What are the diagnostic criteria for Attention Deficit Hyperactivity Disorder (ADHD)?

From the Guidelines

Diagnosing Attention Deficit Hyperactivity Disorder (ADHD) requires a comprehensive evaluation based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, which includes an ongoing pattern of inattentive and/or hyperactive-impulsive symptoms for at least 6 months, with multiple symptoms present in two or more settings, and evidence that these symptoms interfere with functioning 1. The diagnostic process for ADHD involves several key steps, including:

• A detailed clinical interview to assess symptoms of inattention, hyperactivity, and impulsivity
• The use of standardized rating scales, such as the Adult ADHD Self-Report Scale (ASRS-V1.1), to quantify symptoms 1
• Gathering information from multiple sources, such as parents, teachers, or spouses
• Reviewing developmental, medical, and educational history
• Ruling out other conditions that might explain the symptoms The DSM-5 criteria for ADHD include:
• At least 6 months of persistent symptoms of inattention and/or hyperactivity-impulsivity
• Multiple symptoms present in two or more settings (e.g., home, work, school)
• Evidence that symptoms interfere with functioning (e.g., interpersonal, occupational)
• Symptoms must have been present before age 12 and persist for at least six months The DSM-5 also categorizes ADHD into three presentations:
• Predominantly inattentive type: 5 or more symptoms of inattention for at least 6 months, but <5 symptoms of hyperactivity-impulsivity
• Predominantly hyperactive-impulsive type: 5 or more symptoms of hyperactivity-impulsivity for at least 6 months, but <5 symptoms of inattention
• Combined type: 5 or more symptoms of inattention AND 5 or more symptoms of hyperactivity-impulsivity for at least 6 months A positive screen for ADHD is indicated when a patient checks "often" or "very often" for 4 or more of the 6 questions on the ASRS-V1.1, prompting further evaluation 1.

From the FDA Drug Label

A diagnosis of ADHD (DSM-IV) implies the presence of hyperactive-impulsive or inattentive symptoms that cause impairment and that were present before age 7 years. The symptoms must be persistent, must be more severe than is typically observed in individuals at a comparable level of development, must cause clinically significant impairment, e.g., in social, academic, or occupational functioning, and must be present in 2 or more settings, e.g., school (or work) and at home. The symptoms must not be better accounted for by another mental disorder. For the Inattentive Type, at least 6 of the following symptoms must have persisted for at least 6 months: lack of attention to details/careless mistakes, lack of sustained attention, poor listener, failure to follow through on tasks, poor organization, avoids tasks requiring sustained mental effort, loses things, easily distracted, forgetful For the Hyperactive-Impulsive Type, at least 6 of the following symptoms must have persisted for at least 6 months: fidgeting/squirming, leaving seat, inappropriate running/climbing, difficulty with quiet activities, “on the go,” excessive talking, blurting answers, can’t wait turn, intrusive. For a Combined Type diagnosis, both inattentive and hyperactive-impulsive criteria must be met.

The diagnostic criteria for Attention Deficit Hyperactivity Disorder (ADHD) include:

• Persistent symptoms: Hyperactive-impulsive or inattentive symptoms that cause impairment and were present before age 7 years.
• Severity: Symptoms must be more severe than typically observed in individuals at a comparable level of development.
• Impairment: Symptoms must cause clinically significant impairment in social, academic, or occupational functioning.
• Settings: Symptoms must be present in 2 or more settings, such as school and home.
• Duration: Symptoms must have persisted for at least 6 months.
• Types:
  • Inattentive Type: At least 6 symptoms, including lack of attention to details, lack of sustained attention, and poor organization.
  • Hyperactive-Impulsive Type: At least 6 symptoms, including fidgeting, leaving seat, and excessive talking.
  • Combined Type: Both inattentive and hyperactive-impulsive criteria must be met 2 2.

From the Research

Diagnostic Criteria for Attention Deficit Hyperactivity Disorder (ADHD)

The diagnostic criteria for ADHD involve a comprehensive clinical history and evaluation, patient symptom and function assessment, and gathering of collateral information 3. The Diagnostic and Statistical Manual of Mental Disorders, 5th ed., criteria are used to diagnose ADHD, which requires the presence of functionally disruptive inattentive and/or hyperactive/impulsive behaviors 3, 4.

Key Components of ADHD Diagnosis

• A comprehensive history and physical examination to assess for comorbid or other conditions that can mimic ADHD 4
• The use of validated screening tools completed by parents, teachers, or other adults to aid in establishing the diagnosis 4
• Assessment of various organic conditions, functional disorders, developmental status, situational, environmental, and family problems 5
• Clinical interview of the child and family, comprehensive medical history and examination, psychoeducational tests, and school-related evaluation 5

Diagnostic Challenges and Considerations

• The absence of a diagnostically definitive test for ADHD, requiring comprehensive assessments involving multiple domains, informants, methods, and settings 5
• The need to consider comorbid disorders, such as depression, disruptive behavior disorders, or substance abuse, which need to be addressed first in the treatment plan 6
• The importance of regular follow-up to assess symptoms, overall function, presence of comorbidities, adverse effects of treatment, and medication use 4