ADHD: Identifying and Treating Attention Deficit Hyperactivity Disorder – Part 3

How Do We Identify ADHD?

Although toddlers and preschoolers, on occasion, may show characteristics of ADHD, some of these behaviors may be normal for their age or developmental stage. These behaviors must be exhibited to an abnormal degree to warrant identification as ADHD. Even with older children, other factors (including environmental influences) can produce behaviors resembling ADHD.

The criteria set forth by the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) are used as the standardized clinical definition to determine the presence of ADHD (see DSM-IV Criteria for ADHD). A person must exhibit several characteristics to be clinically diagnosed as having ADHD:

  • Severity: The behavior in question must occur more frequently in the child than in other children at the same developmental stage.
  • Early onset: At least some of the symptoms must have been present prior to age 7.
  • Duration: The symptoms must also have been present for at least 6 months prior to the evaluation.
  • Impact: The symptoms must have a negative impact on the child's academic or social life.
  • Settings: The symptoms must be present in multiple settings.

The specific DSM-IV criteria are set forth in the following chart.

DSM-IV Criteria for Attention Deficit/Hyperactivity Disorder
A. According to the DSM-IV, a person with Attention Deficit/Hyperactivity Disorder must have either (1) or (2):
(1)  Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
Inattention(a) often fails to give close attention to details or makes careless mistakes in school work, work, or other activities(b) often has difficulty sustaining attention in tasks or play activities(c) often does not seem to listen when spoken to directly(d) often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)

(e) often has difficulty organizing tasks and activities

(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)

(g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)

(h) is often easily distracted by extraneous stimuli

(i) is often forgetful in daily activities

(2)  Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
Hyperactivity(a) often fidgets with hands or feet or squirms in seat(b) often leaves seat in classroom or in other situations in which remaining seated is expected(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings or restlessness)(d) often has difficulty playing or engaging in leisure activities quietly

(e) is often "on the go" or often acts as if "driven by a motor"

(f) often talks excessively

(g) often blurts out answers before questions have been completed

(h) often has difficulty awaiting turn

(i) often interrupts or intrudes on others (e.g., butts into conversations or games)

B.  Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.
C.  Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).
D.  There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
E.  The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Disassociative Disorder, or a Personality Disorder).
Attention Deficit/Hyperactivity Disorder, Combined Type: if both Criteria A1 and A2 are met for the past 6 months.
Attention Deficit/Hyperactivity Disorder, Predominantly Inattentive Type: if Criterion A1 is met but Criterion A2 is not met for the past 6 months.
Attention Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type: if Criterion A2 is met but Criterion A1 is not met for the past 6 months.

Source: American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994.

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Source: Adapted from U.S. Department of Education, Office of Special Education and Rehabilitative Services, Office of Special Education Programs, Identifying and Treating Attention Deficit Hyperactivity Disorder: A Resource for School and Home, Washington, D.C., 2008.

Page last modified or reviewed by athealth on January 28, 2014