Attention deficit hyperactivity disorder (ADHD) is characterized by symptoms that include: trouble organizing tasks, being easily distracted, avoiding things that take effort, an inability to sustain attention on a task, and problems with follow-through. Hyperactivity (fidgeting, excessive talking, restlessness) and impulsivity (difficulty waiting one’s turn or with patience, interrupting others) may also be symptoms of ADHD.
The primary symptom of attention deficit hyperactivity disorder (ADHD) is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or a child’s development.
Attention deficit disorder begins in childhood (although it may not be diagnosed until later in life). The symptoms of inattention and hyperactivity need to show themselves in a manner and degree which 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 (which is why ADHD is classified as a neurodevelopmental disorder, even if not diagnosed until adulthood). 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 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 symptoms that are predominantly characterized by 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
- 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)
In order for a diagnosis of ADHD to be made, 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.
This criteria has been updated for DSM-5. See next page for diagnostic codes and related resources for ADHD.
Diagnostic Codes for ADHD (consider past 6 months of symptoms)
- 314.01 for both combined presentation (i.e., inattention with hyperactivity/impulsivity) and for predominantly hyperactive/impulsive presentation (i.e., inattention criteria is not met).
- 314.00 for Predominantly inattentive presentation (hyperactivity-impulsivity criteria is not met).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Millichap, J.G. (2011). Attention Deficit Hyperactivity Disorder Handbook: A Physician’s Guide to ADHD (2nd ed.). New York: Springer.
National Institute of Mental Health. (2018). Attention deficit hyperactivity disorder. Retrieved from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml on February 27, 2018.