What are the main ADHD Symptoms and How do they Diagnose ADHD?
To obtain an ADHD diagnosis you must speak to a health professional, the usual first step would be to speak to your GP. If there is enough evidence to seek a referral you will then be referred to a specialist or consultant who will be able to assess and diagnose ADHD. Unfortunately in the UK there is a real need for ADHD specialists and waiting list times can be in excess of 18 months after referral.
At your first appointment the specialist will ask you a series of questions about ADHD symptoms that you may have now, and that you may remember experiencing as a child. I actually took along my mum to the appointment so that she could answer questions about my childhood that I struggle to remember. You may also be asked to complete a number of questionnaires to aid the consultant in reaching a diagnosis.
In the case of a child referral to a Community Paediatrician is usually made rather than a specific ADHD specialist. This means shorter referral times and the Paediatrician will have a broad knowledge of a number of conditions which may exhibit similar symptoms to ADHD. It is usual for the school setting to be involved in diagnosis, the Paediatrician may carry out observations in the school setting and the school will be asked to fill out a questionnaire to assess the symptoms of the child. The same questionnaire will be given to the parents/carer to assess symptoms shown in the home setting and these will be compared.
To diagnose ADHD there needs to be evidence of symptoms in three core areas:
The checklist below outlines the diagnostic symptoms of ADHD, including examples of how they may be exhibited, which are directly referenced from the DSM-5 1. The additional symptoms listed in the table may be taken into consideration by the consultant but are not included in the diagnosis, nor are they listed in the DSM-5. This checklist is for information only, a diagnosis must be made by a health professional.
To open the image as a PDF click here
Source: The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013)
How many ADHD symptoms need to be evident for diagnosis?
Using the criteria outlined in the DSM-5 there must be evidence of at least six (for children) or five (for adults over age 17) symptoms in either the Inattention section or in the Hyperactivity/Impulsivity section (or both). The additional ADHD symptoms are not diagnostic but may help your consultant to gain a complete picture of your symptoms.
That means that if, as an adult, you score 2 in inattention and 4 in hyperactivity/impulsivity there is not enough evidence to support an ADHD diagnosis, however if you score 5 in inattention and 2 in hyperactivity you would gain an ADHD diagnosis. A child with a score of 5 in inattention and 2 in hyperactivity would again not receive an ADHD diagnosis, as they need a minimum of 6 in one area.
There are then three presentations (no longer referred to as types) outlined in the DSM-5:
- Combined Presentation – 6 Child/5 Adult symptoms or more in both inattention and hyperactivity/impulsivity criterion are evident for the past six months.
- Predominantly Inattentive Presentation – 6 Child/5 Adult symptoms or more in inattention but not hyperactivity/impulsivity criterion are evident for the past six months.
- Predominantly Hyperactivity/Impulsive Presentation – 6 Child/5 Adult symptoms or more in hyperactivity/impulsivity but not inattention criterion are evident for the past six months.
There is also now a call to diagnose severity of ADHD as either Mild, Moderate or Severe.
Changes to Diagnosis Conditions Outlined in 2013
In 2013 there were significant changes to the diagnosis conditions as detailed in the DSM-5 publication which enable medical professionals to make a more informed diagnosis.
- Previously there needed to be evidence of ADHD symptoms before the age of 7, this has been raised to the age of 12 to take into account the likelihood of adults with ADHD finding it hard to recall incidents during childhood.
- Examples of how symptoms may manifest were added to the symptoms list to aid the professional in assessing whether the symptom is exhibited (see checklist above)
- There must be several symptoms present across two or more settings, e.g. home, work, school. Previously the wording stated that there must be impairment due to symptoms, rather than just symptoms present across settings.
- The requirement of ‘clinically significant impairment in social, academic or occupational environments’ has been reworded to ‘clear evidence that the symptoms interfere with, or reduce the quality of social, academic or occupational functioning’.
- You can now be diagnosed with both Autistic Spectrum Disorder and ADHD, before diagnosis of one condition would exclude the other.
- ADHD is now listed as a Neurodevelopmental Disorder, previously it was a listed as a Disruptive Behaviour Disorder.
If you have previously been assessed before 2013 and not confirmed as ADHD because of the lack of evidence in childhood it may be worth asking for a reassessment under the new conditions.
Are there any symptoms that you feel should be added to the diagnosis criteria?
Those ADHD symptoms that I’ve added at the bottom of the checklist are currently not listed in the official diagnosis guidelines which I find surprising, particularly knowing from personal experience just how much my ADHD symptoms affect my sleep patterns and my general mood from day to day. I don’t feel they really cover the impairment to executive functions that I think are the core of ADHD symptoms. Are there any additional symptoms that you would like to see included in assessment for ADHD? I’d love to hear from you, leave a comment below or contact me here.