Attention-deficit hyperactivity disorder diagnostic criteria

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2], Haleigh Williams, B.S. Yashasvi Aryaputra[3]

Diagnostic Criteria

The diagnosis of ADHD is based on the DSM-V criteria, which include:

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A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (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 negatively impacts directly on social and academic/occupational activities: Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required. A. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate). B. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading). C. Often does not seem to listen when spoken to directly (e.g., mind seems to be elsewhere, even in the absence of any obvious distraction). D. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked). E. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines). F. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers). G. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paper work, eyeglasses, mobile telephones). H. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts). I. Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, 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 negatively impacts directly on social and academic/occupational activities: Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required. A. Often fidgets with or taps hands or feet or squirms in seat. B. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office, or other workplace, or in other situations that require remaining in place). C. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.) D. Often unable to play or engage in leisure activities quietly. E. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with). F. Often talks excessively. G. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation). H. Often has difficulty waiting his or her turn (e.g., while waiting in line). I. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing). AND B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years. AND C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities). AND D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning. AND E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance abuse or withdrawal).

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A.Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g, physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation. B.The temper outbursts are inconsistent with developmental level. C.The temper outbursts occur, on average, three or more times per week. D.The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers). E.Criteria A-D have been present for 12 or more months. Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D. F.Criteria A and D are present in at least two of the three settings (i.e., at home, at school, with peers) and are severe in at least one of these. G.The diagnosis should not be made for the first time before age 6 years or after 18 years. H.By history or observation, the age of onset of Criteria A-E is before 10 years. I.There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met J.The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder (e.g., autism spectrum disorder, post-traumatic stress disorder, separation anxiety disorder, persistent depressive disorder [dysthymia]). K.The symptoms are not attributable to the physiological effects of a substance or to another medical or neurological condition.

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Other Specified Attention-Deficit/Hyperactivity Disorder

• Subjects who have symptoms of ADHD that significantly impair their social and occupational lives are considered to have "other specified attention-deficit/hyperactivity disorder" when the presentation does not meet the full diagnostic criteria of ADHD or any other neurodevelopmental disorder, and the physician specifies the reason why the diagnostic criteria are not met.

Unspecified Attention-Deficit/Hyperactivity Disorder

• Subjects who have symptoms of ADHD that significantly impair their social and occupational lives are considered to have "unspecified attention-deficit/hyperactivity disorder" when the presentation does not meet the full diagnostic criteria of ADHD or any other neurodevelopmental disorder, and the physician does not specify the reason why the diagnostic criteria are not met.