Picture of two students looking at a computer screen. Picture of a professor with a computer teaching a small group of students. Picture of a student working at a laptop.

ADHD Module

Diagnostic Features and Subtypes of AD/HD

According to the DSM-IV-TR (American Psychiatric Association, 2000), the most recent version of this publication,

The essential feature of Attention-Deficit/Hyperactivity Disorder is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development (Criterion A). Some hyperactive-impulsive or inattentive symptoms that cause impairment must have been present before age 7 years, although many individuals are diagnosed after the symptoms have been present for a number of years, especially in the case of individuals with the Predominantly Inattentive type (Criterion B). Some impairment from the symptoms must be present in at least two settings (e.g., at home and at school or work) (Criterion C). There must be clear evidence of clinically significant impairment in developmentally appropriate social, academic, or occupational functioning (Criterion D). The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., a Mood Disorder, Anxiety Disorder, Dissociative Disorder, or Personality Disorder) (Criterion E).

Diagnostic Criterion A refers to the following:

Either (1) or (2):

  1. six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

    Inattention
    1. often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
    2. often has difficulty sustaining attention in tasks or play activities
    3. often does not seem to listen when spoken to directly
    4. 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. often has difficulty organizing tasks and activities
    6. often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
    7. often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
    8. is often easily distracted by extraneous stimuli
    9. is often forgetful in daily activities
  2. six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

    Hyperactivity
    1. often fidgets with hands or feet or squirms in seat
    2. often leaves seat in classroom or in other situations in which remaining seated is expected
    3. often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
    4. often has difficulty playing or engaging in leisure activities quietly
    5. is often “on the go” or often acts as if “driven by a motor”
    6. often talks excessively
    Impulsivity
    1. often blurts out answers before questions have been completed
    2. often has difficulty awaiting turn
    3. often interrupts or intrudes on others (e.g., butts into conversations or games)

Subtypes

Although many individuals present with symptoms of both inattention and hyperactivity-impulsivity, there are individuals in whom one or the other pattern is predominant. The appropriate subtype should be indicated based on the predominant symptom pattern for the past 6 months.

  • Attention-Deficit/Hyperactivity Disorder, Combined Type
    This subtype should be used if six (or more) symptoms of inattention and six (or more) symptoms of hyperactivity-impulsivity have persisted for the past 6 months.
  • Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type
    This subtype should be used if six (or more) symptoms of inattention (but fewer than six symptoms of hyperactivity-impulsivity) have persisted for the past six months.
  • Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type
    This subtype should be used if six (or more) symptoms of hyperactivity-impulsivity (but fewer than six symptoms of inattention) have persisted for the past six months.

image of students with laptops

The diagnosis of AD/HD is complicated. Currently, a critical diagnostic test for the syndrome does not exist. This lack of an objective test reflects the complex nature of AD/HD and the interactions of the symptoms with the environment (Goldstein & Naglieri, 2008). A trained medical or psychology professional will make the diagnosis of AD/HD generally using a comprehensive psycho-educational assessment (Byron & Parker, 2002). These assessments usually include a detailed history of presenting attention related problems, intellectual assessments, indicators of executive functioning, and observations, and can include reports from parents, teachers, and self-reports. While many colleges and universities have comprehensive guidelines for documentation to verify AD/HD, some only require results from the DSM-IV checklist or a doctor’s note to confirm the diagnosis of AD/HD (Byron & Parker).

 

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4th ed.). Washington, DC: Author.

Byron, J., & Parker, D. R. (2002). College students with ADHD: New challenges and directions. In L. C. Brinckerhoff, J. M. McGuire, & S. F. Shaw (Eds.), Postsecondary education and transition for students with learning disabilities (pp. 335-387). Austin, TX: PRO-ED.

Goldstein, S., & Naglieri, J. (2008). The school neuropsychology of ADHD: Theory, assessment, and intervention. Psychology in the Schools, 45(9), 859-874.