Criteria for diagnosing attention deficit hyperactivity disorder (ADHD)

The American Psychiatric Association describes the symptoms and criteria for diagnosing mental disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Diagnosis of attention deficit hyperactivity disorder (ADHD) depends upon a person fitting the descriptions of sections A through E.

Part of the criteria for diagnosing ADHD includes identifying the specific type (primarily inattentive, impulsive, or hyperactive). These guidelines, from section A, are listed in the following table.¹

Types of ADHD based upon DSM-IV criteria

Type of ADHD	Criteria for diagnosing
Inattentive	Criterion A1 is met but Criterion A2 is not met for the past 6 months.
Hyperactive-impulsive	Criterion A2 is met but Criterion A1 is not met for the past 6 months.
Combined	Both Criteria A1 and A2 are met for the past 6 months.
Not otherwise specified	The person has significant symptoms related to inattentiveness or hyperactivity-impulsiveness ADHD, but the pattern does not meet the full criteria for the disorder.

To fully diagnose ADHD, a person must fit the criteria from sections A through E.

DSM-IV criteria

A. Either 1 or 2:

1. Six or more of the following symptoms of inattention have persisted for at least 6 months to a degree that is not consistent with the normal expected behavior for the person's age.

a. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities

b. Often has difficulty sustaining attention in tasks or play activities

c. Often does not seem to listen when spoken to directly

d. 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)

e. Often has difficulty organizing tasks and activities

f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort, such as schoolwork or homework

g. Often loses things necessary for tasks or activities, such as toys, school assignments, pencils, books, or tools

h. Is often easily distracted by things around him or her

i. Is often forgetful in daily activities

2. Six or more of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months and are not consistent with the normal expected behavior of a person his or her age.

Hyperactivity

a. Often fidgets with hands or feet or squirms in seat

b. Often leaves seat in classroom or in other situations in which remaining seated is expected

c. Often runs about or climbs excessively in situations in which it is inappropriate (in teens or adults, may be limited to stated feelings of restlessness)

d. Often has difficulty playing or engaging in leisure activities quietly

e. Is often "on the go" or often acts as if "driven by a motor"

f. Often talks excessively

Impulsivity

g. Often blurts out answers before questions have been completed

h. Often has difficulty awaiting his or her turn

i. Often interrupts or intrudes on others, such as butting into conversations or games

B. Some hyperactive, impulsive, or inattentive symptoms that caused behavior problems were present before the child was 7 years old.

C. Some problems from the symptoms are present in two or more settings, such as at school, work, or home.

D. There must be clear evidence that the symptoms have caused problems in the person's social, school, or work setting.

E. The symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other mental disorder such as a mood, anxiety, dissociative, or personality disorder.

Note:

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition, Text Revision. Copyright 2000, American Psychiatric Association.

Citations

1. American Psychiatric Association (2000). Attention-deficit and disruptive behavior disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 85–103. Washington, DC: American Psychiatric Association.