DSM 5: ADHD:  Attention Deficit Hyperactivity Disorder

By now we’ve all heard of attention deficit hyperactivity disorder, sometimes shortened to simply ADD when the hyperactivity (H) isn’t present.  Individuals with this disorder are quite varied.  My professional experience includes a number of clients diagnosed prior to attending therapy with me in which depression, anxiety disorders, a personality disorder, as well as bipolar disorder were the focus of concern before proper evaluation.  So what is ADHD, and why might it be a bit difficult to diagnose, especially in adults?

For starters, the DSM 5 lists the criteria for this disorder “six or more” symptoms within two overarching patterns of behavior to meet the threshold when compared to the developmental level of the individual in question: inattention and hyperactivity or impulsivity.  The threshold lowers to at least 5 or more when applied to adults.  With children or adults, the symptoms must impact “social and academic/occupational activities” (p. 59).

Lack of following directions. Is the individual easily distracted?

DSM 5: ADHD: Attention Deficit Hyperactivity DisorderUnder inattention, the 9 options include failure to consider details, including completion of an assignment or task without following through with handing it off to a boss or teacher; this is repeated as lack of follow-through later within the symptom descriptions, including the lack of following directions.  The inability to sustain focus on tasks, including hobbies or play activities is next up. If the person seems to daydream, lose concentration – even while listening to another person relay information – these distractions can be fodder for AD(H)D.  Tasks that require organization, neatness, or “sustained mental effort” are avoided or disliked, not necessarily because the tasks are beyond their capacity.  Is the individual easily distracted?  Does the individual lose things easily and often?  Is there a pattern of forgetfulness that can seem nearly defiant (when in fact it there is an honest desire to run errands, return calls, pay bills, or keep appointments).  (P. 59)

Under hyperactivity, the 9 options include tapping, fidgeting, squirming in seat; the individual may even find it hard to remain seated through a class, meeting, or meal.  If the person climbs or runs about when inappropriate, as well as “unable to engage in leisure activities quietly” you may be witness to ADHD. Does the person interrupt, talk excessively, or not wait their turn?  In adults, this may also mean taking over a project for someone or intruding on others’ conversations, tasks, games, or otherwise.

The severity may be mild, moderate, or severe, and the 3 a clinician needs to clarify whether the diagnosis contains a combined presentation, predominantly inattentive, or predominantly hyperactive/impulsive.

The next article will further elucidate the criteria for ADHD, as well as explore prevalence, cultural determinants (if any), as well as the differential diagnoses based on shared symptoms across disorders.