Opinion
Video
ADHD Diagnosis Criteria
Author(s):
Panelists discuss how the DSM-5-TR criteria for ADHD require at least 6 of 9 symptoms in either inattentive or hyperactive-impulsive domains, with inattentive presentations often going unrecognized especially in females and highly intelligent students.
The DSM-5-TR criteria for ADHD require at least six of nine symptoms in either inattentive or hyperactive-impulsive domains for children under 16 years. Inattentive symptoms include difficulty listening, following multi-step instructions, losing items, making careless mistakes, avoiding sustained mental effort, and easy distractibility. These symptoms often go unrecognized, particularly in females who predominantly present with inattentive type ADHD.
Hyperactive-impulsive symptoms are more externally visible and include feeling driven by a motor, difficulty waiting turns, blurting responses, inability to remain seated, interrupting others, excessive fidgeting, and inappropriate running or climbing. The combined presentation incorporates both symptom clusters, and presentations can evolve over time as children mature and academic demands change.
Diagnostic challenges include ensuring symptoms are developmentally appropriate rather than normal childhood behavior, differentiating ADHD from overlapping conditions like depression and anxiety, and recognizing that highly intelligent children may compensate until academic demands exceed their coping abilities. Assessment tools like the Vanderbilt and Conners scales help gather multi-informant data across different environments. Clinicians must be particularly vigilant for inattentive presentations that may be overlooked, especially in female patients and academically gifted children.
