ADHD: Recognizing Signs, Symptoms, and DSM-5 Criteria

Dr. Alexander Sidawi

Dr. Sidawi is an Orlando based, UF trained physician who is happy to be serving the community he grew up in by offering a combination of psychiatric medication management and psychodynamic psychotherapy.

What Is Attention-Deficit/Hyperactivity Disorder (ADHD)?

ADHD is a neurodevelopmental condition characterized by trouble focusing for long periods of time, due to trouble sustaining attention and/or sitting still. ADHD affects individuals of all ages, often leading to many challenges in daily life. In this blog post, we will discuss the signs and symptoms of ADHD, along with the diagnostic criteria outlined in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), to promote a better understanding of this complex disorder.

What Are The Signs and Symptoms of ADHD?

Signs and symptoms of ADHD can be differentiated into two categories, the inattentive symptoms and the hyperactive-impulsive symptoms.

Inattention Symptoms of ADHD

Individuals with ADHD may show several signs of inattention, which can manifest in various aspects of life, including school, work, and social interactions. Key symptoms include:

Difficulty Sustaining Attention: Challenges in maintaining focus on tasks or play activities, often seeming to drift away in tasks requiring sustained mental effort.
Disorganization: Struggles with organizing tasks and activities, which may result in missed deadlines, chaotic workspaces, and a general sense of disarray.
Forgetfulness in Daily Activities: Frequently forgetting routine tasks, such as appointments, obligations, or errands, even if they are part of the individual’s daily routine.
Avoidance of Tasks Requiring Mental Effort: A tendency to avoid, dislike, or be reluctant to engage in tasks that require sustained mental effort, such as schoolwork or homework.
Difficulty Following Through on Instructions: Failure to complete schoolwork, chores, or duties in the workplace, not due to oppositional behavior or failure to understand instructions.

Hyperactivity-Impulsivity Symptoms of ADHD

Hyperactivity and impulsivity in ADHD manifest through behaviors that are excessively energetic or hasty, often in inappropriate situations. Symptoms include:

Fidgeting and Restlessness: Frequent fidgeting with hands or feet, or squirming in seat. An inability to stay seated in situations where it is expected.
Excessive Talking: A tendency to talk excessively, often interrupting or intruding on others’ conversations or activities.
Difficulty Waiting Their Turn: Impatience and difficulties in waiting for their turn in games or group situations, often leading to interrupting or acting out of turn.
Running or Climbing in Inappropriate Situations: In children, a constant motion, including running or climbing in situations where it is not appropriate. In adults, this may manifest as restlessness.
Acting Without Much Thought: Demonstrating behaviors that seem to be acted on the spur of the moment without forethought, which can lead to potential harm or engaging in activities with a high potential for painful consequences.

What are the DSM-5 Criteria for ADHD?

The DSM-5 outlines specific criteria to diagnose ADHD, considering both inattention and hyperactivity/impulsivity:

Inattention:

Six or more symptoms of inattention present for children up to age 16, or five or more for adolescents 17 and older and adults. Symptoms must have persisted for at least six months, causing impairment in social, academic, or occupational functioning.

Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).
Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).
Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).
Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).
Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).
Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).

Hyperactivity/Impulsivity:

Six or more symptoms of hyperactivity/impulsivity present for children up to age 16, or five or more for adolescents 17 and older and adults. Symptoms must have persisted for at least six months, causing impairment in social, academic, or occupational functioning.

Often fidgets with or taps hands or feet, or squirms in seat.
Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).
Often runs about or climbs in situations where it is inappropriate (Note: In adolescents or adults, may be limited to feeling restless).
Often unable to play or engage in leisure activities quietly.
Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).
Often talks excessively.
Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).
Often has difficulty waiting his or her turn (e.g., while waiting in line).
Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).

Combined Presentation:

Both inattention and hyperactivity/impulsivity symptoms are present for the past six months.

