How is ADHD Diagnosed?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the manual used by clinicians and researchers to diagnose and classify mental disorders and is produced by The American Psychiatric Association (APA).  The APA is a national medical specialty society whose more than 36,000 physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including ADHD. 

DSM-V is the guide that lays out the criteria to be used by doctors, mental health professionals, and other qualified clinicians when making a diagnosis of ADHD.

The 5th edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-V), was released by the APA in May 2013.

According to DSM-V, ADHD is now listed in the new category of ‘Neurodevelopmental Disorders’ and described as:

“a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with development, has symptoms presenting in two or more settings (e.g. at home, school, or work), and negatively impacts directly on social, academic or occupational functioning”.

Symptoms are divided into two categories:

1.     Inattention; and

2.     Hyperactivity and Impulsivity.

Children must have at least six symptoms from either, or both categories, while older adolescents and adults (over age 17 years) must present with five.

Symptoms must have been present before age 12 (compared to age 6 in DSM-IV).

Because everyone shows some of these behaviors at times, the DSM-V contains very specific guidelines for determining when they indicate ADHD. The behaviors must appear before age 12, and continue for at least 6 months.  In children, they must be more frequent or severe than in others of the same age.  In particular, the behaviours must create a real hindrance in at least two areas of a person's life, such as school, home, work, or social settings.  Therefore someone whose work or friendships are not impaired by these behaviors would not be diagnosed with ADHD. Nor would a child or adult who seems overly active at school or work but functions well elsewhere.DSM-V was updated to reflect more accurately the experience of adults with ADHD. Although ADHD is a disorder that commences in childhood, it can continue throughout adulthood for some people.

DSM-V has provided guidance to clinicians in diagnosing adults with the condition and ensuring that children with ADHD will continue to have access to care for the condition throughout their lives if necessary.

DSM-5 includes no exclusion criteria for people with autism spectrum disorder, since symptoms of both disorders co-occur, meaning that a person can now have a diagnosis of both ADHD and Autism Spectrum Disorder.  However, ADHD symptoms must not occur exclusively during the course of schizophrenia or another psychotic disorder and must not be better explained by another mental disorder, such as a depressive or bipolar disorder, anxiety disorder, dissociative disorder, personality disorder, or substance intoxication or withdrawal.

A person’s ‘presentations’ can be subject to change during their lifetime which better describes how the disorder affects an individual at different points in their life.

A person can now be diagnosed with mild, moderate or severe ADHD based on how many symptoms a person has and how difficult those symptoms make daily life.

What symptoms must a person have for a diagnosis of ADHD?

To confirm a diagnosis children should have six or more symptoms of the disorder.  In older teens and adults the DSM-V states they should have at least five symptoms.

The criteria of symptoms for a diagnosis of ADHD:

Inattentive presentation:

· Fails to give close attention to details or makes careless mistakes

· Has difficulty sustaining attention

· Does not appear to listen

· Struggles to follow through on instructions

· Has difficulty with organization

· Avoids or dislikes tasks requiring a lot of thinking

· Loses things

· Is easily distracted

· Is forgetful in daily activities

Hyperactive-impulsive presentation:

· Fidgets with hands or feet or squirms in chair

· Has difficulty remaining seated

· Runs about or climbs excessively in children; extreme restlessness in adults

· Difficulty engaging in activities quietly

· Acts as if driven by a motor

· Talks excessively

· Blurts out answers before questions have been completed

· Difficulty waiting or taking turns

· Interrupts or intrudes upon others

Combined inattentive & hyperactive-impulsive presentation:

· Has symptoms from both of the above presentations 

The DSM-V diagnosis is a label informing us the observed behaviours are considered to be outside the normal range.  However, the label does not tell us why that might be so or about any possible underlying causes.