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

From the Guidelines

The diagnostic criteria for ADHD, as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, require an ongoing pattern of inattentive and/or hyperactive-impulsive symptoms for at least 6 months, with multiple symptoms present in two or more settings, and evidence that these symptoms interfere with or reduce the quality of functioning 1.

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 (eg, home, work)
• Evidence that inattentive and/or hyperactive-impulsive symptoms interfere with or reduce the quality of functioning (eg, interpersonal, occupational)

Inattention and Hyperactivity-Impulsivity Symptoms

• Inattentive symptoms:
  • 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 (eg, resulting in chronic lateness—for appointments or deadlines, messiness, disorganized work)
  • Reluctance to engage in tasks that require sustained mental effort (eg, preparing reports, reviewing lengthy papers)
  • Difficulty keeping track of personal belongings/items required for task completion
  • Easily distracted
  • Frequently forgetful
• Hyperactive-impulsive symptoms:
  • Frequent fidgeting (eg, 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 (eg, difficulty waiting in line)
  • Often intrudes into others’ activities (eg, may take over what others are doing)

Diagnosis

ADHD is diagnosed through comprehensive evaluation by qualified healthcare professionals using clinical interviews, rating scales, and observations across multiple settings, as no single test can definitively diagnose the condition, and the Adult ADHD Self-Report Scale (ASRS-V1.1) can be used as a screening tool 1.

From the FDA Drug Label

A diagnosis of ADHD (DSM-IV) implies the presence of hyperactive-impulsive or inattentive symptoms that cause impairment and that were present before age 7 years. The symptoms must be persistent, must be more severe than is typically observed in individuals at a comparable level of development, must cause clinically significant impairment, e.g., in social, academic, or occupational functioning, and must be present in 2 or more settings, e.g., school (or work) and at home. For the Inattentive Type, at least 6 of the following symptoms must have persisted for at least 6 months: lack of attention to details/careless mistakes, lack of sustained attention, poor listener, failure to follow through on tasks, poor organization, avoids tasks requiring sustained mental effort, loses things, easily distracted, forgetful For the Hyperactive-Impulsive Type, at least 6 of the following symptoms must have persisted for at least 6 months: fidgeting/squirming, leaving seat, inappropriate running/climbing, difficulty with quiet activities, “on the go,” excessive talking, blurting answers, can’t wait turn, intrusive. For a Combined Type diagnosis, both inattentive and hyperactive-impulsive criteria must be met.

The diagnostic criteria for ADHD include:

• Hyperactive-impulsive symptoms: at least 6 symptoms must have persisted for at least 6 months, such as fidgeting, leaving seat, or excessive talking
• Inattentive symptoms: at least 6 symptoms must have persisted for at least 6 months, such as lack of attention to details, poor listener, or easily distracted
• Combined Type: both inattentive and hyperactive-impulsive criteria must be met
• Symptoms must be persistent, severe, and cause clinically significant impairment in social, academic, or occupational functioning
• Symptoms must be present in 2 or more settings, such as school and home 2 2

From the Research

Diagnostic Criteria for ADHD

The diagnostic criteria for Attention-Deficit/Hyperactivity Disorder (ADHD) are not explicitly stated in the provided studies. However, the studies mention the characteristics and symptoms of ADHD, which include:

• Inattention
• Impulsivity
• Hyperactivity
• Combination of the three 3 Some studies also mention the use of rating scales, such as the ADHD Rating Scale, to measure the severity of ADHD symptoms 4.

Symptoms and Characteristics

The symptoms and characteristics of ADHD can vary across different age groups and individuals. For example:

• In adolescents, ADHD can manifest as significant reductions in total symptom score on the ADHD Rating Scale, with both stimulant and non-stimulant medications leading to clinically significant reductions 4
• In adults, ADHD can impact social functions and quality of life, with treatments such as methylphenidate and atomoxetine showing efficacy in improving symptoms and quality of life 5
• In youths, ADHD can be associated with emotional and behavioral problems, such as aggressive behavior and somatic complaints, which can be improved with treatments like methylphenidate and atomoxetine 6

Treatment and Management

The treatment and management of ADHD often involve pharmacological and psychosocial interventions. Some studies suggest that:

• Stimulant medications, such as methylphenidate and amphetamine, are effective in reducing ADHD symptoms 4, 7
• Non-stimulant medications, such as atomoxetine, can also be effective in improving ADHD symptoms and quality of life 3, 5
• Psychosocial treatments, such as behavioral and cognitive-behavioral therapies, can be beneficial in improving academic and organizational skills, as well as reducing emotional and behavioral problems 4, 6