Subtypes:

Predominantly Inattentive Presentation: The majority of symptoms are related to inattention.
Predominantly Hyperactive/Impulsive Presentation: The majority of symptoms are related to hyperactivity/impulsivity.
Combined Presentation: Significant symptoms of both inattention and hyperactivity/impulsivity are observed.

How Do You Treat ADHD?

ADHD can be treated with either behavioral changes, such as establishing routines, using reminders, and applying time management techniques, or through medications, including stimulants and non-stimulants. Both are effective, and seeing a mental health provider can help determine what treatment plan is best for that individual.

How Do You Treat ADHD With Behavioral Changes?

Structured Routines

Creating a structured and predictable routine helps reduce chaos and provides stability for individuals with ADHD. Consistent schedules for meals, homework, play, and sleep can minimize distractions and help manage inattention.

Organizational Systems

Introducing organizational systems can address challenges with disorganization and forgetfulness. This includes using planners, timers, and reminder systems to keep track of tasks, deadlines, and appointments. Organizing living and workspaces with clear, labeled places for everything can also reduce clutter and make it easier to focus.

Break Tasks into Smaller Steps

Large tasks can be overwhelming for someone with ADHD. Breaking tasks into smaller, manageable steps and focusing on one step at a time can make tasks seem more achievable, reducing avoidance behaviors.

Positive Reinforcement

Positive reinforcement encourages the repetition of desirable behaviors by offering rewards or praise. Setting clear, achievable goals and rewarding accomplishments can motivate individuals with ADHD to maintain focus and effort towards tasks.

Time Management Techniques

Time management techniques, such as using timers to allocate specific periods for tasks and breaks, can improve focus and productivity. This approach helps in managing procrastination and in completing tasks within deadlines.

Mindfulness and Stress Reduction Techniques

Practicing mindfulness and relaxation techniques can help manage symptoms of hyperactivity and impulsivity. Techniques such as deep breathing, meditation, and yoga can promote calmness, reduce stress, and improve attention.

Physical Activity

Regular physical activity is beneficial for managing ADHD symptoms. Exercise increases the brain’s dopamine, norepinephrine, and serotonin levels—all of which affect focus and attention. Incorporating physical activity into daily routines can help improve concentration, mood, and sleep.

Limiting Distractions

Creating environments that minimize distractions can significantly improve focus. This can involve having a dedicated, quiet space for work or study, limiting access to electronic devices, and using noise-canceling headphones in noisy environments.

Social Skills Training

For some individuals with ADHD, social interactions can be challenging. Social skills training can help improve communication skills, empathy, and the ability to read social cues, enhancing relationships and social functioning.

How Do You Treat ADHD With Medications?

Stimulant Medications

Regarded as the first line option for medication treatment of ADHD, stimulants can start to be effective within 30 minutes of ingestion, offering symptom relief from 4 to 10 hours depending on the formulation. There are two main classes of stimulants, the amphetamine class and the methylphenidate class. Common amphetamines include Adderall IR/XR and Vyvanse, and are generally used first in adults. Common methylphenidate medications include Ritalin IR/LA and Concerta, and are generally used first in children. These medications unfortunately come with potential risks including disrupted sleep, decreased appetite, risk of addiction, cardiovascular strain, and other side effects. It’s essential to discuss these risks and benefits with your physician to make an informed decision.

Nonstimulant Medication

When stimulant medications for ADHD are not suitable or preferred, non-stimulant options like Strattera, Wellbutrin, and Clonidine may be considered. Typically viewed as secondary treatment options, non-stimulants can be especially beneficial in cases where stimulants are contraindicated or have proven ineffective. Strattera, also known as atomoxetine, and Wellbutrin, also known as bupropion, are both antidepressant medications that were found to also provide significant improvement in ADHD symptoms. Clonidine, originally used as a blood pressure medicine, has been found by some to improve attention and aid in sleep in some individuals.