According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), attention deficit–hyperactivity disorder (ADHD) is characterized by symptoms of impulsivity, inattention, and hyperactivity that emerge in childhood.
Criteria for the Diagnosis of Attention Deficit–Hyperactivity Disorder (ADHD).
ADHD consists of a pattern of behavior that is present in multiple settings and gives rise to difficulties with social and academic or work performance. The diagnosis requires evidence of inattention, hyperactivity and impulsivity, or both.
Inattention
Six or more of the following symptoms (five or more in adolescents and adults 17 years of age or older) have persisted for at least 6 months to a degree that is inconsistent with the person’s developmental level and that directly affects social and academic or occupational activities*:
- Often fails to give close attention to details and makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).
- Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures or conversations or when reading lengthy writings).
- Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
- 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; does not finish schoolwork, household chores, or tasks in the workplace).
- Often has difficulty organizing tasks and activities (e.g., has difficulty managing sequential tasks and keeping materials and belongings in order; has messy, disorganized work; has poor time management; tends to fail to meet deadlines).
- Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., doing schoolwork or homework; preparing reports, completing forms, or reviewing lengthy papers).
- Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, or mobile phones).
- Is often easily distracted by extraneous stimuli (in older adolescents and adults, may include unrelated thoughts).
- Is often forgetful in daily activities (e.g., performing chores and running errands, returning telephone calls, paying bills, and keeping appointments).
Hyperactivity and impulsivity
Six or more of the following symptoms (five or more in adolescents and adults 17 years of age or older) have persisted for at least 6 months to a degree that is inconsistent with the person’s developmental level and that directly affects social and academic or occupational activities* **:
- Often fidgets with or taps hands or feet or squirms in seat.
- Often leaves seat in situations in which one is expected to remain seated (e.g., leaves his or her place in the classroom or office).
- Often runs about or climbs in situations in which it is inappropriate. (In adolescents or adults, this symptom may be limited to feeling restless.)
- Often is unable to play or engage in leisure activities quietly.
- Often is “on the go,” acting as if “driven by a motor” (e.g., is unable to be still or feels uncomfortable being still for an extended period of time in restaurants or meetings; other people may perceive him or her as being restless and difficult to keep up with).
- Often talks excessively.
- Often blurts out an answer before a question has been completed (e.g., completes people’s sentences and “jumps the gun” in conversations, cannot wait for next turn in conversation).
- Often has difficulty waiting his or her turn (e.g., while waiting in line).
- Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities or uses other people’s things without asking or receiving permission; adolescents or adults may intrude in or take over what others are doing).
Symptoms that cause impairment
Several symptoms of inattention or hyperactivity and impulsivity were present before 12 years of age.
Criteria for the disorder are met in two or more settings (e.g., at home, school, or work or with friends or relatives).
There is clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning.
The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better accounted for by another mental disorder (e.g., a mood disorder, an anxiety disorder, a dissociative disorder, or a personality disorder).
Current presentation***
Combined presentation: criteria for both inattention and hyperactivity and impulsivity have been present for the past 6 months.
Predominantly inattentive presentation: criteria for inattention are met but criteria for hyperactivity and impulsivity are not met.
Predominantly hyperactive and impulsive presentation: criteria for hyperactivity and impulsivity are met and criteria for inattention are not met.
* The DSM-5 committee considered reducing the cutoff to four symptoms for the diagnosis in adults (as suggested by some follow-up studies), but this was not accepted or included in the final version.
** An earlier revision of the DSM-5 added four additional symptoms of impulsivity to give this domain more prominence, but this addition was not included in the final version.
*** In persons (especially adolescents and adults) who currently have symptoms with impairment that no longer meet the full criteria, “in partial remission” should be specified.
References:
- Volkow ND, Swanson JM. Clinical practice: Adult attention deficit-hyperactivity disorder. N Engl J Med. 2013 Nov 14;369(20):1935-44. [Medline]
- DSM-5 development. Arlington, VA: American Psychiatric Association, 2012 (http://www.dsm5.org).
Created Nov 14, 2013.
