Symptoms and Diagnosis

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Deciding if a person has Attention-Deficit/Hyperactivity Disorder (ADHD) is a several step process. There is no single test to diagnose ADHD and many other problems, like anxiety and depression, can have similar symptoms. Thus, diagnosing ADHD should be done only by trained health care providers

What is ADHD?

ADHD is a neurodevelopmental disorder affecting both children and adults. It is described as a “persistent” or on-going pattern of inattention and/or hyperactivity-impulsivity that gets in the way of daily life or typical development. Individuals with ADHD may also have difficulties with maintaining attention, executive function (or the brain’s ability to begin an activity, organize itself and manage tasks) and working memory.

There are three presentations of ADHD:

  • Inattentive
  • Hyperactive-impulsive
  • Combined inattentive & hyperactive-impulsive

What is the DSM-5?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5), published by the American Psychiatric Association 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 DSM-5 was published in 2013 and made changes to the definition of ADHD that will affect how the disorder is diagnosed in children and in adults.

What about ADHD has changed with the DSM-5?

Adult ADHD: For many years, the diagnostic criteria for ADHD stated that it was children who were diagnosed with the disorder. That meant that teens and adults with symptoms of the disorder, and who may have been struggling for many years but didn’t know why, couldn’t officially be diagnosed with ADHD. The DSM-5 has changed this; adults and teens can now be officially diagnosed with the disorder. The diagnostic criteria mentions and gives examples of how the disorder appears in adults and teens.

  • In diagnosing ADHD in adults, clinicians now look back to middle childhood (age 12) and the teen years when making a diagnosis for the beginning of symptoms, not all the way back to childhood (age 7).
  • In the previous edition, DSM-IV TR*, the three types of ADHD were referring to as “subtypes.” This has changed; subtypes are now referred to as “presentations.” Furthermore, a person can change “presentations” during their lifetime. This change better describes how the disorder affects an individual at different points of life.
  • A person with ADHD can have now have mild, moderate or severe ADHD. This is based on how many symptoms a person has and how difficult those symptoms make daily life.

What is a significant change between DSM-IV TR and DSM-5?

A person can now be diagnosed with ADHD and Autism Spectrum Disorder.

What symptoms must a person have for a diagnosis of ADHD?

In making the diagnosis, children still should have six or more symptoms of the disorder. In older teens and adults the DSM-5 states they should have at least five symptoms.

The criteria of symptoms for a diagnosis of ADHD:

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 a lot of thinking.
  • Loses things.
  • Is easily distracted.
  • Is forgetful in daily activities.

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 inside like 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.

Combined inattentive & hyperactive-impulsive presentation:

  • Has symptoms from both of the above presentations.

Reference: American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (DSM-5), Washington, D.C.: American Psychiatric Association

Prepared by the National Resource Center on ADHD: A Program of CHADD (NRC). The NRC is supported through Cooperative Agreement Number CDC-RFA-DD13-1302 from the Centers for Disease Control and Prevention (CDC). The contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.


Previous (DSM-IV-TR) Criteria for ADHD

The DSM-IV-TR criteria for ADHD are presented here in modified form for information purposes only.

I. Either A or B:

  1. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is inappropriate for developmental level:

Inattention

    1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
    2. Often has trouble keeping attention on tasks or play activities.
    3. Often does not seem to listen when spoken to directly.
    4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
    5. Often has trouble organizing activities.
    6. Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
    7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
    8. Is often easily distracted.
    9. Is often forgetful in daily activities.
  1. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:

Hyperactivity

    1. Often fidgets with hands or feet or squirms in seat when sitting still is expected.
    2. Often gets up from seat when remaining in seat is expected.
    3. Often excessively runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
    4. Often has trouble playing or doing leisure activities quietly.
    5. Is often “on the go” or often acts as if “driven by a motor”.
    6. Often talks excessively.
  1. Impulsivity
    1. Often blurts out answers before questions have been finished.
    2. Often has trouble waiting one’s turn.
    3. Often interrupts or intrudes on others (e.g., butts into conversations or games).

II. Some symptoms that cause impairment were present before age 7 years.

III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).

IV. There must be clear evidence of clinically significant impairment in social, school, or work functioning.

V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Based on these criteria, three types of ADHD are identified:

IA.  ADHD, Combined Type: if both criteria IA and IB are met for the past 6 months

IB.  ADHD, Predominantly Inattentive Type: if criterion IA is met but criterion IB is not met for the past six months

IC.  ADHD, Predominantly Hyperactive-Impulsive Type: if Criterion IB is met but Criterion IA is not met for the past six months.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

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