The primary characteristic of attention deficit hyperactivity disorder (ADHD) is a pattern of inattention and/or hyperactivity-impulsivity. This pattern of behavior interferes with functioning or development — that is, deficits in performance at school, home, and in social relationships. ADHD without the hyperactivity component is often referred to as just plain attention deficit disorder (ADD).
ADHD begins in childhood. The symptoms of inattention or hyperactivity need to manifest themselves in a manner that is inconsistent with the child’s current developmental level. That is, the child’s behavior is significantly more inattentive or hyperactive than that of his or her peers of a similar age.
Several symptoms must be present before age 12. This age requirement supports ADHD/ADD as a neurodevelopmental disorder. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), symptoms were required before age 7.
Now the age of 12 is seen as an acceptable criterion because it is often difficult for adults (e.g., parents) to look retrospectively and establish a precise age of onset for a child. Indeed, adult recall of childhood symptoms tends to be unreliable. Thus, the DSM-5 has added some leeway to the age cut-off.
A person can present with predominantly inattention, predominantly hyperactivity-impulsivity, or a combination of the two. To meet for each of these ADHD specifiers, a person must exhibit at least 6 symptoms from the appropriate categories below.
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 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 (not due to oppositional behavior or failure to understand instructions)
- Often has difficulty organizing tasks and activities
- Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
- Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
- Is often easily distracted by extraneous stimuli
- Is often forgetful in daily activities–even those the person performs regularly (e.g., a routine appointment)
Symptoms of Hyperactivity/Impulsivity:Hyperactivity
- 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 it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
- Often has difficulty playing or engaging in leisure activities quietly
- Is often “on the go” or often acts as if “driven by a motor”
- Often talks excessively
- Often blurts out answers before questions have been completed
- Often has difficulty awaiting turn
- Often interrupts or intrudes on others (e.g., butts into conversations or games)
Symptoms must have persisted for at least 6 months.
Some of these symptoms need to have been present as a child, at 12 years old or younger. The symptoms also must exist in at least two separate settings (for example, at school and at home). The symptoms should be creating significant impairment in social, academic or occupational functioning or relationships.