DSM-5 Diagnostic Criteria for ADHD

I just want to know what the symptoms of ADHD are, you say. What’s a DSM-5 and why should I care?

The DSM is a book called the Diagnostic and Statistical Manual of Mental Disorders. But, we refer to it as the DSM because, well, try saying “Diagnostic and Statistical Manual of Mental Disorders five times fast.

The DSM is sometimes called the “bible” of psychiatry because it contains extensive standards for diagnosing different mental health conditions. Unlike the actual bible, though, the DSM is put together by committees of mental health professionals and published by the American Psychiatric Association.

One of the conditions outlined in the DSM is, you guessed it, ADHD. The guidelines in the DSM are widely used by psychiatrists in the United States for diagnosing ADHD. In other words, while the DSM isn’t actually holy writ, it is the closest thing we have to a standard definition of what ADHD is.

The DSM lays out 18 core symptoms of ADHD. Before we get into those, however, there are a few things to keep in mind about how to interpret the symptoms in the DSM. (Or, just scroll down if you want to know what the symptoms are right now.)

What are the requirements for diagnosis?

The DSM-5 lists nine symptoms that have to do with being inattentive and nine symptoms that have to do with being hyperactive or impulsive. People with ADHD can have either inattentive symptoms, hyperactive symptoms or both.

For adults and older teenagers, the requirement for being diagnosed with inattentive ADHD is having at least five of the nine inattentive symptoms listed in the DSM. For being diagnosed with the hyperactive-impulsive side of ADHD, the requirement is again to experience at least five symptoms.

Beyond that, the person being diagnosed should have had some of the symptoms before the age of 12, and they should have some of the symptoms in at least two different settings at work, at home, in social situations, etc.

Finally, the symptoms have to have some impact on the person’s life. Specifically, the DSM-5 requires that the symptoms “interfere with, or reduce the quality of, social, academic, or occupational functioning.”

In general terms, these requirements mean that for someone to be diagnosed with ADHD, they should have symptoms that have been around since childhood, that show up in multiple parts of the person’s life, and that cause real problems in terms of functioning.

What’s new in the DSM-5?

The DSM-5 is, as the name suggests, the fifth edition of the DSM. The DSM is regularly updated as new research sheds more light on different psychiatric disorders, and DSM-5 was published in 2013. So yes, technically what this means is that the definition of what ADHD is changes every time this book is updated.

From the DSM-IV to the DSM-5, the changes in the guidelines for diagnosing ADHD were relatively small. The core symptoms themselves have remained unchanged, but some of the requirements for being diagnosed with ADHD have been relaxed to fit with a new understanding of how ADHD can look different in different people.

For example, the DSM-IV required symptoms of ADHD show up by age 7. Now, the cutoff is 12. The old DSM required that symptoms be “clinically significant.” Now it’s only necessary that they “reduce the quality of … functioning.” And the DSM-IV required at least six symptoms for diagnosis, but in the DSM-V that threshold is five.

Therefore, the difference between the DSM-IV and DSM-5 is relatively minor as far as ADHD is concerned. However, if you’re interested in learning more about the specifics of how ADHD is diagnosed and the philosophical questions that come up when mental health professionals have to decide exactly who does and doesn’t get an official diagnosis, here’s a good summary that describes the changes from the last version of the DSM to this one as “subtle but important.”

What are the symptoms defined in DSM-5?

Let’s get to the good stuff. The DSM-5 lists 18 symptoms of ADHD overall, including nine symptoms involving inattention and nine involving hyperactivity and impulsivity.

Here are the nine inattentive symptoms:

  • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or in other activities
  • Often has trouble sustaining attention
  • Often does not seem to listen when spoken to directly
  • Often does not follow through on instructions and fails to finish schoolwork, chores or workplace duties
  • Often has difficulty organizing tasks and activities
  • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental
  • Often loses things necessary for tasks or activities
  • Is often easily distracted by extraneous stimuli
  • Is often forgetful in daily activities

And here are the nine hyperactive symptoms:

  • Often fidgets with or taps hands or feet, or squirms in seat
  • Often leaves seat in situations when remaining seated is expected
  • Often runs about or climbs in situations where it is not appropriate (in adolescents or adults, may be limited to feeling restless
  • Often unable to play or engage in leisure activities quietly
  • Is often “on the go,” acting as if “driven by a motor”
  • Often talks excessively
  • Often blurts out an answer before a question has been completed
  • Often has difficulty waiting their turn
  • Often interrupts or intrudes on others

Are both inattentive and hyperactive symptoms required for diagnosis?

To be diagnosed with ADHD under the DSM-5 criteria, it’s only necessary to have five of the inattentive symptoms or five of the hyperactive symptoms. In fact, this is one reason someone might not be diagnosed with ADHD until later in life: if they have only inattentive symptoms with few or no outward signs of hyperactivity, it’s plausible that their parents and teachers wouldn’t have picked up on the signs of ADHD when they were growing up.

People who meet the DSM-5 criteria for inattention but not for hyperactivity are said to have a predominantly inattentive presentation of ADHD. Correspondingly, people who meet the criteria for hyperactivity but not inattention are said to have a predominantly hyperactive-impulsive presentation.

Of course, many people with ADHD have both inattentive and hyperactive/impulsive symptoms. These people are said to have a combined presentation.

Can I diagnose myself using the DSM-5 criteria?

Reading through the DSM-5 criteria for diagnosing ADHD is useful for getting a better sense of what ADHD looks like and how it’s diagnosed, but ultimately, these diagnostic guidelines can’t be used for self-diagnosis.

Figuring out whether specific behaviors you have meet the criteria set forth by the DSM for diagnosis requires an in-depth conversation with a mental health professional. If after reading through the ADHD symptoms outlined in the DSM-5 you suspect you may have ADHD, you owe it to yourself to get in touch with a mental health professional who is knowledgeable about ADHD so you can take steps toward getting an official diagnosis and access to treatment.

Image: Flickr/Richard Masoner

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