Diagnostic Symptoms

For mental disorders, a psychiatrist uses guidelines in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) to evaluate an adult for the possible presence of ADHD. This manual contains diagnostic criteria for three types of ADHD: combined, predominantly inattentive, and predominantly hyperactive-impulsive.  DSM-IV  lists the symptoms and signs required for a diagnosis of any type of ADHD:

(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

1. often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
2. often has difficulty sustaining attention in tasks or play activities
3. often does not seem to listen when spoken to directly
4. 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)
5. often has difficulty organizing tasks and activities
6. often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
7. often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
8. is often easily distracted by extraneous stimuli
9. is often forgetful in daily activities

(2) six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:

Hyperactivity

1. often fidgets with hands or feet or squirms in seat
2. often leaves seat in classroom or in other situations in which remaining seated is expected
3. often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
4. often has difficulty playing or engaging in leisure activities quietly
5. is often "on the go" or often acts as if "driven by a motor"
6. often talks excessively

Impulsivity

1. often blurts out answers before questions have been completed
2. often has difficulty awaiting turn
3. often interrupts or intrudes on others (e.g., butts into conversations or games)

Significantly, the onset of "symptoms that caused impairment" must have been "before age 7 years."  The age of seven was arbitrarily set by a group of national experts several years ago. The inattentive child without disruptive behavior, may not demonstrate impairment in school until middle school or high school. Therefore, the age of seven may be too restrictive for diagnosis.

DSM-IV requires that the symptoms of inattention and/or hyperactivity impulsivity must cause "some impairment" in two or more settings, and "there must be clear evidence of clinically significant impairment in social, academic, or occupational functioning."  Further, DSM-IV requires the psychiatrist to be sure that the symptoms of impulsivity and/or hyperactivity-impulsivity" are not better accounted for by another mental disorder."  Although the DSM-IV criteria were designed for use in evaluating children and adolescents, the editors do note that a "minority" of children and adolescents with ADHD retain "the full complement of symptoms" into adulthood.  For adults who retain "only some of the symptoms" of ADHD which they had in childhood and adolescence, DSM-IV advises using a diagnosis of "attention-deficit/hyperactivity disorder, in partial remission."