Study Notes on DSM-5 Attention-Deficit/Hyperactivity Disorder (ADHD)

DSM-IV vs. DSM-5 Classification of Disorders

  • Disorder Classifications

    • Disorders Usually Diagnosed in Infancy, Childhood, and Adolescence
    • Neurodevelopmental Disorders

  • ## Attention-Deficit/Hyperactivity Disorder (ADHD) Criteria

    • A. Persistent Pattern of Inattention and/or Hyperactivity-Impulsivity
    • Must interfere with functioning or development.
    • Must be characterized either by inattention, hyperactivity-impulsivity, or both.

Inattention Criteria

  • For Diagnosis:

    • Six (or more) symptoms must persist for at least 6 months to a degree that is:
    • Maladaptive and inconsistent with developmental level.
    • Negatively impacts social and academic/occupational activities.

  • Symptoms of Inattention:

    1. Careless Mistakes: Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities (e.g., overlooks or misses details, work is inaccurate).
    2. Sustaining Attention: Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
    3. Listening: Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
    4. Following Through: 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. Organizing Tasks: Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks, keeping materials and belongings in order, messy work, poor time management, failing to meet deadlines).
    6. Avoidance of Tasks: Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework).
    7. Losing Things: Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, tools).
    8. Easily Distracted: Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).
    9. Forgetfulness: Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).

Hyperactivity-Impulsivity Criteria

  • For Diagnosis:

    • Six (or more) symptoms of hyperactivity-impulsivity must persist for at least 6 months to a degree that is:
    • Maladaptive and inconsistent with developmental level.
    • Negatively impacts social and academic/occupational activities.

  • Symptoms of Hyperactivity-Impulsivity:

    1. Fidgeting: Often fidgets with or taps hands or feet or squirms in seat.
    2. Leaving Seat: Often leaves seat in classroom or in other situations where remaining seated is expected.
    3. Running About: Often runs about or climbs excessively in inappropriate situations (in adolescents or adults, it may be limited to subjective feelings of restlessness).
    4. Difficulty Playing Quietly: Often has difficulty playing or engaging in leisure activities quietly.
    5. On the Go: Is often "on the go" or often acts as if "driven by a motor" (e.g., unable to be or uncomfortable being still for extended time).
    6. Excessive Talking: Often talks excessively.
    7. Blurting Out: Often blurts out an answer before a question has been completed.
    8. Difficulty Waiting Turn: Often has trouble waiting for his/her turn.
    9. Interrupting Others: Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities).

Additional Criteria for Diagnosis of ADHD

  • B. Evidence of Symptoms:
    • Some inattentive or hyperactive-impulsive symptoms must have been present before age 7.
  • C. Settings of Impairment:
    • Symptoms must present in at least two settings (e.g., at school or work and at home).
  • D. Clinically Significant Impairment:
    • Clear evidence of clinically significant impairment in social, academic, or occupational functioning.
  • E. Exclusion of Other Disorders:
    • Symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorders and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder).

Coding according to DSM-5 criteria for ADHD

  • Types of ADHD:
    • 314.01 Attention-Deficit/Hyperactivity Disorder, Combined Type:
    • If both criteria for inattention and hyperactivity-impulsivity are met for the past 6 months.
    • 314.00 Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type:
    • If only criterion for inattention is met, but not hyperactivity-impulsivity, for the past 6 months.
    • 314.01 Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type:
    • If only criterion for hyperactivity-impulsivity is met, but not inattention, for the past 6 months.

Partial Remission

  • Coding Note:
    • For individuals who currently have symptoms that no longer meet full criteria, "In Partial Remission" should be specified.
  • Severity Specification:
    • Mild: Few, if any, symptoms in excess of those required to make the diagnosis, resulting in no more than minor impairments in social or occupational functioning.
    • Moderate: Symptoms or functional impairment between "mild" and "severe".
    • Severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, resulting in marked impairment in social or occupational functioning.