The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), used globally* for the formal diagnosis of ADHD, was released by the American Psychiatric Association during its annual meeting in May 2013.
ADHD is described as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with development, has symptoms presenting in two or more settings (e.g. at home, school, or work), and negatively impacts directly on social, academic or occupational functioning”. The symptoms must be present before age 12.
Key changes in DSM-5 include the update of the definition of ADHD to illustrate the symptoms experienced by adults affected by the condition. In addition, children need to present with at least six symptoms from either (or both) the inattention criteria and the hyperactivity and impulsivity criteria, while for older adolescents and adults (over the age of 17), according to DSM-5, it is now sufficient to present with five symptoms.
For individuals to be diagnosed with ADHD the symptoms cannot occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal). Pervasive developmental disorder (autism spectrum disorder) is no longer an exclusion criterion.
The inclusion of criteria helping the identification of affected adults facilitates continuation of care from childhood through adolescence and adulthood in patients who need it. In the DSM-5 several examples are included to describe the type of behaviour that patients of different ages might exhibit to further aid the identification of patients and allow continued care that can be adjusted to patients’ changing needs.
ADHD is now listed in the new category of ‘Neurodevelopmental Disorders’, acknowledging the growing body of scientific evidence supporting the diagnosis.
Table. Overview of the DSM-5 medical classification system for ADHD
- ≥6 symptoms of inattention and/or ≥6 symptoms of hyperactivity-impulsivity, for 6 months prior to assessment
- ≥5 symptoms of inattention and/or ≥5 symptoms of hyperactivity-impulsivity, for 6 months prior to assessment
- Hyperactive-impulsive or inattentive symptoms prior to 12 years of age
- Impairment present in ≥2 settings
- Clinically significant impairment in social, academic or occupational environments
- Symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder, or are not better accounted for by another mental disorder
*The DSM system is used primarily in the United States and to different degrees in other countries worldwide
- American Psychiatric Association: Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA, American Psychiatric Association, 2013
- ADHD fact Sheet. American Psychiatric Publishing. (Last accessed 11 June 2013)
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Interactive module: Rating scales used for the assessment of ADHD prior to formal diagnosis
How do current guidelines measure up in managing ADHD?