Criteria

Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR)[1]

A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterised by (1) and/or (2):

1. Inattention: 6 (or more) of the following symptoms have persisted 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. Note: the symptoms are not solely a manifestation of oppositional behaviour, defiance, hostility, or failure to understand tasks or instructions.

  • Often fails to give close attention to details or makes careless mistakes in school work, 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, conversations, or lengthy reading).

  • 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 school work, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).

  • Often has difficulty organising tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganised work; has poor time management; fails to meet deadlines).

  • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., school work or homework).

  • Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

  • Is often easily distracted by extraneous stimuli.

  • Is often forgetful in daily activities (e.g., doing chores, running errands).

2. Hyperactivity and impulsivity: 6 (or more) of the following symptoms have persisted 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. Note: the symptoms are not solely a manifestation of oppositional behaviour, defiance, hostility, or failure to understand tasks or instructions.

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

  • Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom).

  • Often runs about or climbs excessively in situations in which it is inappropriate.

  • Often unable to play or engage in leisure activities quietly.

  • Is often 'on the go', acting as if 'driven by a motor' (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants; may be experienced by others as being restless or 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; cannot wait for their turn in conversation).

  • Often has difficulty awaiting his or her turn (e.g., while waiting in line).

  • Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission).

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before 12 years of age.

C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).

D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).

Criteria from sections A, B, C, D, and E must be met for a diagnosis to be given.

Specify whether:

  • Combined presentation: if both criterion A1 (inattention) and criterion A2 (hyperactivity-impulsivity) are met for the past 6 months.

  • Predominantly inattentive presentation: if criterion A1 (inattention) is met but criterion A2 (hyperactivity-impulsivity) is not met for the past 6 months.

  • Predominantly hyperactive/impulsive presentation: if criterion A2 (hyperactivity-impulsivity) is met and criterion A1 (inattention) is not met for the past 6 months.

Also specify current severity:

  • Mild: few, if any, symptoms in excess of those required to make the diagnosis are present, and symptoms result in no more than minor impairments in social or occupational functioning.

  • Moderate: symptoms or functional impairment between 'mild' and 'severe' are present.

  • Severe: many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present, or the symptoms result in marked impairment in social or occupational functioning.

Patients may be classified as being 'in partial remission' if full criteria were previously met, fewer than the full criteria have been met for the past 6 months, and the symptoms still result in impairment in social, academic, or occupational functioning.

International Classification of Diseases 11th revision (ICD-11)[2]

Hyperkinetic disorder in ICD 10th revision (ICD-10) has been replaced with ADHD in ICD-11. ADHD has also been moved from ‘Disruptive behaviour or dissocial disorders’ to ‘Neuro-developmental disorders’ to avoid stigma and reflect that individuals with ADHD are not intentionally disruptive.

In ICD-11, ADHD is characterised by a persistent pattern (e.g., at least 6 months) of inattention symptoms and/or a combination of hyperactivity and impulsivity symptoms that is outside the limits of normal variation expected for age and level of intellectual development. Symptoms vary according to chronological age and disorder severity.

Inattention

  • Several symptoms of inattention that are persistent, and sufficiently severe that they have a direct negative impact on academic, occupational, or social functioning. Symptoms are typically from the following clusters:

    • Difficulty sustaining attention to tasks that do not provide a high level of stimulation or reward or require sustained mental effort; lacking attention to detail; making careless mistakes in school or work assignments; not completing tasks.

    • Easily distracted by extraneous stimuli or thoughts not related to the task at hand; often does not seem to listen when spoken to directly; frequently appears to be daydreaming or to have mind elsewhere.

    • Loses things; is forgetful in daily activities; has difficulty remembering to complete upcoming daily tasks or activities; difficulty planning, managing and organising schoolwork, tasks and other activities.

  • Inattention may not be evident when the individual is engaged in activities that provide intense stimulation and frequent rewards.

Hyperactivity/impulsivity

  • Several symptoms of hyperactivity/impulsivity that are persistent, and sufficiently severe that they have a direct negative impact on academic, occupational, or social functioning. These tend to be most evident in structured situations that require behavioural self-control. Symptoms are typically from the following clusters:

    • Excessive motor activity; leaves seat when expected to sit still; often runs about; has difficulty sitting still without fidgeting (younger children).

    • Difficulty engaging in activities quietly; talks too much.

    • Blurts out answers in school, comments at work; difficulty waiting turn in conversation, games, or activities; interrupts or intrudes on others conversations or games.

    • A tendency to act in response to immediate stimuli without deliberation or consideration of risks and consequences (e.g., engaging in behaviours with potential for physical injury; impulsive decisions; reckless driving).

  • Evidence of significant inattention and/or hyperactivity-impulsivity symptoms prior to age 12, though some individuals may first come to clinical attention later in adolescence.

  • Manifestations of inattention and/or hyperactivity-impulsivity must be evident in more than one situation or setting (e.g., home, school, work, with friends or relatives), but are likely to vary according to the structure and demands of the setting.

  • Symptoms are not better accounted for by another mental disorder (e.g., an anxiety or fear-related disorder or a neuro-cognitive disorder such as delirium).

  • Symptoms are not due to the effects of a substance (e.g., cocaine) or medication (e.g., bronchodilators, thyroid replacement medication) on the central nervous system, including withdrawal effects, and are not due to a disease of the nervous system.

Specifiers

  • The characteristics of the current clinical presentation should be described using one of the following specifiers, which are meant to assist in recording the main reason for the current referral or services. Predominance of symptoms refers to the presence of several symptoms of either an inattentive or hyperactive/impulsive nature with few or no symptoms of the other type.

    • Predominantly inattentive presentation: all diagnostic requirements for ADHD are met and inattentive symptoms predominate.

    • Predominantly hyperactive-impulsive presentation: all diagnostic requirements for ADHD are met and symptoms of hyperactivity-impulsivity predominate.

    • Combined presentation: all diagnostic requirements for ADHD are met and both hyperactive-impulsive and inattentive symptoms are clinically significant aspects of the current clinical presentation, with neither clearly predominating.

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