Attention-deficit hyperactivity disorder classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2]

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Overview

ADHD may be classified according to the DSM-V criteria into three subgroups: predominantly inattentive type, predominantly hyperactive-impulsive type, and combined type. ADHD has at times been classified as a neurological disorder based on MRI imaging of the pre-frontal cortex, and also as a neurobehavioral disorder associated with hyperkinesis and conduct disorder.

Classification

===Classification Based on DSM-V Criteria===.

1. ADHD Combined Type: if both criteria 1A and 1B are met for the past six months
2. ADHD Predominantly Inattentive Type: if criterion 1A is met but criterion 1B is not met for the past six months
3. ADHD Predominantly Hyperactive-Impulsive Type: if criterion 1B is met but criterion 1A is not met for the past six months

The terminology of ADD expired with the revision of the most current version of the DSM. Consequently, ADHD is the current nomenclature used to describe the disorder as one distinct disorder which can manifest itself as being a primary deficit resulting in hyperactivity/impulsivity (ADHD, predominately hyperactive-impulsive type), inattention (ADHD predominately inattentive type), or both (ADHD combined type).

DSM-V Criteria for ADHD

• 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 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 intoxication or withdrawal).

Classification Based on Neurological and Psychiatric Factors

• ADHD is a developmental disorder, in that, in the diagnosed population, certain traits such as impulse control significantly lag in development when compared to the general population. Using magnetic resonance imaging, this developmental lag has been estimated to range between 3 years, to 5 years in the prefrontal cortex of those with ADHD patients in comparison to their peers; consequently these delayed attributes are considered an impairment.
• ADHD has also been classified as a behavior disorder
• ADHD has also been classified as a neurological disorder or combinations of these classifications such as neurobehavioral or neurodevelopmental disorders.
• In the tenth edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) the symptoms of ADD are given the name "Hyperkinetic disorders". When a conduct disorder (as defined by ICD-10) is present, the condition is referred to as "Hyperkinetic conduct disorder". Otherwise the disorder is classified as "Disturbance of Activity and Attention", "Other Hyperkinetic Disorders" or "Hyperkinetic Disorders, Unspecified". The latter is sometimes referred to as, "Hyperkinetic Syndrome".