Deciding whether someone has Attention-Deficit/Hyperactivity Disorder (ADHD) is a detailed process that requires careful evaluation. It’s crucial to understand that there isn’t a single, definitive test for ADHD. Many conditions, such as sleep disorders, anxiety, depression, and learning disabilities, can present symptoms that overlap with ADHD, making accurate diagnosis essential.
When to Consult a Healthcare Professional
If you have concerns about yourself or someone you know exhibiting signs of ADHD, the first step is to schedule a consultation with a healthcare provider. This initial discussion will help determine if the observed symptoms align with the criteria for an ADHD diagnosis. A diagnosis can be officially made by qualified mental health professionals, including psychologists and psychiatrists, or by primary care providers such as pediatricians and family doctors. These professionals are trained to differentiate ADHD from other conditions and conduct a thorough assessment.
Diagnosing ADHD in Children and Adolescents
For children and adolescents, diagnosing ADHD involves a comprehensive approach. Healthcare providers will first rule out any other medical or psychological conditions that might better explain the symptoms or co-exist with ADHD. The American Academy of Pediatrics (AAP) provides clear guidelines1 for healthcare providers, emphasizing the importance of gathering information from multiple sources. This includes parents, teachers, and other adults who interact with the child in different environments like home, school, and social settings. These insights help to create a holistic picture of the child’s behavior and functioning across various contexts. For more in-depth information, you can explore the recommendations for the diagnosis and treatment of ADHD in children and adolescents.
Further Reading: Understanding the Connection Between Family Health History, ADHD, and Learning Disorders
Diagnosing ADHD in Adults
ADHD is not just a childhood condition; it frequently persists into adulthood. However, ADHD symptoms can manifest differently as individuals age. For instance, hyperactivity in adults might present as extreme restlessness, difficulty relaxing, or a tendency to overwhelm others with constant activity. Recognizing these varied presentations is vital for accurate diagnosis in adults. To gain a deeper understanding of how ADHD evolves across the lifespan, resources on ADHD in adults are readily available.
For comprehensive guidance on ADHD diagnosis and treatment across all age groups, the websites of the National Resource Center on ADHD and the National Institute of Mental Health offer valuable information and support.
DSM-5 Diagnostic Criteria for ADHD
Healthcare professionals rely on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)2 as the standard guidelines for diagnosing ADHD. These criteria ensure consistent and appropriate diagnosis and treatment of ADHD across different populations and settings. Using a uniform diagnostic standard also enables public health researchers to accurately assess the prevalence of ADHD and its impact on communities.
Symptom Thresholds for ADHD Diagnosis by Age
The DSM-5 specifies the number of symptoms required for an ADHD diagnosis based on age:
- Children up to age 16: Must exhibit six or more symptoms of inattention and/or hyperactivity-impulsivity.
- Adolescents ages 17 and older and adults: Must exhibit five or more symptoms of inattention and/or hyperactivity-impulsivity.
These symptoms must represent a persistent pattern of inattentionA and/or hyperactivity–impulsivityB–impulsivityC that significantly interferes with an individual’s daily functioning or development.
Detailed DSM-5 Criteria for ADHD Diagnosis
The following is a concise overview of the DSM-5 criteria for ADHD. It’s important to remember that only qualified healthcare providers are authorized to diagnose and treat ADHD. This information is for educational purposes only and should not be used for self-diagnosis.
Inattention Symptoms
Note: Inattention symptoms must have been present for at least 6 months and be inappropriate for the individual’s developmental age.
- Frequently overlooks details or makes careless errors in schoolwork, work, or other activities. For example, missing details, work lacking accuracy.
- Struggles to sustain attention in tasks or play activities. For example, difficulty remaining focused during lectures, conversations, or lengthy reading.
- Often appears not to listen when spoken to directly. For example, mind seems elsewhere, even without obvious distraction.
- Often fails to follow through on instructions and does not complete schoolwork, chores, or workplace duties. For example, starts tasks but quickly loses focus and is easily sidetracked.
- Experiences difficulty organizing tasks and activities. For example, struggles with managing sequential tasks, keeping materials and belongings in order, poor time management, fails to meet deadlines.
- Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort. For example, schoolwork, homework, for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers.
- Loses items necessary for tasks or activities. For example, school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile phones.
- Is easily distracted by extraneous stimuli. For older adolescents and adults may include unrelated thoughts.
- Is forgetful in daily activities. For example, doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments.
Hyperactivity and Impulsivity Symptoms
Note: Hyperactivity-impulsivity symptoms must have been present for at least 6 months and be inappropriate for the individual’s developmental age.
- Fidgets with or taps hands or feet or squirms in seat.
- Leaves seat in situations when remaining seated is expected. For example, leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place.
- Runs about or climbs in situations where it is inappropriate. Note: In adolescents or adults, may be limited to feeling restless.
- Unable to play or engage in leisure activities quietly.
- Is often “on the go,” acting as if “driven by a motor”. Unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as restless or difficult to keep up with.
- Talks excessively.
- blurts out an answer before a question has been completed. For example, completes other people’s sentences; cannot wait for turn in conversation.
- Has difficulty waiting their turn. For example, while waiting in line, while speaking in conversations.
- Interrupts or intrudes on others. For example, butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into/take over what others are doing.
Additional Conditions for ADHD Diagnosis
In addition to meeting the symptom criteria, the following conditions must also be satisfied for an ADHD diagnosis:
- Several inattentive or hyperactive-impulsive symptoms were present before age 12.
- Symptoms are present in two or more settings (e.g., at home, school, work; with friends or relatives; in other activities).
- There is clear evidence that the symptoms significantly interfere with, or reduce the quality of, social, academic, or occupational functioning.
- The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or personality disorder). The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder.
For further information on diagnosis and treatment across the lifespan, please visit the National Resource Center on ADHD and the National Institute of Mental Health websites.
Resources
References
[1] American Academy of Pediatrics. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 144(4), e20192528.
[2] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Footnotes
[A] Inattention means not being able to keep focused on a task, being disorganized, and having trouble paying attention to details.
[B] Hyperactivity means moving around too much, fidgeting, and talking too much.
[C] Impulsivity means acting without thinking or having difficulty with self-control.
