Let’s have a look at the diagnostic criteria today
According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) the following criteria are required for a diagnosis of ADHD.
Symptoms of Inattention
Children (up to age 16): Six or more symptoms. Adolescents (17 and older) and adults: Five or more symptoms. Symptoms present for at least 6 months and are inappropriate for developmental level and may include:
- Fails to give attention to details, makes careless mistakes.
- Has trouble holding attention on tasks or play activities.
- Doesn’t seem to listen when spoken to directly.
- Doesn’t follow through on instructions, fails to finish tasks.
- Has trouble organizing tasks and activities.
- Avoids tasks requiring long-term mental effort.
- Frequently loses necessary items for tasks.
- Easily distracted.
- Often forgetful in daily activities.
Symptoms of Hyperactivity and Impulsivity
Children (up to age 16): Six or more symptoms. Adolescents (17 and older) and adults: Five or more symptoms. Symptoms present for at least 6 months are disruptive and inappropriate for developmental level and may include:
- Fidgets with or taps hands/feet, or squirms in seat.
- Leaves seat when remaining seated is expected.
- Runs or climbs in inappropriate situations.
- Unable to play quietly.
- Acts as if “driven by a motor” and is often on the go.
- Talks excessively.
- Blurts out answers prematurely.
- Has trouble waiting for their turn.
- Interrupts or intrudes on others.
Symptoms must occur “often”, must appear in two or more settings, and interfere with social, school, or work functioning. They cannot be explained by another disorder.
Specifying presentation and severity
How do your ADHD symptoms present?
ADHD has three presentations (not types), and these can change over time.
- If you meet the criteria for inattention, you have ADHD predominantly inattentive presentation.
- If you meet the criteria for hyperactivity and impulsivity, you have ADHD predominantly hyperactive-impulsive presentation.
- If you meet the criteria for both, you have ADHD combined presentation.
How much does your ADHD impair your life?
ADHD symptoms vary from one person to the next, and they can also vary over time. Moreover, the extent to which ADHD has a negative impact on your quality of life is considered. The DSM 5 requires that a diagnosing clinician specify the severity of the disorder, based on the number of symptoms and the degree of impairment: “mild” (few symptoms and minor impairment) to “severe” (more symptoms than required, some symptoms especially severe and/or marked impairment), with “Mild” filling the gap.
ADHD in remission?
As ADHD symptoms and the extent to which they impact your life can change over time, there are periods when you may present fewer than the necessary number in the past six months to meet the criteria. Yet, the symptoms still cause impairment in your social, academic, or occupational functioning. Clinicians can then say your ADHD is in partial remission.
The DSM 5 criteria for ADHD are outdated
The diagnostic criteria for ADHD have not changed much in 20 years. Furthermore, back in 2013, recommendations by the committee trying to change the DSM 5 criteria for ADHD were largely rejected. Russell Barkley notes that:
- Symptoms are male biased.
- Symptoms are mainly worded for children.
- Clarifications for adults were not based on research.
- Impulsively is under-represented.
- Inattention falls within the executive functioning, and executive functioning symptoms not included.
- No symptoms for emotional dysregulation (before 1968, emotional regulation was a central feature of the many descriptions of ADHD)
- The threshold for adults should be 4 and not 5.
- Age of onset should not be included (recall of age of onset is poor and therefore unreliable) — you could miss half of the criteria if you apply the age of onset.
- The criterion for symptoms occurring 6-months is too short (should be a year, to account for episodic presentation.
