DSM-5® for Adult ADHD: Diagnostic Criteria [by Type]
When you seek a diagnosis for Attention Deficit Hyperactivity Disorder (ADHD) you’ll be asked a lot of specific questions about your thoughts, behaviours, and challenges.
That’s because ADHD is characterized by a distinct set of symptoms based on the Diagnostic and Statistical Manual Fifth Edition (DSM-5).
Table of contents
What is the DSM-5?
The DSM-5, first released in 1952, is the official guidebook that psychiatrists, psychologists, and other mental health care practitioners use to define every mental health disorder. Clinicians use guidelines from the DSM-5, known as diagnostic criteria, to determine if a person has ADHD. You can think of these criteria as a checklist of symptoms.
The DSM-5 groups mental health disorders into categories based on shared qualities (i.e. mood disorders, eating disorders) and lists the specific criteria for diagnosing each one. ADHD is grouped into the category of “Neurodevelopmental Disorders” because it begins in childhood. Updates are made to the DSM-5 through years of research, expert panels, and consultations with focus groups. Assessment tools used to diagnose mental health disorders are also based on DSM-5 criteria. So how exactly does the DSM-5 define ADHD?
DSM-5 criteria for ADHD in adults
There are three possible types of ADHD with their own specific symptoms. To receive any diagnosis of ADHD, you must have:
Persistent symptoms for ≥ 6 months in ≥ 2 settings (e.g., school, home, church)
Several symptoms of ADHD present prior to age 12
Symptoms that are not better accounted for by a different psychiatric disorder (e.g., anxiety) and do not occur exclusively during a psychotic disorder (e.g., schizophrenia)
Several symptoms that significantly disrupt your functioning at work/school, with family, or socially
The three different types of ADHD include:
Predominantly inattentive type
Hyperactive-impulsive type; and
Your type of ADHD is then determined based on your most predominant symptoms.
Criteria for predominantly inattentive ADHD
In order to be diagnosed with ADHD predominantly inattentive type you must meet five or more of the following symptoms if you are an adult (≥ 17 years) and six or more symptoms if you are a child (< 17 years):
Carelessness/poor attention to detail: Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate)
Diminished attention span: Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading)
Poor listening skills: Often does not seem to listen when spoken to directly (e.g., the mind seems elsewhere, even in the absence of any obvious distraction)
Lacks follow-through: Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked)
Disorganized: Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines)
Avoids tasks requiring concentration: Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., preparing reports, completing forms, reviewing lengthy papers)
Loses things: Often loses things necessary for tasks or activities (e.g., wallets, keys, paperwork, eyeglasses, phones)
Easily distracted: Is often easily distracted by things in the environment or unrelated thoughts.
Forgetful: Is often forgetful in daily activities (e.g., doing chores, running errands, returning calls, paying bills, keeping appointments)
Criteria for hyperactive-impulsive ADHD
In order to be diagnosed with ADHD predominately hyperactive-impulsive type you must meet five or more of the following symptoms if you are an adult (≥ 17 years) and six or more symptoms if you are a child (< 17 years):
Fidgets a lot: Often fidgets with or taps hands or feet, may squirm when seated.
Trouble staying still: Often leaves seat in situations when remaining seated is expected (e.g., in the office, or during movies)
Restlessness: Desire to move about when it’s inappropriate or consistent feelings of restlessness that are difficult to control
Trouble keeping quiet: Often unable to engage in leisure activities quietly. May engage in self-talk or struggle to keep from interjecting or pivoting to more “exciting” activities
Very much “on the go”: Acting as if “driven by a motor.” Uncomfortable being still for an extended time, as in restaurants or meetings and people may find it hard to keep up with you
Often talks excessively: Excessively chatty, sometimes unaware of the effect it has on others.
Impulsively blurting things out: Often blurts out an answer before a question has been completed, completes people’s sentences, or cannot wait to speak in a conversation
Trouble waiting your turn: Often has difficulty waiting your turn, such as waiting in line.
Interrupts/Intrudes: Often interrupts or intrudes on others. You may take over activities without being invited, butt into conversations, or start using other people’s things without asking or receiving permission
Criteria for ADHD combined type
When a person meets the criteria for both types of ADHD they are diagnosed with a combined type. In many cases, a person may have symptoms from both categories but only meet the criteria for one type. This is a pretty normal presentation and doesn’t impact your treatment plan.
Other considerations when getting diagnosed with ADHD
In addition to determining the type of ADHD, your clinician may also give you a rating based on the status of your condition (is it active or are you in remission) and the severity.
Status of your ADHD
If you previously met the criteria for ADHD but are currently experiencing fewer symptoms, you may get labeled as in partial remission. In this case, you still have impairments but don’t meet enough symptoms to have a full diagnosis. Oftentimes, people who are receiving effective treatment may fall into this category.
Severity of ADHD
Your clinician may also give you a rating of severity based on your symptoms. You may be rated as:
Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and symptoms result in only minor functional impairments.
Moderate: Symptoms or functional impairment between “mild” and “severe” are present.
Severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present, or the symptoms result in marked impairment in social or occupational functioning
Common questions about the DSM-5 for ADHD
What are the DSM-5 codes for ADHD?
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is a globally used diagnostic tool that provides codes for classifying diseases. Clinicians often use these codes for insurance and billing purposes. The ICD-10-CM does not formally recognize ADHD and instead includes it in the diagnostic criteria for hyperkinetic disorder (HKD), which is primarily defined as inattention and overactivity.
ICD-10-CM codes used for ADHD include:
F90.0, Attention-deficit hyperactivity disorder, predominantly inattentive type
F90.1, Attention-deficit hyperactivity disorder, predominantly hyperactive type
F90.2, Attention-deficit hyperactivity disorder, combined type
F90.8, Attention-deficit hyperactivity disorder, other type
F90.9, Attention-deficit hyperactivity disorder, unspecified type
In the most recently released version of the ICD, known as the ICD-11-CM, ADHD has now replaced HKD and is moved to the grouping of neurodevelopmental disorders. The ICD-11-CM also recognizes ADHD subtypes including predominantly inattentive, predominantly hyperactive-impulsive, or combined type. This current version of the ICD is being adopted into clinical use in 2022.
ICD-11-CM codes (adopted in 2022) for ADHD include:
6A05.Z Attention deficit hyperactivity disorder, presentation unspecified
6A05.2 Attention deficit hyperactivity disorder, combined presentation
6A05.Y Attention deficit hyperactivity disorder, other specified presentation
6A05.0 Attention deficit hyperactivity disorder, predominantly inattentive presentation
6A05.1 Attention deficit hyperactivity disorder, predominantly hyperactive-impulsive presentation
Is ADHD considered a mental illness by the DSM-5?
The category of “mental illness” is broad. The American Psychiatric Association defines mental illness as health conditions involving significant changes in emotion, thinking, or behavior (or any combination of these) that cause significant distress in social, work, or family activities.
ADHD does fall within the definition of mental illness but is most often referred to as a disorder or mental disorder. Mental illness and disorder are often used interchangeably.
Where to go from here
If you think you have ADHD, a diagnosis is a vital first step to help you better understand your challenges and find ways forward to overcome them. Frida offers a free ADHD screening tool to help you determine if you might have ADHD as well as the option to connect with a qualified clinician who can offer you a diagnosis and treatment plan.