Question:

Can ADHD actually go undiagnosed and really appear not an issue until puberty? How early can ADHD be diagnosed?

A concerned teacher

Answer:

Thank you for your interesting question.

Attention Deficit Hyperactivity Disorder (ADHD) is diagnosed by a psychologist, school psychologist, physician or psychiatrist based on criteria in the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV). The DSM-IV criteria specifically state:

• “symptoms of inattention have persisted for at least 6 months”
• “some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.”
• “some impairment from symptoms is present in two or more settings (e.g., at school [or work] and at home).”

Many research studies of developmental course have been done. However, taking the criteria literally, clearly, some impairment has to be present before the age of seven years. In real life situations, a severe degree of impairment is sometimes not evident until later in life. Some children do not demonstrate significant impairment at school until organizational demands increase in middle school or high school. In the process of diagnosis, the professional may search for evidence in school records or in interviews of “some … symptoms” being present before the age of seven years. Adults who think they may have ADHD are often asked to provide evidence of early impairment based on interviews with people who knew them when they were young.

Many people worry about whether a diagnosis in early childhood is appropriate and express concern about the use of medications in young children. The DSM-IV mentions that excess motor activity is common when children are toddlers and states that “caution should be exercised in making this diagnosis in early years.” Some children, particularly those with more severe impairment, may be diagnosed in preschool but the decision about whether to administer medication is made by a physician and family. Like any other medical conditions the benefits and possible side effects of medication use must be weighed carefully.

Most children with ADHD are diagnosed when in elementary school. As far as the long-term course, the DSM-IV describes symptoms as typically becoming milder, not more severe through adolescence and adulthood. “In most individuals, symptoms attenuate during late adolescence and adulthood although a minority experience the full complement of symptoms of Attention-Deficit/Hyperactivity Disorder into mid-adulthood.”

In summary, children can be diagnosed with ADHD as preschoolers. Adolescents can also be diagnosed with ADHD during or post-puberty providing they demonstrated some symptoms before age seven.

Source:

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition . (1994) Washington, DC: American Psychiatric Association. Pages 82-84