Attention deficit hyperactivity disorder (ADHD) is a developmental condition of inattention and distractibility, with or without accompanying hyperactivity. There are 3 basic forms of ADHD described in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) of the American Psychiatric Association: inattentive; hyperactive-impulsive; and combined. 

Diagnostic criteria (DSM-5)

According to DSM-5, the 3 types of attention deficit/hyperactivity disorder (ADHD) are (1) predominantly inattentive, (2) predominantly hyperactive/impulsive, and (3) combined. The specific criteria for attention-deficit/hyperactivity disorder are as follows:

Inattentive

This must include at least 6 of the following symptoms of inattention that must have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

• Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities

• Often has difficulty sustaining attention in tasks or play activities

• Often does not seem to listen to what is being said

• 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)

• Often has difficulties organizing tasks and activities

• Often avoids or strongly dislikes tasks (such as schoolwork or homework) that require sustained mental effort

• Often loses things necessary for tasks or activities (school assignments, pencils, books, tools, or toys)

• Often is easily distracted by extraneous stimuli

• Often forgetful in daily activities

Hyperactivity/impulsivity

This must include at least 6 of the following symptoms of hyperactivity-impulsivity that must have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

• Fidgeting with or tapping hands or feet, squirming in seat

• Leaving seat in classroom or in other situations in which remaining seated is expected

• Running about or climbing excessively in situations where this behavior is inappropriate (in adolescents or adults, this may be limited to subjective feelings of restlessness)

• Difficulty playing or engaging in leisure activities quietly

• Unable to be or uncomfortable being still for extended periods of time (may be experienced by others as “on the go” or difficult to keep up with)

• Excessive talking

• Blurting out answers to questions before the questions have been completed

• Difficulty waiting in lines or awaiting turn in games or group situations

• Interrupting or intruding on others (for adolescents and adults, may intrude into or take over what others are doing)

Other

• Onset is no later than age 12 years

• Symptoms must be present in 2 or more situations, such as school, work, or home

• The disturbance causes clinically significant distress or impairment in social, academic, or occupational functioning

• Disorder does not occur exclusively during the course of schizophrenia or other psychotic disorder and is not better accounted for by mood, anxiety, dissociative, personality disorder or substance intoxication or withdrawal

In addition, attention-deficit/hyperactivity disorder is specified by the severity based on social or occupational functional impairment: mild (minor impairment), moderate (impairment between “mild” and “severe”), severe (symptoms in excess of those required to meet diagnosis; marked impairment).

Case study

The parents of a 7-year-old boy take him to the family practitioner because they have become increasingly concerned about his behavior not only in school but also a home. In the first grade, he has been bored, disruptive, fighting with classmates, and rude to his teacher. At home he cannot sit still and meals have been very unpleasant. The lad himself wonders why he is there. The parents have 2 older daughters who say their brother is a “pain” and spoiled. There were no pregnancy or birth problems and the child is on no medications. He has had all his scheduled shots.

The doctor decides more information is required before any treatment is indicated. She wants careful observations of the child both at home and in school. She wishes to talk with his teacher and suggests psychological testing. She also wants some time to see the patient alone. Careful investigation and thorough observations must be done before any intervention. Both the physician and the parents are concerned about overuse of medications and the value for behavioral interventions.