ADHD Diagnostic Criteria

DSM-V, the official diagnostic manual for psychiatrists and psychologists, sets very specific criteria for diagnosign ADD/ADHD to distinguish between ADHD and other or co-morbid conditions.

Updated ADD/ADHD Classification introduced by DSM-V

DSM-V: The criteria for diagnosing ADD/ADHD is:

A. Either (1) and/or (2).

1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that impact directly on social and academic/occupational activities. Note: for older adolescents and adults (ages 17 and older), only 4 symptoms are required. The symptoms are not due to oppositional behaviour, defiance, hostility, or a failure to understand tasks or instructions.

• Often fails to give close attention to details or makes careless mistakes in school work, at work, or during other activities (for example, overlooks or misses details, work is inaccurate).
• Often has difficulty sustaining attention in tasks or play activities (for example, has difficulty remaining focused during lectures, conversations, or reading lengthy writings).
• Often does not seem to listen when spoken to directly (mind seems elsewhere, even in the absence of any obvious distraction).
• Frequently does not follow through on instructions (starts tasks but quickly loses focus and is easily sidetracked, fails to finish school work, household chores, or tasks in the workplace).
• Often has difficulty organizing tasks and activities. (Has difficulty managing sequential tasks and keeping materials and belongings in order. Work is messy and disorganized. Has poor time management and tends to fail to meet deadlines.)
• Characteristically avoids, seems to dislike, and is reluctant to engage in tasks that require sustained mental effort (such as school work or homework or, for older adolescents and adults, preparing reports, completing forms, or reviewing lengthy papers).
• Frequently loses objects necessary for tasks or activities (e.g., school assignments, pencils, books, tools, wallets, keys, paperwork, eyeglasses, or mobile telephones).
• Is often easily distracted by extraneous stimuli. (for older adolescents and adults may include unrelated thoughts.).
• Is often forgetful in daily activities, chores, and running errands (for older adolescents and adults, returning calls, paying bills, and keeping appointments).

2. Hyperactivity and Impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that impact directly on social and academic/occupational activities. Note: for older adolescents and adults (ages 17 and older), only 4 symptoms are required. The symptoms are not due to oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions.

• Often fidgets or taps hands or feet or squirms in seat.
• Is often restless during activities when others are seated (may leave his or her place in the classroom, office or other workplace, or in other situations that require remaining seated).
• Often runs about or climbs on furniture and moves excessively in inappropriate situations. In adolescents or adults, may be limited to feeling restless or confined.
• Is often excessively loud or noisy during play, leisure, or social activities.
• Is often “on the go,” acting as if “driven by a motor.” Is uncomfortable being still for an extended time, as in restaurants, meetings, etc. Seen by others as being restless and difficult to keep up with.
• Often talks excessively.
• Often blurts out an answer before a question has been completed. Older adolescents or adults may complete people’s sentences and “jump the gun” in conversations.
• Has difficulty waiting his or her turn or waiting in line.
• Often interrupts or intrudes on others (frequently butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission, adolescents or adults may intrude into or take over what others are doing).
• Tends to act without thinking, such as starting tasks without adequate preparation or avoiding reading or listening to instructions. May speak out without considering consequences or make important decisions on the spur of the moment, such as impulsively buying items, suddenly quitting a job, or breaking up with a friend.
• Is often impatient, as shown by feeling restless when waiting for others and wanting to move faster than others, wanting people to get to the point, speeding while driving, and cutting into traffic to go faster than others.
• Is uncomfortable doing things slowly and systematically and often rushes through activities or tasks.
• Finds it difficult to resist temptations or opportunities, even if it means taking risks (A child may grab toys off a store shelf or play with dangerous objects; adults may commit to a relationship after only a brief acquaintance or take a job or enter into a business arrangement without doing due diligence).

B. Several noticeable inattentive or hyperactive-impulsive symptoms were present by age 12.

C. The symptoms are apparent in two or more settings (e.g., at home, school or work, with friends or relatives, or in other activities).

D. There must be clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).

To distinguish between the different sub-types, the following conditions must be met:

1. Combined Presentation: If both Criterion A1 (Inattention) and Criterion A2 (Hyperactivity-Impulsivity) are met for the past 6 months.
2. Predominately Inattentive Presentation: If Criterion A1 (Inattention) is met but Criterion A2 (Hyperactivity-Impulsivity) is not met and 3 or more symptoms from Criterion A2 have been present for the past 6 months.
3. Predominately Hyperactive/Impulsive Presentation: If Criterion A2 (Hyperactivity-Impulsivity) is met and Criterion A1 (Inattention) is not met for the past 6 months.
4. Inattentive Presentation (Restrictive): If Criterion A1 (Inattention) is met but no more than 2 symptoms from Criterion A2 (Hyperactivity-Impulsivity) have been present for the past 6 months

In previous releases, the following conditions were used to distinguish between the different sub-types:

1. Attention Deficit Hyperactivity Disorder (ADHD) combined type
   (hyperactive-impulsive behaviours with difficulties of attention, learning and executive control)
   For a person to be diagnosed, both A1 and A2 of the criteria above must be met.
   
   
2. Attention Deficit Hyperactivity Disorder (ADHD) predominantly inattentive type
   (predominant problems of attention, learning and executive control).
   For a person to be diagnosed this sub-type, criteria A1 must be met but not A2 (for the last 6 months).
   
   
3. Attention Deficit Hyperactivity Disorder (ADHD) predominantly hyperactive-impulsive type
   (hyperactive, impulsive, poor self control of behaviour. Behaviour Inhibition Disorder)
   For a person to be diagnosed this sub-type, criteria A2 must be met but not A1 (for the last 6 months).
   

It is important to note that³

• there must be a persistent pattern
• impairment must have been present before the age of 7 years (now 12)
• the impairment or symptoms must be present in at least two settings (e.g. home and work/school)
• there must be clear evidence of interference with academic or occupational functioning.
• the impairment is not associated with any other mental disorder like mood disorders, anxiety disorders etc.

Reference:

1. BehaveNet
2. Barkley, JA
3. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). 1994
4. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-V). 2013

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