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Neurodevelopmental Disorders

Attention-Deficit/Hyperactivity Disorder

ICD-10-CM: F90.9

1. Criteria

DSM Criteria

Criterion A1: Inattention

  • Six or more symptoms of inattention are present for at least 6 months, or five or more if age 17 years or older.
  • The symptoms are inconsistent with developmental level and have a direct negative effect on social, academic, or occupational activities.
  • 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 when spoken to directly.
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace.
  • Often has difficulty organizing tasks and activities.
  • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort.
  • Often loses things necessary for tasks or activities.
  • Is often easily distracted by extraneous stimuli or unrelated thoughts.
  • Is often forgetful in daily activities.

DSM Criteria

Criterion A2: Hyperactivity and Impulsivity

  • Six or more symptoms of hyperactivity and impulsivity are present for at least 6 months, or five or more if age 17 years or older.
  • The symptoms are inconsistent with developmental level and have a direct negative effect on social, academic, or occupational activities.
  • Often fidgets with or taps hands or feet or squirms in seat.
  • Often leaves seat in situations when remaining seated is expected.
  • Often runs about or climbs in situations where it is inappropriate, or in adolescents and adults may feel restless.
  • Often unable to play or engage in leisure activities quietly.
  • Is often on the go or often acts as if driven by a motor.
  • Often talks excessively.
  • Often blurts out an answer before a question has been completed.
  • Often has difficulty waiting turn.
  • Often interrupts or intrudes 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.

DSM Criteria

Specify Current Presentation

  • Predominantly inattentive presentation applies if enough inattentive symptoms are present but enough hyperactive-impulsive symptoms have not been present for the past 6 months.
  • Predominantly hyperactive-impulsive presentation applies if enough hyperactive-impulsive symptoms are present but enough inattentive symptoms have not been present for the past 6 months.
  • Combined presentation applies if both inattentive and hyperactive-impulsive symptom thresholds have been met for the past 6 months.

DSM Criteria

Specify Severity

  • Mild applies when few, if any, symptoms beyond the diagnostic threshold are present and impairment is minor.
  • Moderate applies when symptoms or impairment fall between mild and severe.
  • Severe applies when many symptoms beyond the diagnostic threshold are present, several symptoms are especially severe, or symptoms cause marked impairment.

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.

Common treatment side effects

Check drugs.com/sfx for common side effects. Direct side-effect links for the medications in this section are below when available.

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 treatment side effects

Check drugs.com/sfx for common side effects. Direct side-effect links for the medications in this section are below when available.

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.

Related Guides

6. ADHD symptoms in adults

  • Adult ADHD often looks less like obvious childhood hyperactivity and more like restlessness, difficulty organizing life, inconsistent follow-through, and trouble sustaining attention on tasks that are not especially interesting.1
  • Adults may describe impulsive decision-making, emotional reactivity, procrastination, chronic lateness, forgetfulness, and trouble managing long or detail-heavy tasks.1
  • A good evaluation usually includes current symptoms, childhood history, developmental and social history, impairment across settings, and screening for other psychiatric conditions that can mimic or overlap with ADHD.1

7. ADHD vs anxiety

  • ADHD and anxiety can overlap around concentration problems, restlessness, sleep disruption, irritability, and a sense of mental overload, which is one reason ADHD is often missed in anxious adults.2
  • In anxious adult populations, some hyperactivity-type items such as difficulty relaxing and feeling driven by a motor may reflect anxiety more than ADHD when taken in isolation.2
  • The most useful clinical move is to look past one overlapping symptom and ask about developmental timing, lifelong pattern, setting-specific impairment, and whether the attentional symptoms persist even when anxiety is lower.2

5. Top management articles

  1. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults The Lancet Psychiatry, 2018
  2. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder Archives of General Psychiatry, MTA study
  3. World Federation of ADHD international consensus statement Consensus literature

When to seek professional help

  • Seek urgent help if there are thoughts of suicide, self-harm, or feeling unable to stay safe.3
  • Seek urgent help if there are thoughts of harming someone else, escalating violent urges, or loss of behavioral control.3
  • Take hopelessness seriously, especially if the person feels trapped, cannot imagine staying safe, or is withdrawing from support.4
  • Use emergency services if there is immediate danger, severe agitation, psychosis, intoxication, or inability to care for basic needs. In the United States, call or text 988 for crisis support and call 911 for immediate danger. Use emergency services in your region if you are outside the U.S.3
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References