Neurodevelopmental Disorders
Attention-Deficit/Hyperactivity Disorder
ICD-10-CM: F90.9
1. Criteria
DSM Criteria
Criterion A1
- Six or more symptoms of inattention persist for at least 6 months, or 5 or more if age 17 or older.
- The symptoms are inconsistent with developmental level and negatively affect functioning.
- Inattention symptoms include careless mistakes, difficulty sustaining attention, seeming not to listen, not following through on instructions, difficulty organizing tasks, avoiding sustained mental effort, losing necessary items, distractibility, and forgetfulness.
DSM Criteria
Criterion A2
- Six or more symptoms of hyperactivity-impulsivity persist for at least 6 months, or 5 or more if age 17 or older.
- Hyperactivity-impulsivity symptoms include fidgeting, leaving seat when expected to remain seated, running or climbing in inappropriate situations or inner restlessness, difficulty engaging quietly, acting as if driven by a motor, excessive talking, blurting out answers, trouble waiting, and interrupting or intruding on others.
DSM Criteria
Criterion B
- Several symptoms were present before age 12.
DSM Criteria
Criterion C
- Several symptoms are present in two or more settings.
DSM Criteria
Criterion D
- There is clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning.
DSM Criteria
Criterion E
- Symptoms interfere with social, academic, or occupational functioning and are not better explained by another mental disorder.
2. Context
- ADHD is not just distractibility. It is a longstanding pattern of inattention, hyperactivity, impulsivity, or some combination of the three that starts early, shows up across settings, and genuinely gets in the way of functioning.
- Two-domain structure: It helps to think in two buckets: inattentive symptoms and hyperactive-impulsive symptoms. Some patients live mostly in one domain, while others clearly show both.
- Cross-setting rule: The pattern should not live in just one environment. Symptoms need to show up in at least two settings, such as home, school, work, or social life.
- Adult nuance: Adults often look less overtly hyperactive than children. What shows up instead may be restlessness, disorganization, forgetfulness, and chronic executive-function problems.
- Clinical focus: Common adult screening and follow-up tool.
3. Validated scales
Adult ADHD Self-Report Scale (ASRS v1.1)
Common adult screening and follow-up tool.
Vanderbilt ADHD Diagnostic Rating Scales
Useful when gathering parent and teacher collateral in pediatric practice.
Conners Rating Scales
Broad symptom and impairment profiling across settings.
WFIRS
Measures functional impairment rather than symptoms alone.
4. FDA approved treatments
Stimulants for ADHD
These medications are FDA-indicated for ADHD in specific age ranges and formulations; product-level labeling differs.
Nonstimulants for core ADHD symptoms
These options are useful when stimulant tolerability, misuse risk, anxiety, tics, sleep issues, or patient preference changes treatment selection.
Common off-label medications
Interventional psychiatry modalities
- TMS is being studied for ADHD but is not standard care.
- Neurofeedback and other device-based approaches are under study.
- ECT and ketamine are not standard ADHD interventions.
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5. Top management articles
- Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults The Lancet Psychiatry, 2018
- A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder Archives of General Psychiatry, MTA study
- World Federation of ADHD international consensus statement Consensus literature