DSM-5 Criteria for ADHD
According to the DSM-5, ADHD diagnosis requires persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning or development, with at least 5 symptoms for adults (17+ years) or 6 symptoms for children, present in multiple settings for at least 6 months, with onset before age 12. 1, 2
Inattention Symptoms
A person must have at least 5 (adults) or 6 (children) of these symptoms:
- Often fails to give close attention to details or makes careless mistakes
- Often has difficulty sustaining attention in tasks or activities
- Often does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish tasks
- Often has difficulty organizing tasks and activities
- Often avoids, dislikes, or is reluctant to engage in tasks requiring sustained mental effort
- Often loses things necessary for tasks or activities
- Is often easily distracted by extraneous stimuli
- Is often forgetful in daily activities
Hyperactivity and Impulsivity Symptoms
A person must have at least 5 (adults) or 6 (children) of these symptoms:
- Often fidgets with or taps hands or feet or squirms in seat
- Often leaves seat in situations when remaining seated is expected
- Often runs about or climbs in situations where it is inappropriate (in adolescents or adults, may be limited to feeling restless)
- Often unable to play or engage in leisure activities quietly
- Is often "on the go," acting as if "driven by a motor"
- Often talks excessively
- Often blurts out an answer before a question has been completed
- Often has difficulty waiting his or her turn
- Often interrupts or intrudes on others
Additional Diagnostic Requirements
Age of onset: Several symptoms must be present before age 12 (changed from age 7 in DSM-IV) 1, 2
Multiple settings: Symptoms must be present in two or more settings (e.g., home, school, work, with friends) 1, 2
Functional impairment: Clear evidence that symptoms interfere with or reduce the quality of social, academic, or occupational functioning 1, 2
Exclusionary criteria: Symptoms are not better explained by another mental disorder and do not occur exclusively during the course of schizophrenia or another psychotic disorder 1, 2
ADHD Presentations
The DSM-5 defines four presentations of ADHD 1, 2:
Predominantly Inattentive Presentation (314.00 [F90.0]): When sufficient inattention criteria are met but not hyperactivity-impulsivity criteria
Predominantly Hyperactive-Impulsive Presentation (314.01 [F90.1]): When sufficient hyperactivity-impulsivity criteria are met but not inattention criteria
Combined Presentation (314.01 [F90.2]): When sufficient criteria for both inattention and hyperactivity-impulsivity are met
Other Specified and Unspecified ADHD (314.01 [F90.8]): When symptoms characteristic of ADHD cause impairment but do not meet full criteria
Key Differences Between Child and Adult Diagnosis
Symptom threshold: Adults (17+ years) need at least 5 symptoms in either category, while children need at least 6 symptoms 2, 3
Symptom manifestation: Adult hyperactivity may manifest as extreme restlessness or wearing others out with activity 2
Developmental context: Symptoms must be excessive for developmental (not just chronological) age 2
Important Clinical Considerations
A comprehensive evaluation should include structured clinical interviews, information from multiple sources, standardized rating scales, and screening for comorbid conditions 2
Alternative causes for symptoms must be ruled out, including medical conditions, other psychiatric disorders, substance use effects, and environmental factors 1, 2
The DSM-5 no longer excludes autism spectrum disorders as a comorbid condition with ADHD 4
Research supports the lower symptom threshold for adults, as symptoms tend to decrease with age while impairment often persists 5, 3
The change in age of onset from 7 to 12 years allows for better identification of cases that may have been missed under DSM-IV criteria 4