What are the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) criteria for Attention Deficit Hyperactivity Disorder (ADHD)?

DSM-5 Criteria for ADHD

According to the DSM-5, ADHD diagnosis requires an ongoing pattern of inattention and/or hyperactivity-impulsivity symptoms persisting for at least 6 months, with multiple symptoms present before age 12, occurring in 2 or more settings, and causing functional impairment. 1, 2

Core Diagnostic Requirements

• Duration: Symptoms must persist for at least 6 months
• Age of onset: Several symptoms present before age 12
• Multiple settings: Symptoms present in 2+ settings (e.g., home, school, work)
• Functional impairment: Clear evidence that symptoms interfere with or reduce quality of functioning
• Alternative explanations ruled out: Symptoms not better explained by another mental disorder

Symptom Threshold Requirements

• For children under 17 years: At least 6 symptoms from either category
• For adults (17+ years): At least 5 symptoms from either category 1, 2

Inattentive Symptoms

1. Poor attention to detail, makes careless mistakes
2. Difficulty sustaining attention in tasks or activities
3. Seems not to listen when spoken to directly
4. Fails to follow through on instructions or complete tasks
5. Difficulty organizing tasks and activities
6. Avoids tasks requiring sustained mental effort
7. Loses things necessary for tasks or activities
8. Easily distracted by extraneous stimuli
9. Forgetful in daily activities 1, 2

Hyperactive-Impulsive Symptoms

1. Fidgets or taps hands/feet, squirms in seat
2. Leaves seat when remaining seated is expected
3. Runs or climbs excessively (in adults: feelings of restlessness)
4. Unable to engage in leisure activities quietly
5. "On the go," acting as if "driven by a motor"
6. Talks excessively
7. Blurts out answers before questions completed
8. Difficulty waiting turn
9. Interrupts or intrudes on others 1, 2

ADHD Presentations

The DSM-5 defines four presentations of ADHD:

1. Predominantly Inattentive Presentation (314.00 [F90.0])
2. Predominantly Hyperactive-Impulsive Presentation (314.01 [F90.1])
3. Combined Presentation (314.01 [F90.2])
4. Other Specified and Unspecified ADHD (314.01 [F90.8]) 1

Assessment Approach

• Structured clinical interview with the patient
• Collateral information from multiple sources (parents, teachers, partners)
• Standardized rating scales (e.g., Adult ADHD Self-Report Scale)
• Comprehensive evaluation to rule out alternative explanations 2

Common Diagnostic Pitfalls

• Failing to obtain information from multiple sources
• Missing comorbid conditions (ADHD rarely occurs in isolation)
• Not considering developmental context (symptoms must be excessive for developmental age)
• Relying on self-diagnosis or screening tools alone
• Overlooking functional impairment requirement 2

Special Considerations for Different Age Groups

Preschool-Aged Children (4-5 years)

• Same diagnostic criteria apply
• Clinical interview with parents, observation of child
• Information from parents and teachers through DSM-based rating scales
• Challenges in observing symptoms across multiple settings 1

Adults

• Research supports the lower symptom threshold (5+ symptoms) for adults
• Adults more likely to present with inattentive symptoms
• Adult ADHD Self-Report Scale (ASRS-V1.1) useful for initial screening 1, 3

The DSM-5 criteria represent the current gold standard for ADHD diagnosis, based on expert consensus and research evidence, and are widely accepted by clinicians, researchers, and third-party payers 1, 2.