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

From the Guidelines

The diagnostic criteria for Attention Deficit Hyperactivity Disorder (ADHD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) include an ongoing pattern of inattentive and/or hyperactive-impulsive symptoms, with at least 6 months of symptoms, 5 or more symptoms of inattention and/or hyperactivity-impulsivity, onset before age 12, presence in 2 or more settings, and evidence of interference with functioning. The DSM-5 criteria for ADHD, as outlined in the study by Scoten 1, include two main symptom categories: inattention and hyperactivity-impulsivity.

Key Diagnostic Criteria

• An ongoing pattern of inattentive and/or hyperactive-impulsive symptoms—at least 6 months
• Multiple inattentive and/or hyperactive-impulsive symptoms—5 or more (for age 17 y; 6 or more are required for age <17 y)
• Several inattentive and/or hyperactive-impulsive symptoms with an onset before the age of 12 y
• Several inattentive and/or hyperactive-impulsive symptoms that are present in 2 or more settings (e.g., home, work)
• Evidence that inattentive and/or hyperactive-impulsive symptoms interfere with or reduce the quality of functioning (e.g., interpersonal, occupational)

Inattention and Hyperactivity-Impulsivity Symptoms

The symptoms of inattention include:

• Poor attention to detail
• Difficulty concentrating or sustaining attention on tasks
• Seems preoccupied, difficulty in shifting focus even when spoken to directly
• Difficulty with completing tasks (gets distracted/side-tracked)
• Organizational challenges (e.g., resulting in chronic lateness—for appointments or deadlines, messiness, disorganized work)
• Reluctance to engage in tasks that require sustained mental effort (e.g., preparing reports, reviewing lengthy papers)
• Difficulty keeping track of personal belongings/items required for task completion
• Easily distracted
• Frequently forgetful The symptoms of hyperactivity-impulsivity include:
• Frequent fidgeting (e.g., tapping a desk)
• Finds it difficult to sit still for prolonged periods
• Feeling of inner restlessness or agitation
• Often loud and disruptive
• Always on the go, difficult for others to keep up
• Often talks excessively
• Frequently interrupts others (difficulty restraining themselves from sharing their perspectives or waiting their turn in conversation)
• Highly impatient (e.g., difficulty waiting in line)
• Often intrudes into others’ activities (e.g., may take over what others are doing) The DSM-5 specifies three presentation types: predominantly inattentive, predominantly hyperactive-impulsive, or combined presentation, as noted in the study by Scoten 1.

Presentation Types

• 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 Symptoms must occur in multiple settings (such as home, school, or work) and cannot be better explained by another mental disorder, as stated in the study by Wolraich et al. 1. The severity can be specified as mild, moderate, or severe based on functional impairment.

From the Research

Diagnostic Criteria for ADHD in DSM-5

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes the following diagnostic criteria for Attention Deficit Hyperactivity Disorder (ADHD):

• The disorder begins before age 12 2
• Symptoms are present in at least two settings 2, 3
• Symptoms cannot be explained by another condition 2
• The DSM-5 includes three phenotypes of ADHD: predominantly inattentive, predominantly hyperactive/impulsive, or combined 2, 4

Symptoms of ADHD

The symptoms of ADHD are described in three domains:

• Inattention
• Hyperactivity
• Impulsivity 4 The DSM-5 criteria are useful in diagnosing these three subtypes of ADHD based on the presence of symptoms in these domains 4

Age of Onset and Diagnosis

The age of onset criterion has been raised to 12 years of age in the DSM-5 5 The diagnosis of ADHD relies primarily on the clinical interview, including the medical and social history, along with the aid of objective measures 3

Comorbidities and Treatment

Many patients with ADHD have comorbid disorders such as depression, disruptive behavior disorders, or substance abuse, which need to be addressed first in the treatment plan 3 Treatment of ADHD relies on a combination of psychopharmacologic, academic, and behavioral interventions, which produce response rates up to 80% 3