental range of individuals. The ADOS-G introduced a modular format, allowing different protocols to be used depending on developmental and language factors. It became commercially available in 2001 through Western Psychological Services. The second edition, published in 2012, included updated norms, improved algorithms for Modules 1 to 3, and

5133-499: The Autism Diagnostic Interview, published in 1989, was used mainly for research purposes. The ADI was developed in response to four major developments in the field of diagnosing autism which led to a need for updated diagnostic tools. These developments included improvements in the diagnostic criteria, the need to differentiate between autism and other developmental disorders that appear similar early in life, and

5220-438: The algorithm as a whole. However, further research has led to overall acceptance of the ADI-R algorithm. The social communication questionnaire (SCQ) is a brief, 40-item, true/false questionnaire, completed by parents regarding the behavior of their child. It parallels the ADI-R in content and is used for brief screening to determine the need to conduct a full ADI-R interview. The autism diagnostic observation schedule (ADOS),

5307-603: The algorithm for diagnosis, the writers chose questions from the interview that were most closely related to the criteria for diagnosis of Autism Spectrum Disorder in the DSM-IV and the ICD-10 . An autism diagnosis is indicated when scores in all three behavioral areas meet or exceed the specified minimum cutoff scores. These cutoff scores were determined using the results of many years of extensively reviewed research. Extensive training and knowledge about autism spectrum disorder and

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5394-422: The brains of ADHD individuals, self-treatment and increased psychosocial risk factors. This makes the evaluation and treatment of ADHD more difficult, with serious substance misuse problems usually treated first due to their greater risks. Other psychiatric conditions include reactive attachment disorder , characterised by a severe inability to appropriately relate socially, and cognitive disengagement syndrome ,

5481-536: The cost of a 14% reduction in sensitivity; however, due to overlapping confidence intervals, that result could not be considered statistically significant. Autism Diagnostic Interview-Revised The Autism Diagnostic Interview-Revised ( ADI-R ) is a structured interview conducted with the parents of individuals who have been referred for the evaluation of possible autism or autism spectrum disorders . The interview, used by researchers and clinicians for decades, can be used for diagnostic purposes for anyone with

5568-401: The desire, in the area of psychology, for standardized diagnostic instruments. The original ADI could be used on individuals with a chronological age of at least five years and a mental age of at least two years, but autism spectrum disorder is usually diagnosed much earlier than this age. This finding led Rutter, LeCouteur, and Lord to revise the ADI in 1994 so that it could be used to determine

5655-424: The disorder is primarily genetic with a heritability rate of 70-80%, where risk factors are highly accumulative. The environmental risks are not related to social or familial factors; they exert their effects very early in life, in the prenatal or early postnatal period. However, in rare cases, ADHD can be caused by a single event including traumatic brain injury , exposure to biohazards during pregnancy, or

5742-616: The disorder than siblings of children without the disorder. The association of maternal smoking observed in large population studies disappears after adjusting for family history of ADHD, which indicates that the association between maternal smoking during pregnancy and ADHD is due to familial or genetic factors that increase the risk for the confluence of smoking and ADHD. ADHD presents with reduced size, functional connectivity and activation as well as low noradrenergic and dopaminergic functioning in brain regions and networks crucial for executive functioning and self-regulation. Typically,

5829-583: The disorder) tends to be much higher. However their usefulness as tools for diagnosis is limited as no single gene predicts ADHD. ASD shows genetic overlap with ADHD at both common and rare levels of genetic variation. In addition to genetics, some environmental factors might play a role in causing ADHD. Alcohol intake during pregnancy can cause fetal alcohol spectrum disorders which can include ADHD or symptoms like it. Children exposed to certain toxic substances, such as lead or polychlorinated biphenyls , may develop problems which resemble ADHD. Exposure to

