Symptoms and Diagnosis

Deciding if a child has ADHD is a several-step process. This page gives you an overview of how ADHD is diagnosed. There is no single test to diagnose ADHD, and many other problems, like sleep disorders, anxiety, depression, and certain types of learning disabilities, can have similar symptoms.

If you are concerned about whether a child might have ADHD, the first step is to talk with a healthcare professional to find out if the symptoms fit the diagnosis. The diagnosis can be made by a mental health professional, like a psychologist or psychiatrist, or by a primary care provider, like a pediatrician(https://www.cdc.gov/ncbddd/adhd/features/how-us-children-diagnosed.html).

The American Academy of Pediatrics (AAP) recommends that healthcare professionals ask parents, teachers, and other adults who care for the child about the child's behavior in different settings, like at home, school, or with peers. Read more about the recommendations(https://www.cdc.gov/ncbddd/adhd/guidelines.html).

The health professional should also determine whether the child has another condition that can either explain the symptoms better, or that occurs at the same time as ADHD. Read more about other concerns and conditions(https://www.cdc.gov/ncbddd/adhd/conditions.html).

How is ADHD diagnosed?

Healthcare professionals use the guidelines in the American Psychiatric Association's Diagnostic and Statistical Manual, Fifth edition (DSM-5)¹, to help diagnose ADHD. This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD. Using the same standard across communities can also help determine how many children have ADHD, and how public health is impacted by this condition.

DSM-5 Criteria for ADHD

People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development:

1. Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
   • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
   • Often has trouble holding attention on tasks or play activities.
   • 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 (e.g., loses focus, side-tracked).
   • Often has trouble organizing tasks and activities.
   • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
   • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
   • Is often easily distracted
   • Is often forgetful in daily activities.
2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
   • 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 (adolescents or adults may be limited to feeling restless).
   • Often unable to play or take part 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 trouble waiting his/her turn.
   • Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:

• Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
• Several symptoms are present in two or more setting, (such as at home, school or work; with friends or relatives; in other activities).
• There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
• The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.

Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months

Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months

Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.

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

ADHD in Adults

ADHD often lasts into adulthood. For more information about diagnosis and treatment throughout the lifespan, please visit the websites of the National Resource Center on ADHD and the National Institutes of Mental Health.

Changes in the DSM-5

The fifth edition of the DSM was released in May 2013 and replaces the previous version, the text revision of the fourth edition (DSM-IV-TR). There were some changes in the DSM-5 for the diagnosis of ADHD: 

• Symptoms can now occur by age 12 rather than by age 6; 
• Several symptoms now need to be present in more than one setting rather than just some impairment in more than one setting; 
• New descriptions were added to show what symptoms might look like at older ages; and 
• For adults and adolescents age 17 or older, only 5 symptoms are needed instead of the 6 needed for younger children.

Reference

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.