Diagnosing Attention-Deficit Hyperactivity Disorder (ADHD), Part 1

Diagnosing Attention-Deficit Hyperactivity Disorder (ADHD), Part 1

OVERVIEW

The goal of this post is to describe the specific symptoms needed for an Attention-Deficit Hyperactivity Disorder (ADHD) diagnosis. Later posts will discuss how healthcare providers evaluate children for ADHD, other features of ADHD, and how it is treated.

ADHD SYMPTOMS DEFINED

Most children have brief periods where they are inattentive (have difficulty staying focused on tasks), hyperactive (constant, sometimes disruptive, activity), or impulsive (acting “on a whim” or without considering the consequences). It is a normal part of childhood. The diagnosis of ADHD can be considered when symptoms are long-standing (present for at least 6 months), they are not considered normal for the child’s developmental stage, and they interfere with normal functioning or development.

DIAGNOSTIC CRITERIA

The DSM (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) lists the specific diagnostic criteria for ADHD,1 which are summarized below:

A. A persistent pattern of inattention and/or hyperactivity-impulsivity (described in sections 1 and 2 below) that interferes with functioning or development

1. Inattention: At least 6 of the following, present for at least 6 months, not consistent with normal developmental level, and directly affects social and academic (or occupational) activities. Ages 17 years and older, at least 5 symptoms are required.

  1. Often fails to give close attention to details or makes careless mistakes in schoolwork or during other activities
  2. Often has difficulties sustaining attention during tasks or play
  3. Often does not seem to listen when spoken to directly
  4. Often foes not follow through on instructions
  5. Often has difficulty organizing tasks and activities
  6. Often avoids, dislikes, or is reluctant to participate in tasks that sustained mental effort
  7. Often loses things necessary for tasks and activities (e.g., school materials)
  8. Is often easily distracted
  9. Is often forgetful

2. Hyperactivity and Impulsivity: At least 6 of the following, present for at least 6 months, not consistent with normal developmental level, and directly affects social and academic (or occupational) activities, at least 5 symptoms are required.

  1. Often fidgets with or taps hands or feet or squirms in seat
  2. Often leaves seat when remaining in seat is expected
  3. Often runs or climbs where it is not appropriate
  4. Often unable to play or engage in leisure activities quietly
  5. Is often “on the go” or acting as if “driven by a motor”
  6. Often talks excessively
  7. Often blurts out an answer before the question has been completed
  8. Often has difficulty waiting his or her turn
  9. Often interrupts or intrudes on others

B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.

C.  Several inattentive or hyperactive-impulsive symptoms are present in two or more settings.

D. There is clear evidence that symptoms interfere with (or reduce the quality of) social, academic, or occupational functioning.

E. The symptoms cannot be better explained by another disorder.

ADHD SUBTYPES

There are three subtypes of ADHD: (1) primarily inattentive, (2) primarily hyperactive and impulsive, (3) and combined (both inattentive and hyperactive-impulsive). After diagnosing ADHD, the healthcare provider also can establish which subtype.

FUTURE POSTS

The next post will describe how healthcare providers evaluate children and adolescents for symptoms of ADHD.

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, D.C.: American Psychiatric Association; 2013