Attention Deficit Hyperactivity Disorder: Diagnosis

For a diagnosis of ADHD, the American Psychiatric Association requires at least 6 symptoms of inattention or at least 6 symptoms of hyperactivity and impulsivity, which are listed below.¹ Symptoms must have lasted for at least 6 months, must have begun prior to age 7, and must be present in at least 2 settings (eg, school and home). Also, there must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

Symptoms of Inattention

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

Symptoms of Hyperactivity and Impulsivity

• Often fidgets with hands or feet or squirms in seat.
• Often leaves seat in classroom or in other situations in which remaining seated is expected.
• Often runs about or climbs excessively in situations in which these behaviors are inappropriate (in adolescents, or adults, may be limited to subjective feelings of restlessness).
• Often has difficulty playing or engaging in leisure activities quietly.
• Often "on the go" or acts as if "driven by a motor."
• Often talks excessively.
• Impulsivity.
• Often blurts out answers before questions have been completed.
• Often has difficulty awaiting turn.
• Often interrupts or intrudes on others (eg, butts into conversations or games).

A medical, neurologic, psychological, and cognitive evaluation should be performed to rule out underlying medical contributors, cognitive deficiencies, and mimicking disorders. Diagnosis of adult ADHD is similar to that in children, but may be complicated by a more subtle presentation, usually lacking the hyperactivity component.