What is DSM-5?
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders – 5th edition) is a medical reference that sets the criteria for a formal diagnosis of ADHD by doctors and trained health professionals.
It is published by the American Psychiatric Association and was last updated in 2013, replacing the DSM-IV with several significant changes that we have highlighted below.
DSM-5 Criteria for ADHD
In DSM-5, ADHD is defined as follows:
A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, has symptoms presenting in two or more settings (e.g. at home, school, or work; with friends or relatives; in other activities), and negatively impacts directly on social, academic or occupational functioning. Several symptoms must have been present before age 12 years.
What are the symptoms?
The symptoms are divided in to three categories which are used to diagnose the correct ‘presentation’ (type) of ADHD.
Six symptoms must be displayed over a period of six months for a diagnosis. For adults and teens aged 17+, only five symptoms are required.
Inattentive symptoms and criteria
- The criteria of symptoms for a diagnosis of ADHD:
- Inattentive presentation:
- 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.
Hyperactive-impulsive symptoms and criteria
- 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.
Combined type symptoms and criteria
- Has symptoms from both of the previous types: inattentive and hyperactive-impulsive.
What has changed from the ADHD DSM-IV diagnosis criteria?
Before 2013, the DSM-IV (Diagnostic Manual of Mental Disorders – 4th Edition) was used to diagnose ADHD both in the United States, and around the rest of the world.
The DSM-5 Criteria has some key changes.
Adults and teens can now be formally diagnosed with ADHD
Sounds remarkable, but until recently this was not the case.
Previously the DSV-IV implied that only children could be diagnosed with ADHD. The new criteria lists several scenarios where the disorder can and should be diagnosed in adults and teens. It also acknowledges that a significant proportion of children remain relatively impaired by ADHD when entering into adulthood.
Doctors can diagnose based on symptoms appearing in the teen years
In line with the previous changes, doctors no longer have to pinpoint symptoms of ADHD from the formative childhood years (by aged 7). The ADHD criteria has changed so that a diagnosis is possible providing the symptoms were present by the age of 12.
‘Types’ have become ‘presentations’
A minor point, but worth noting. ADHD has traditionally been divided in to three ‘types’ (inattentive, hyperactive-impulsive and combined). The DSM-5 has changed the wording so that they are now called ‘presentations’.
This is designed to better describe how the disorder evolves.
Note: You’ll still find us referring to the forms of ADHD as ‘types’. But it is not technically correct!
Introduction of ‘Inattentive Presentation’
Previously there were three types of ADHD. DSM-5 adds a fourth type: Inattentive Presentation (Restrictive).
Here the patient must have two or fewer of the 12 symptoms from the list for hyperactivity-impulsivity.
DSM-5 introduces scales of ADHD: mild, moderate and severe
There are now levels of ADHD based on how many symptoms are detected and their severity.
This can influence treatment considerations such as medication, dosage and scheduling.
DSM-5 also diagnoses Autism Spectrum Disorder
Advances in the understanding of both ADHD and Autism has drawn connections between the two, both of which can now be diagnosed as part of the DSM-5 criteria.
Do I need to worry about DSM-5 and the ADHD diagnostic criteria?
While it is certainly useful to understand how and why ADHD is diagnosed, for transparency’s sake, these are issues that your doctor will take care of for you.
DSM-5 is a formal diagnosis tool, meaning, a reference for doctors and other qualified professionals.
The diagnostic criteria for ADHD will continue to evolve as further research takes us closer to a better understanding of the disorder.