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

Diagnostic Criteria for Attention Deficit Hyperactivity Disorder (ADHD)

According to the DSM-5 criteria, ADHD diagnosis requires an ongoing pattern of inattentive and/or hyperactive-impulsive symptoms persisting for at least 6 months, with multiple symptoms present in two or more settings that interfere with functioning. 1

Core Diagnostic Requirements

• Symptom Threshold:

  • Adults (17+ years): 5 or more symptoms from either category
  • Children (<17 years): 6 or more symptoms from either category 2

• Duration: Symptoms must persist for at least 6 months 2

• Age of Onset: Several symptoms must have been present before age 12 years 2, 1

• Multiple Settings: Symptoms must be present in 2 or more settings (e.g., home, school, work) 2, 1

• Functional Impairment: Evidence that symptoms interfere with or reduce quality of functioning (social, academic, occupational) 2

• Exclusion Criteria: Symptoms are not better explained by:

  • Oppositional behavior, defiance, hostility
  • Another mental disorder (psychotic disorder, mood disorder, anxiety disorder, dissociative disorder, personality disorder)
  • Substance intoxication or withdrawal 2

Inattentive Symptoms

1. Poor attention to detail/makes careless mistakes
2. Difficulty concentrating or sustaining attention on tasks
3. Seems preoccupied, difficulty shifting focus even when spoken to directly
4. Difficulty completing tasks (gets distracted/sidetracked)
5. Organizational challenges (chronic lateness, messiness, disorganized work)
6. Reluctance to engage in tasks requiring sustained mental effort
7. Difficulty keeping track of belongings/items needed for tasks
8. Easily distracted 2

Hyperactive-Impulsive Symptoms

1. Frequent fidgeting (e.g., tapping)
2. Difficulty sitting still for prolonged periods
3. Feeling of inner restlessness or agitation
4. Often loud and disruptive
5. Always "on the go," difficult for others to keep up
6. Often talks excessively
7. Frequently interrupts others
8. Highly impatient 2

Diagnostic Approach

Initial Screening

• For adults: Use the Adult ADHD Self-Report Scale (ASRS-V1.1) - a positive screen occurs when a patient checks "often" or "very often" for 4 or more of the 6 questions 2, 3

Comprehensive Assessment

• Obtain information from multiple sources (parents/guardians, teachers, self-reports) 1
• Document developmental history, academic/occupational functioning, social relationships, family history 1
• For children aged 4-6: Behavioral checklists from parents and teachers/childcare providers 2
• For adolescents: Attempt to gather information from multiple teachers despite challenges 2

Rule Out Mimicking Conditions

• Medical conditions: Thyroid disorders, sleep disorders, seizure disorders 1
• Medication side effects 1
• Psychiatric conditions: Anxiety disorders, mood disorders, learning disabilities, autism spectrum disorders 1
• For adolescents: Substance use (particularly marijuana) can mimic ADHD symptoms 2

Special Considerations

Preschool-Aged Children (4-6 years)

• Parent Training and Behavioral Management (PTBM) is recommended as first-line intervention before finalizing diagnosis 2
• Behavioral interventions can help clarify diagnosis and may be sufficient for children with milder symptoms 2

Adolescents (12-18 years)

• Must establish symptom onset before age 12 2
• Consider comorbid conditions including substance use, depression, anxiety 2
• Increased risk for mood disorders, risky behaviors, and self-harm 2

Adults

• Adult ADHD is often characterized by more inattentive symptoms 2
• High comorbidity with anxiety, depression, substance use disorders 3, 4
• ADHD in adults is often misdiagnosed as atypical depression, mixed affective disorder, or personality disorders 5

Common Diagnostic Pitfalls

• Failing to document symptoms across multiple settings
• Not establishing symptom onset before age 12
• Misattributing symptoms to other conditions (especially in adults)
• Not screening for common comorbidities
• Relying solely on self-report without collateral information 1

By following these diagnostic criteria and assessment approaches, clinicians can accurately identify ADHD and distinguish it from other conditions with overlapping symptoms, leading to appropriate treatment planning and improved outcomes.