DSM-5 Criteria for ADHD: How Is Adult ADHD Evaluated?

The prevalence of symptomatic adult ADHD has been estimated at 6.76% in recent years, equating to about 366 million adults affected worldwide.^[1]

That’s a significant number of people, and it’s part of what motivates ADDA to reach out and help adults with ADHD.

Despite its high prevalence, ADHD in adults is challenging to diagnose because the symptoms can vastly differ from those in children.

Currently, no single medical test can determine if you have ADHD. Instead, your physician will do a comprehensive exam of your symptoms and how they affect different areas of your daily life.

In most cases, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is utilized in the symptom assessment process. This professional medical handbook helps healthcare professionals diagnose mental health disorders more accurately, including adult ADHD.

Keep in mind that an ADHD diagnosis isn’t a bad thing. While there is still some stigma surrounding it, many adults with ADHD thrive due to their ability to focus, think outside the box, creativity, and many others!

How Is ADHD Diagnosed?

Because ADHD cannot be diagnosed with a brain scan, blood test, or genetic testing, your doctor will ask you about your symptoms to make an assessment.

Additionally, your physician might use a behavioral rating scale to assess your ADHD symptoms. This questionnaire will have questions about your experiences, challenges, and behaviors at work, school, and home.

They might also request to meet your parents, ex-teachers, or anyone who knew you well when you were a child. This allows them to ask questions about your childhood history and struggles with ADHD – a crucial part of the diagnosis as ADHD is a childhood-onset disorder.

The DSM-5 can help your doctor assess the information received. The handbook contains important diagnostic standards that should be met for an ADHD diagnosis to be made.

It also includes more clarifications and examples of how an adolescent or adult may experience ADHD – instead of focusing solely on symptoms mainly seen in children.^[2]

What Are the DSM-5 Criteria for ADHD?

There are three main subtypes of ADHD:

• Predominantly-inattentive ADHD
• Predominantly-hyperactive ADHD
• Combined-type ADHD

Different criteria need to be met for each subtype.

Let’s explore how the three different subtypes of adult ADHD are diagnosed based on the DSM-5.

ADHD Predominantly-Inattentive Presentation

A person may be diagnosed with predominantly-inattentive ADHD if five or more symptoms of inattention have persisted for at least six months. For this diagnosis, the person should also show fewer than five symptoms of hyperactivity or impulsivity.^[3]

Based on the DSM-5, symptoms of inattention in adults include the following:^[3]

• Lacking attention to detail: This includes making careless mistakes at school, work, and other activities.
• Difficulty focusing: The person might struggle to pay attention throughout meetings, lectures, or lengthy reading sessions.
• Trouble listening: It might seem like the person doesn’t listen and often thinks of unrelated matters during conversations.
• Failing to complete tasks: They might have trouble following instructions, get easily sidetracked, and fail to finish their assignments, tasks, or chores.
• Poor organizational skills: A person may struggle to organize their work documents and belongings, manage sequential tasks, schedule their time, or meet deadlines.
• Avoiding tasks requiring sustained focus: Examples include completing reports and reviewing lengthy papers.
• Losing important items: Constantly misplacing items, such as documents, glasses, wallets, keys, and mobile phones, is another sign of ADHD.
• Distracted easily: An adult ADHDer may often be distracted by unrelated thoughts.
• Forgetfulness: A person with ADHD might forget their bill payments, chores, or appointments.

ADHD Predominantly Hyperactive-Impulsive Presentation

An ADHD presentation that’s predominantly hyperactive/impulsive can be diagnosed if five or more symptoms of hyperactivity/impulsivity have persisted for at least six months. The person should also have less than five symptoms of inattention.^[3] 

The following are symptoms of hyperactivity and impulsivity in adults based on the DSM-5:^[3]

• Leaving their seat when expected to remain seated (e.g., during a meeting or lecture)
• Blurting out answers and completing other people’s sentences
• Interrupting other people or intruding on their activities
• Struggling to stay quiet during activities
• Fidgetting and tapping hands or feet
• Often on the go and unable to sit still
• Trouble waiting their turn
• Talking excessively
• Feeling restless

ADHD Combined Type Presentation

Combined-type ADHD involves a balanced mix of both symptoms of inattention and hyperactivity/impulsivity. A person may be diagnosed with this type of ADHD if they show five or more symptoms of inattention and five or more symptoms of hyperactivity/impulsivity in the last six months.^[3]

Apart from the number of symptoms, there are a few other criteria to consider when diagnosing different types of ADHD. For a diagnosis to be made, the following conditions should also be met:^[3]

• Symptoms cannot be explained by another mental health issue, such as anxiety or a mood disorder.
• Symptoms do not only happen during the course of schizophrenia or another psychotic disorder.
• Two or more areas of life are affected (e.g., school, work, social life).
  • Symptoms should clearly reduce functioning in these areas.
• Symptoms were present before the age of 12.

The DSM-5 also categorizes ADHD based on its severity as follows:^[3] 

• Mild: Fewer symptoms are present, and their effect on daily functioning is minor.
• Moderate: The severity of the person’s ADHD falls between the “mild” and “moderate” categories.
• Severe: Many symptoms are present, or several symptoms are especially severe. This significantly affects the person’s daily functioning.

Getting an Accurate ADHD Diagnosis

If you’re concerned about your symptoms, you can take an ADHD screening test for adults. The ADDA adult ADHD test is a questionnaire that can help you better understand your symptoms and whether they align with an ADHD diagnosis.

Of course, this test isn’t meant to diagnose you. The best thing to do is seek advice from a medical professional, preferably one with experience in adult ADHD.

They’ll conduct a thorough assessment to get to the root of your symptoms and provide recommendations to manage them. This may include medications, therapy, and ADHD coaching.

Proper support and treatment can help you do much more than cross off your daily to-do list. You’ll be in the best position to pursue success and achieve your goals in your career, academics, and relationships!

Explore ADDA’s virtual support group for beginners to learn more about your ADHD.

References

[1] Song, P., Zha, M., Yang, Q., Zhang, Y., Li, X., & Rudan, I. (2021). The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of global health, 11, 04009. https://doi.org/10.7189/jogh.11.04009

[2] Epstein, J. N., & Loren, R. E. (2013). Changes in the Definition of ADHD in DSM-5: Subtle but Important. Neuropsychiatry, 3(5), 455–458. https://doi.org/10.2217/npy.13.59

[3] Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 7, DSM-IV to DSM-5 Attention-Deficit/Hyperactivity Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t3/