5916-414: The evidence is weak and may apply to only children with food sensitivities . The European Union has put in place regulatory measures based on these concerns. In a minority of children, intolerances or allergies to certain foods may worsen ADHD symptoms. Individuals with hypokalemic sensory overstimulation are sometimes diagnosed as having ADHD, raising the possibility that a subtype of ADHD has

6003-410: The few words or sounds that the individual uses and repeats most often. The restricted and repetitive behaviors section includes questions about unusual preoccupations, hand and finger mannerisms, and unusual sensory interests. Finally, the assessment contains questions about behaviors such as self-injury, aggression, and over activity which would help in developing treatment plans. After the interview

6090-469: The importance of close collaboration between health services to avoid clinical overshadowing. In June 2021, Neuroscience & Biobehavioral Reviews published a systematic review of 82 studies that all confirmed or implied elevated accident-proneness in ADHD patients and whose data suggested that the type of accidents or injuries and overall risk changes in ADHD patients over the lifespan. In January 2014, Accident Analysis & Prevention published

6177-599: The individual ages. Hyperactivity tends to become less overt with age and turns into inner restlessness, difficulty relaxing or remaining still, talkativeness or constant mental activity in teens and adults with ADHD. Impulsivity in adulthood may appear as thoughtless behaviour, impatience, irresponsible spending and sensation-seeking behaviours, while inattention may appear as becoming easily bored, difficulty with organization, remaining on task and making decisions, and sensitivity to stress. Although not listed as an official symptom, emotional dysregulation or mood lability

6264-505: The interview was revised. The ADI-R has also been tested thoroughly for reliability and validity using inter-rater reliability , test-retest reliability and internal validity tests. The results of this research have led to the ADI's acceptance among both researchers and clinicians for decades. The ADI-R is often used in conjunction with other related instruments to determine an autism diagnosis. The writers have published psychometric results that indicate both reliability and validity of

6351-485: The interview, including more specific questions about ages when abnormal behaviors began. Other items were removed in order to increase the interview's ability to diagnose autism at a younger age. These question revisions also led the writers to revise the scoring algorithm and cut-off scores as there were more questions added to some sections. Questions from the original version of the ADI that were found, through research, to be unreliable or not applicable were removed when

6438-578: The need for diagnostic tools for autism in younger children, researchers developed the Pre-Linguistic Autism Diagnostic Observation Schedule (PL-ADOS). The PL-ADOS adapted the content and format of the original ADOS to rely less on verbal communication. It consisted of 12 tasks, retaining only the free/unstructured playtime from the original ADOS and adding new activities designed to be less dependent on speech. In 2000, Lord and her colleagues introduced

6525-458: The other. Additionally, traumatic events in childhood are a risk factor for ADHD; they can lead to structural brain changes and the development of ADHD behaviours. Finally, the behavioural consequences of ADHD symptoms cause a higher chance of the individual experiencing trauma (and therefore ADHD leads to a concrete diagnosis of a trauma-related disorder). Some non-psychiatric conditions are also comorbidities of ADHD. This includes epilepsy ,

6612-401: The pathophysiology of ADHD, as well as imbalances in the noradrenergic and dopaminergic systems that mediate these brain regions. Genetic factors play an important role; ADHD has a heritability rate of 70-80%. The remaining 20-30% of variance is mediated by de-novo mutations and non-shared environmental factors that provide for or produce brain injuries; there is no significant contribution of

6699-773: The rearing family and social environment. Very rarely, ADHD can also be the result of abnormalities in the chromosomes. In November 1999, Biological Psychiatry published a literature review by psychiatrists Joseph Biederman and Thomas Spencer found the average heritability estimate of ADHD from twin studies to be 0.8, while a subsequent family , twin, and adoption studies literature review published in Molecular Psychiatry in April 2019 by psychologists Stephen Faraone and Henrik Larsson that found an average heritability estimate of 0.74. Additionally, evolutionary psychiatrist Randolph M. Nesse has argued that

