Click here to skip navigation

Close

DSM-5 Criteria

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition handbook, or DSM-5*, is the authoritative guide to the diagnosis of mental disorders, including ADHD, in the United States and other parts of the world. It defines the following dimensions, or presentations of ADHD:

  1. ADHD primarily of the Inattentive presentation
  2. ADHD primarily of the Hyperactive-Impulsive presentation
  3. ADHD Combined presentation
  4. ADHD Other Specified, and Unspecified ADHD

The diagnosis of ADHD must establish that 6 or more (5 or more if the adolescent is aged 17 or older) core symptoms are present in either or both the Inattention Dimension and/or the Hyperactivity-Impulsivity Dimension presentations, and occur inappropriately often. The core symptoms and dimensions are presented in the table below. Note that symptoms may present differently at different ages.

 

Table 1. Core Symptoms of ADHD Adapted from the DSM-5

Inattention Dimension

Hyperactivity-Impulsivity Dimension

Hyperactivity

Impulsivity
  • Careless mistakes
  • Difficulty sustaining attention
  • Seems not to listen
  • Fails to finish tasks
  • Difficulty organizing
  • Avoids tasks requiring sustained attention
  • Loses things
  • Easily distracted
  • Forgetful
  • Fidgeting
  • Unable to stay seated
  • Moving excessively (restless)
  • Difficulty engaging in leisure activities quietly
  • “On the go”
  • Talking excessively

 
  • Blurting answers before questions completed
  • Difficulty awaiting turn
  • Interrupting/intruding upon others

 

Source:ADHD PoC Algorithm, taken from the AAP 2019 ADHD Guideline: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in Children and Adolescents, as adapted from the *DSM 5 Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.

Following are the DSM-5 criteria by dimension. Behaviors must persist for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:

  • ADHD/I: Having at least 6 of 9 Inattention behaviors, and less than 6 Hyperactive-Impulsive behaviors.
  • ADHD/HI: Having at least 6 of 9 Hyperactive-Impulsive behaviors, and less than 6 Inattention behaviors.
  • ADHD/C: Having at least 6 of 9 behaviors in both the Inattention and Hyperactive-Impulsive dimensions.
  • ADHD Other Specified, and Unspecified ADHD: These categories are meant for children who meet many of the criteria for ADHD but not the full criteria, and who have significant impairment. ADHD Other Specified is used if the PCC specifies those criteria that have not been met; Unspecified ADHD is used if the PCC does not specify these criteria.

Following is a recap of the conditions that must be met:

  • Symptoms occur in 2 or more settings, such as home, school, and social situations, and cause some impairment.
  • In a child 4 to under 17 years of age, 6 or more symptoms in at least 1 dimension are identified.
  • In a child aged 17 years and older, 5 or more symptoms in at least 1 dimension are identified.
  • Symptoms significantly impair the child's ability to function in some of the activities of daily life, such as schoolwork, relationships with family, relationships with friends, or the ability to function in groups such as sports teams.
  • Symptoms start before the child reaches 12 years of age. However, these may not be recognized as ADHD symptoms until a child is older.
  • Symptoms have continued for more than 6 months.

Note: Because symptoms can change over time, the presentation may change over time as well.

Reference: AAP 2019 ADHD Guideline: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in Children and Adolescents, as adapted from *DSM-5 Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.

 *Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington, DC: American Psychiatric Association; 2013. Available at: https://dsm.psychiatryonline.org/doi/10.1176/appi.books.9780890425596.Introduction. Accessed August 29, 2019 (Login and subscription required.)