Symptoms and Diagnostic Criteria
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The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA) is the guide that lays out the criteria to be used by doctors, mental health professionals, and other qualified clinicians when making a diagnosis of ADHD. The most recent edition of the manual is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). See this DSM-5 Fact Sheet on ADHD for a summary of recent changes.
As with all DSM-5 diagnoses, it is essential to first rule out other conditions that may be the true cause of symptoms. The DSM-5 identifies three presentations of ADHD, depending on the presence or absence of particular symptoms: Inattentive presentation, Hyperactive-Impulsive presentation , and Combined presentation.
Because everyone shows signs of these behaviors at one time or another, the guidelines for determining whether a person has ADHD are very specific. To be diagnosed with ADHD, children must have six or more of the nine characteristics and older teens or adults must have at least five of the nine characteristics in either or both DSM-5 categories listed below.
In children and teenagers, the symptoms must be more frequent or severe compared to other children the same age. In adults, the symptoms must affect the ability to function in daily life and persist from adolescence.
In addition, the behaviors must create significant difficulty in at least two areas of life, such as home, social settings, school, or work. Symptoms must be present for at least six months.
Criteria for the three primary presentations are:
ADHD - Predominantly Inattentive Presentation
- Fails to give close attention to details or makes careless mistakes.
- Has difficulty sustaining attention.
- Does not appear to listen.
- Struggles to follow through on instructions.
- Has difficulty with organization.
- Avoids or dislikes tasks requiring sustained mental effort.
- Loses things.
- Is easily distracted.
- Is forgetful in daily activities.
ADHD - Predominantly Hyperactive/Impulsive Presentation
- Fidgets with hands or feet or squirms in chair.
- Has difficulty remaining seated.
- Runs about or climbs excessively in children; extreme restlessness in adults. Difficulty engaging in activities quietly.
- Acts as if driven by a motor; adults will often feel internally as if they were driven by a motor.
- Talks excessively.
- Blurts out answers before questions have been completed.
- Difficulty waiting or taking turns.
- Interrupts or intrudes upon others.
ADHD - Combined Presentation
- Individual meets both sets of inattention and hyperactive/impulsive criteria.
As ADHD symptoms affect each person to varying degrees, the DSM-5 requires professionals who diagnose the condition to specify the severity of the disorder in the affected individual, Clinicians can designate the severity of ADHD presentation as "mild," "moderate" or "severe" under the criteria in the DSM-5:
- Mild: Few symptoms beyond the required number for diagnosis are present and symptoms result in minor impairment at home, school, work and/or in social settings.
- Moderate: Symptoms or impairment between "mild" and "severe" are present.
- Severe: Many symptoms are present beyond the number needed to make a diagnosis, or multiple symptoms are particularly severe, or symptoms extremely impair an individual at home, school, work and/or in social settings.
It is also important to note that the severity level and presentation of ADHD can change during a person's lifetime. This includes the possibility that ADHD can go in to partial remission. For this to happen, an individual who previously met all the criteria for a diagnosis would need to experience less than the original number of symptoms found to be present when they were first diagnosed, during the previous six month period.