6786-572: The referred individual's full developmental history, is usually conducted in an office, home or other quiet setting by a psychologist, and generally takes one to two hours. The caregivers are asked 93 questions, spanning the three main behavioral areas, about either the individual's current behavior or behavior at a certain point in time. The interview is divided into five sections: opening questions, communication questions, social development and play questions, repetitive and restricted behavior questions, and questions about general behavior problems. Because

6873-532: The risk as do certain infections during pregnancy, at birth, and in early childhood. These infections include, among others, various viruses ( measles , varicella zoster encephalitis , rubella , enterovirus 71 ). At least 30% of children with a traumatic brain injury later develop ADHD and about 5% of cases are due to brain damage. Some studies suggest that in a small number of children, artificial food dyes or preservatives may be associated with an increased prevalence of ADHD or ADHD-like symptoms, but

6960-451: The risk of bias to be properly evaluated. The authors could not identify any studies for the ADOS-2; the scope of the review was limited to preschool age children (mean age under 6 years), which excluded studies of Modules 3 and 4 from the meta-analysis. One included study examined the additive sensitivity and specificity of the ADOS used in combination with the ADI-R; that study found an 11% improvement in specificity (compared to ADOS alone) at

7047-411: The similarity in presentation between different diagnoses. The symptoms of ADHD and PTSD can have significant behavioural overlap—in particular, motor restlessness, difficulty concentrating, distractibility, irritability/anger, emotional constriction or dysregulation, poor impulse control, and forgetfulness are common in both. This could result in trauma-related disorders or ADHD being mis-identified as

7134-441: The studies examined, the prevalence of suicide attempts in individuals with ADHD was 18.9%, compared to 9.3% in individuals without ADHD, and the findings were substantially replicated among studies which adjusted for other variables. However, the relationship between ADHD and suicidal spectrum behaviours remains unclear due to mixed findings across individual studies and the complicating impact of comorbid psychiatric disorders. There

7221-502: The use of the ADI-R. Researchers are required to attend specific research training and establish their reliability in using the ADI-R in order to use it for research purposes. The standard of practice is to attend an in-person ADI-R research training workshop and establish research reliability with the authors or their colleagues. The ADI-R was developed by Michael Rutter , Ann LeCouteur , and Catherine Lord and published by Western Psychological Services in 2003. The original version of

7308-585: The ventral diencephalon and the fish display a hyperactive/impulsive phenotype . For genetic variation to be used as a tool for diagnosis, more validating studies need to be performed. However, smaller studies have shown that genetic polymorphisms in genes related to catecholaminergic neurotransmission or the SNARE complex of the synapse can reliably predict a person's response to stimulant medication . Rare genetic variants show more relevant clinical significance as their penetrance (the chance of developing

7395-497: Was 0.94 (95% CI 0.89 to 0.97), with sensitivity in individual studies ranging from 0.76 to 0.98. The summary specificity was 0.80 (95% CI 0.68 to 0.88), with specificity in individual studies ranging from 0.20 to 1.00. The studies were evaluated for bias using the QUADAS-2 framework; of the 12 included studies, 8 were evaluated as having a high risk of bias, while for the remaining four there was insufficient information available for

7482-578: Was not an adaptative trait in ancient times. The disorder may remain at a stable rate by the balance of genetic mutations and removal rate (natural selection) across generations; over thousands of years, these genetic variants become more stable, decreasing disorder prevalence. Throughout human evolution, the EFs involved in ADHD likely provide the capacity to bind contingencies across time thereby directing behaviour toward future over immediate events so as to maximise future social consequences for humans. ADHD has

7569-473: Was shown to reduce connections in the cerebellum and prefrontal cortex more broadly. Conduct disorder involves more impairment in motivation control than ADHD. Intermittent explosive disorder is characterised by sudden and disproportionate outbursts of anger and co-occurs in individuals with ADHD more frequently than in the general population. Anxiety and mood disorders are frequent comorbidities. Anxiety disorders have been found to occur more commonly in

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