ADHD - DSM-5

Inattention Symptoms

6+ symptoms, lasting at least 6mo, at a degree that isn’t consistent w/ developmental level & negatively impacts social + academic / occupational activites. if over 17, only 5+ symptoms required.

1. often fails to pay close attention to details or makes careless mistakes in schoolwork / at work / during other activities

2. often has difficulty keeping attention on tasks / play activities for long periods of time

3. often doesn’t seem to listen when spoken to directly

4. often doesn’t follow through on instructions + fails to finish schoolwork, chores, or workplace tasks

5. often has difficulty organising tasks + activities

6. often avoids, dislikes, or is reluctant to participate in tasks that need sustained mental effort

7. often loses things necessary for tasks / activities

8. often easily distracted by unnecessary stimuli (can include unrelated thoughts)

9. often forgetful in daily activities

Hyperactivity + Impulsivity Symptoms

6+ symptoms, lasting at least 6mo, at a degree that isn’t consistent w/ developmental level & negatively impacts social + academic / occupational activites. if over 17, only 5+ symptoms required.

1. often fidgets, taps hands / feet, or squirms in seat

2. often leaves seat in situations where expected to remain sitting

3. often runs about or climbs in inappropriate situations 

   • in teens / adults, may be limited to feeling restless

4. often unable to play or engage in leisure activities quietly

5. often “on the go”, acting as if “driven by a motor”

6. often talks excessively

7. often blurts out answers before questions are finished

8. often has difficulty waiting their turn

9. often interrupts or intrudes on others

Diagnostic Criteria

A) persistent pattern of inattention and/or hyperactivity-impulsivity that interferes w/ functioning / development, lasting at least 6mos

B) several inattentive or hyperactive-impulsive symptoms were present before age 12

C) several inattentive or hyperactive-impulsive symptoms are present in 2+ settings

D) clear evidence that symptoms interfere w/ or reduce the quality of social / academic / occupational functioning

E) symptoms don’t occur exclusively during course of schizophrenia / another psychotic disorder + aren’t better explained by another mental disorder

Specifiers

• combined presentation: if inattention criteria + hyperactivity-impulsivity criteria are both met for past 6mos

• predominantly inattentive presentation: if only inattention criteria is met for the past 6mos

• predominantly hyperactive/impulsive presentation: if only hyperactivity-impulsivity criteria is met for the last 6mos

Risk + Prognostic Factors

• temperamental: reduced behavioural inhibition, negative emotionality, higher amt of novelty seeking, effortful control / constraint

• environmental: v. low birth weight + degree of prematurity (more extreme → more risk), prenatal exposure to smoking, neurotoxin / alcohol / infection exposure in utero

• genetic: 74% heritability; higher prev. in people w/ epilepsy; may be influenced by visual / hearing impairments, metabolic abnormalities, nutritional deficiencies

Development + Course

• symptoms difficult to distinguish from normative behaviours before age 4

• most often IDed during elementary school, as inattention becomes more obvious + impairing in classroom setting

• tends to be stable thru early adolescence

• some find that motor hyperactivity reduces but difficulties w/ restlessness, inattention, impulsivity persist into adulthood

Prevalence

• 7.2% in children worldwide

• 2.5% in adults

• higher prevalence in foster children + correctional settings

Sex + Gender Differences

• more frequently diagnosed in M than W

  • 2:1 in children

  • 1.6:1 in adults

• women more likely to present w/ inattentive features

Culture-Related Diagnostic Issues

• cultural variation in behavioural norms + expectations for children affects how symptoms are interpreted

• higher diagnosis rates in non-Latinx white populations in US than Black or Latinx populations — may be due to mislabeling of ADHD symptoms in these groups as oppositional / disruptive bc of clinician bias, as well as greater parental demand for behaviours to be diagnosed as ADHD

• culturally competent diagnostic practices are crucial

Functional Consequences

• associated w/ reduced school performance + academic achievement

• elevated inattention symptoms → academic deficits, school-related problems

• elevated hyperactivity/impulsivity → peer rejection, accidental injury

• in adults: poorer occupational performance, higher probability of unemployment, elevated interpersonal conflict

• tend to have lower self-estem, more likely to develop conduct disorder in teens + antisocial personality in adulthood

• more likely to be injured + higher mortality rate

• higher risk for suffering trauma + subsequent PTSD

Treatment

• pharmacological treatment is most common

  • methylphenidate + amphetamines are first-line

  • non-stimulant medications: alpha agonists + norepinephrine reuptake inhibitors

• behavioural interventions: behavioural parental training + social skills training

• cognitive interventions: focus on improving working memory, attention, + inhibitory control