ADHD Diagnostic criteria

Question 1

Inattentive presentation

Answer 1

Fails to give close attention to details or makes careless mistakes

Has difficulty sustaining attention.

Does not appear to listen.

Struggles to follow through on instructions.

Has difficulty with organization.

Avoids or dislikes tasks requiring a lot of thinking.

Loses things.

Is easily distracted.

Is forgetful in daily activities.

Question 2

Hyperactive-impulsive presentation

Answer 2

Fidgets with hands or feet or squirms in chair.

Has difficulty remaining seated.

Runs about or climbs excessively in children; extreme restlessness in adults.

Difficulty engaging in activities quietly.

Acts as if driven by a motor; adults will often feel inside like they were driven by a motor.

Talks excessively.

Blurts out answers before questions have been completed.

Difficulty waiting or taking turns.

Interrupts or intrudes upon others.

Question 3

Minimum number of symptoms to make diagnosis

Answer 3

6 in children, 5 in adults (17 and above)

Question 4

Duration symptoms must be present to diagnose ADHD

Answer 4

6 months, to a degree that is judged to be inconsistent with an individual’s developmental level.

Question 5

When symptoms must start, according to DSM-5.

Answer 5

Several inattentive or hyperactive-impulsive symptoms must be present prior to 12 years. (They do not need to be impairing, just present).

Question 6

Where symptoms must be observed, according to DSM-5

Answer 6

“Several inattentive or hyperactive-impulsive symptoms are present in two or more settings.” This differs from DSM-IV which stated symptoms must be impairing in 2 or more settings.

Question 7

Examples of lack of attention to detail

Answer 7

Overlooks or misses details, work is inaccurate, careless mistakes

Question 8

Examples of trouble sustaining focus

Answer 8

Difficulty remaining focused during lectures

Conversations

Lengthy reading

Question 9

Not listening when spoken to directly

Answer 9

Mind seems elsewhere, even in the absence of any obvious distraction

Question 10

Examples of “does not follow through on instructions”

Answer 10

Starts tasks but quickly loses focus and is easily sidetracked:

Schoolwork

Chores

Workplace duties

Question 11

Examples of difficulty with organization

Answer 11

Difficulty managing sequential tasks

Difficulty keeping materials and belongings in order

Messy, disorganized work

Poor time management

Fails to meet deadlines

Question 12

Examples of “often avoids or is reluctant to engage in tasks that require sustained mental effort”

Answer 12

Avoids schoolwork or homework

Preparing reports

Completing forms

Reviewing lengthy papers

Question 13

Examples of “often loses things necessary for tasks or activities”

Answer 13

School materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones.

Forgetting to bring things needed for the day.

Question 14

Examples of “often easily distracted by extraneous stimuli”

Answer 14

Noises

Distractions in the environment

For older adolescents and adults may include unrelated thoughts (looking things up online)

Question 15

Examples of “forgetful in daily activities”

Answer 15

Doing chores, running errands

Returning calls

Paying bills

Keeping appointments

Question 16

Examples of fidgeting

Answer 16

Taps hands or squirms in seat

Question 17

Examples of leaving seat in situation where remaining seated is accepted

Answer 17

Leaves his place in the classroom

Office or other workplace

Church

Family dinners

Question 18

Running or climbing

Answer 18

May be limited to feeling restless in adults or adolescents

Question 19

Examples of “often unable to play or engage in leisure activities quietly”

Answer 19

Talking too much when doing a quiet activity

Can’t watch a movie - standing up, talking, doing other things

Question 20

Examples of blurting out answers

Answer 20

Completes people’s sentences

Cannot wait for turn in conversation

Answer questions prematurely

Question 21

Examples of difficulties awaiting turn

Answer 21

Trouble waiting in line

Traffic

Waiting for things to arrive in the mail

Question 22

Examples of interrupting or intruding on others

Answer 22

Butts into conversations,games, or activities.

Using other people’s things without asking or receiving permission

Adolescents and adults: may intrude into or take over what others are doing

“Too bossy”

Interrupting in conversations

Question 23

Other Specified ADHD in DSM-5

Answer 23

When full criteria are not met

Clinically significant distress or impairment in functioning

The clinician chooses to convey why full criteria are not met (e.g. Other Specified ADHD with insufficient inattention symptoms)

Question 24

Unspecified ADHD in DSM-5

Answer 24

Full symptom criteria are not met

Symptoms are clinically impairing

The clinician chooses not to specify the reason that full criteria are not met and making a more specific diagnosis is not possible.

Question 25

How should the information re: diagnostic criteria be obtained per DSM-5?

Answer 25

No specified sources of information or diagnostic tests required.

ADHD remains a clinical judgment that clinicians make based on the information they obtain using the methods they choose to obtain it.

Question 26

Situations where symptoms may be minimal or absent

Answer 26

Individual is receiving frequent rewards for appropriate behaviour

Close supervision

Novel setting

Especially interesting activities

consistent external stimulation (e.g. electronic screens)

Interacting one-on-one

Question 27

Associated features

Answer 27

Mild delays in language, motor, or social development

Low frustration tolerance

Irritability

Mood lability

Question 28

Basis of the diagnostic criteria for ADHD in DSM-5.

Answer 28

Hundreds of studies (literature review), expert consensus opinion, survey of rating scales and factor structure, field trial. (Barkley 2015). The factor analysis involved behavioral ratings of over 60,000 children. Cutoff for # of symptoms based on field trial.

Question 29

Age of onset in DSM-5

Answer 29

Age 12; this is a rough guideline (Barkley 2015) so clinicians should be flexible in imposing an age of onset, recognizing that recall of onset is unreliable.

Question 31

Degree of agreement between parents and teachers…

Answer 31

… is modest for most dimensions of behavior (between 0.3 and 0.5). Thus there is a low ceiling for level of agreement that can be expected between two informants.

Question 32

How should information from informants be weighted?

Answer 32

This information should be interpreted as providing information on children in that particular context and nothing more. When complete agreement across parent, teacher, and clinician is required for diagnosis, it severely reduces diagnosis. There is no empirical basis for requiring reports from multiple informants so evidence of a history of symptoms in multiple settings should be accepted.

Question 33

Validity of the DSM-5 diagnostic criteria in adults.

Answer 33

The DSM-5 has parenthetical clarifications but these have not been tested for accuracy in discriminating teens or adults with ADHD.

Question 34

Alternative diagnostic criteria for adults

Answer 34

Developed by Barkley 2008; better items than those in the DSM-5 exist for diagnosing or predicting impairment in adults. 9 items (6 or more needed)

1. easily distracted
2. often make decisions impulsively
3. difficulty stopping activities or behaviour when they should do so
4. Starts a project or task without reading or listening to directions carefully
5. Often shows poor follow-through
6. Often trouble doing things in their proper order or sequence.
7. Often likely to speed (or trouble doing leisure activities quietly)
8. Often difficulty sustaining attention in tasks or leisure activities.
9. Difficulty organizing tasks and activities.

Question 35

What is the standard of impairment in ADHD?

Answer 35

The DSM-5 specifies the symptoms interfere with, or reduce, the quality of social, academic or occupational functioning. It does not specify the standard of comparison. Barkley (2015) et al believe it should be judged against the “average person” to be considered a disorder.

Question 36

Validity of ADHD diagnostic criteria in women and girls.

Answer 36

Females in general show fewer ADHD symptoms than males in the general population. Therefore females need to meet a higher threshold relative to other females to be diagnosed with ADHD than do males relative to other males. Females with ADHD show equally if not more engative functional outcomes compared to male counterparts.