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

Diagnostic Criteria for ADHD

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), ADHD diagnosis requires an ongoing pattern of inattentive and/or hyperactive-impulsive symptoms that interfere with functioning or development across multiple settings for at least 6 months. 1

Core Diagnostic Requirements

• ADHD diagnosis requires multiple inattentive and/or hyperactive-impulsive symptoms—5 or more for individuals age 17 years and older; 6 or more are required for those younger than 17 years 1
• Several symptoms must have been present before age 12 years 1, 2
• Symptoms must be present in 2 or more settings (e.g., home, school, work) 1
• There must be clear evidence that symptoms interfere with or reduce the quality of functioning (e.g., interpersonal, academic, occupational) 1
• Symptoms must not be better explained by another mental disorder (e.g., psychotic disorder, mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal) 1

Inattentive Symptoms

The following symptoms characterize the inattentive presentation:

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

Hyperactive-Impulsive Symptoms

The following symptoms characterize the hyperactive-impulsive presentation:

1. Frequent fidgeting (e.g., tapping hands or feet) 1, 2
2. Difficulty remaining seated when expected 1, 2
3. Feeling of inner restlessness or agitation 1
4. Often loud and disruptive 1
5. Always "on the go," difficult for others to keep up 1
6. Often talks excessively 1, 2
7. Frequently interrupts others (difficulty waiting their turn in conversation) 1, 2
8. Highly impatient (e.g., difficulty waiting in line) 1
9. Often intrudes into others' activities 1, 2

ADHD Subtypes

Based on symptom presentation, ADHD is classified into three subtypes:

• Predominantly Inattentive Type: 5 or more symptoms of inattention for at least 6 months, but fewer than 5 symptoms of hyperactivity-impulsivity 1, 2
• Predominantly Hyperactive-Impulsive Type: 5 or more symptoms of hyperactivity-impulsivity for at least 6 months, but fewer than 5 symptoms of inattention 1, 2
• Combined Type: 5 or more symptoms of inattention AND 5 or more symptoms of hyperactivity-impulsivity for at least 6 months 1, 2

Age-Specific Considerations

• For preschool-aged children (4-6 years), hyperactive symptoms are often more prominent than inattentive symptoms 1, 2
• For adolescents, obtaining information from multiple sources is crucial as behavior may vary between different classrooms and with different teachers 1
• For adults, inattentive symptoms are more likely to predominate 1, 3

Screening and Assessment Tools

• For children and adolescents: DSM-based ADHD rating scales completed by parents and teachers 1
• For adults: Adult ADHD Self-Report Scale (ASRS-V1.1) is recommended as an initial screening tool 1, 3

Comorbidity Screening

• Screening for comorbid conditions is essential as the majority of individuals with ADHD also meet criteria for another mental disorder 1
• Common comorbidities include:
  • Emotional or behavioral conditions (anxiety, depression, oppositional defiant disorder, conduct disorders, substance use) 1, 2
  • Developmental conditions (learning and language disorders, autism spectrum disorders) 1, 2
  • Physical conditions (tics, sleep apnea) 1

Diagnostic Pitfalls to Avoid

• Relying solely on parent or teacher reports without obtaining information from multiple sources 2
• Failing to screen for common comorbid conditions that may alter treatment approach 2
• Not considering developmental age (versus chronological age) when evaluating symptom severity 1
• Overlooking the requirement that symptoms must cause impairment in functioning 4
• Misattributing symptoms that are better explained by another disorder 1

ADHD is a chronic condition that often persists from childhood into adulthood, requiring ongoing management to minimize impairment in quality of life and functioning 1, 5.