Diagnostic & Statistical Manual
of Mental Disorders V

A person may be referred for clinical evaluation because of significant deviations in normal activity level, impulsivity, and sustained attention. The most current diagnostic label, according to the Diagnostic and Statistical Manual of Mental Disorders V (APA, 2013), refers to this cluster of behaviors as Attention Deficit/Hyperactivity Disorder (ADHD).
ADHD refers to a person who consistently and repeatedly exhibits age-inappropriate:

a.     inattention;
b.     hyperactivity; and/or
c.      impulsive behaviors.

It is important to note that a factor crucial in making a diagnosis of ADHD is the child's age. The reason that age is crucial in the diagnosis is that in young children moderate levels of diffuse activity and short-attention span are expected. In addition, correlated with age is an increase in sustained attention, concentration and goal-directed activity.  The age criterion has been increased to 12 instead of six years.  In addition, although six symptoms are required of a child to be diagnosed with ADHD, only five symptoms are required of anyone older than 17 years.

The DSM-V has several diagnostic labels for ADHD; the label used will depend on the cluster of behaviors a child exhibits. There are five categories of diagnostic criteria employed by the DSM-V to determine whether a child is diagnosed as having ADHD or not. These categories include the following:

Inattention

Of the following nine criteria, a person must meet six or more (five or more if older than 17 years) of the following symptoms characteristic of inattentive type. In addition, the symptoms must have persisted for at least 6 months and the severity of the symptoms is considered maladaptive and inconsistent with the child's developmental level.

1. Does not pay close attention to details or makes careless errors.
2. Frequently has difficulty maintaining attention in tasks or play activities.
3. Does not appear to listen when spoken to directly.
4. Is frequently not compliant with instructions and fails to complete work.
5. Frequently has difficulty organizing tasks and activities.
6. Tasks that require sustained mental effort, such as homework, are frequently avoided.
7. Materials (such as toys and pencils) that are necessary for the completion of work are frequently misplaced.
8. Extraneous stimuli easily distract from the current task.
9. Frequently is forgetful during daily activities.

Hyperactivity and Impulsivity

Although the DSM-IV had hyperactivity and impulsivity as two separate categories, the two have been combined into one list of nine characteristic symptoms.  The reason for the change is that the two more often than not co-occur.  Of the following criteria, a child must meet six or more of the symptoms, whereas a person 17 years or older is only required to meet a minimum of five symptoms.  In addition, the symptoms must have persisted for at least 6 months and the severity of the symptoms is considered maladaptive and inconsistent with the person's developmental level.

1.     Squirms while in seat and frequently moves hands or feet.

2.     In situations in which remaining seated is expected, will frequently get out of the seat.

3.     Will frequently climb or run about in situations in which it is inappropriate. Adolescents and adults experience such restless behavior as subjective feelings.

4.     Frequently finds it difficult to play or engage in leisure activities quietly.

5.     Constantly on the move as if “driven by a motor.”

6.     Frequently talks excessively.

7.     Frequently answers a question before it has been com­pleted.

8.     Frequently has difficulty waiting for turn in an activity.

9.     Frequently interrupts others during conversations or games.

B. Age of Onset
Some of the inattentive or hyperactive-impulsive symptoms of ADHD were present before age 12 years and caused impairment in the child's functioning.

C. Multiple Settings
The child must demonstrate impairment in two or more settings, such as school, work or home, or with friends or relatives; other activities may also be considered.

D. Clinical Impairment
The impairment must be clinically significant, that is, there must be clear evidence of impairment in social, academic, or occupational functioning.

E. Not Due to Another Disorder
The symptoms must not be better accounted for during the course of another disorder, such as a Pervasive Developmental Disorder, and cannot be better accounted for by another disorder, such as a Mood Disorder or Anxiety Disorder.
Depending on the exhibited behaviors, there are four possible diagnoses.  The first three diagnoses are clinically significant; that means a person who has one of those diagnoses needs professional intervention.  In terms of ADHD, the various diagnoses are determined by the ADHD specifier which has replaced the previous term--subtype.  The specifiers map precisely what the subtypes did.  A specifier refers to a group that can be distinguished by a common symptomatology. 

The subtypes include:

1. ADHD-C:Attention-Deficit/Hyperactivity Disorder, Combined Type. This diagnosis is made if criteria from the inattentive and hyperactive-impulsive categories are met for the past 6 months.
2. ADHD-PI: Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type. This diagnosis is made if the criterion for inattention is met for the past 6 months.
3. ADHD-HI: Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type. This diagnosis is made if the criterion for hyperactive-impulsive category is met for the past 6 months.
4. ADHD-OTHER or UNSPECIFIED: Attention-Deficit/Hyperactivity Disorder, Unspecified or Other Specified Attention-Deficit/Hyperactivity Disorder. This diagnosis is made when a person exhibits a number of behaviors that match the criteria of inattention or hyperactivity-impulsivity, but does not meet the criteria for a diagnosis of one of the ADHD specifiers.  The “Other Specified” is reserved for situations when the full set of criteria are not met.  It is possible that the presenting symptoms create clinically significant distress or impairment in functioning for the person.  However, typically for clinical reasons, the diagnostician decides not to make the diagnosis and provides an explanation for the diagnosis.  For example:  "Other specified ADHD with insufficient inattention symptoms". The “Unspecified ADHD” diagnosis is similarly made, however,  the reason(s) why the diagnosis is not made is/are not stated as to why a more specific diagnosis is not possible.

F.  Additional Diagnostic Requirements

• In addition to the diagnoses, the diagnostician has two additional tasks.  For a previously diagnosed case, the diagnostician is to specify if the previously diagnosed disorder is in “partial remission.”  In other words, the person is showing progress toward normalization and the disorder is becoming more difficult to diagnose due to the positive changes.  However, there is still enough concern not to make a “full remission” diagnosis. 
• Finally, the diagnostician must also determine if the current presentation of the disorder is mild, moderate, or severe; the determination is based on the number and severity of symptoms presented. For example, “mild” is restricted to those situations where there are few if any symptoms beyond the minimum needed for the diagnosis and where the impairment in functioning is minimal. A symptom severity of “moderate” is the presentation of symptoms or functional impairment that lies somewhere between “mild” and “severe” severity.  This is quite a broad range and some people may not necessarily show clinically significant impairment.  The “severe” diagnosis is made in those cases where the presenting symptoms are in excess of those required for the diagnosis.  The diagnosis may also be made if several symptoms are especially severe, or if there is significant impairment from the existing symptoms.