DSM IV ADHD

The DSM IV ADHD definition had been used since the early 1990's is used by members of the health care community because it provided a common language and therefore aided in the overall diagnostic process. DSM stands for Diagnostic and Statistical Manual for Mental Disorders was first produced in 1952. In May of 2013 the APA published its latest version the DSM V.

The DSM is published by the American Psychiatric Association and is used because of its standard criteria and classification of a variety of mental disorders. The criteria used in DSM IV was extensively researched and based on large numbers of trials and published literature, and therefore is referred to as the standard. The DSM manual has been written by experts in the field of medicine and psychology who reviewed this extensive literature clinical trial data. One major change made in DSM IV, was the inclusion of clinically significant distress being seen as a result of the illness.

DSM IV Manual

DSM V - Published May 2013

With regard to ADHD, the newest version of the DSM - DSM V - has expanded information regarding adults with ADHD, specifically so that those individuals who may suffer from the symptoms of ADHD into adulthood can continue to receive treatment for this disorder, as needed. Nearly 20 years of research is now providing more in depth guidance for therapists and doctors as they work to provide help for these individuals. This research has shown that criteria used to diagnose ADHD in Children can be used equally well for adults - although only 5 instead of 6 symptoms are needed fo achieve a reliably accurate diagnosis. A second important adaptation changes the language surrounding the age when a child's ADHD symptoms can be identified, specifically being present prior to age 12, versus age seven in DSM IV manual. For complete information click on the link below and order a copy of the new DSM V:

DSM 5 Manual

There are some who question the assertions made in the DSM publication, including the DSM ADHD criteria. Over the years there has been an increase in the number of ADHD being diagnosed. Some argue that this increase has been seen because of these published criteria - and that there are companies and doctors who may make money from this. Equally persuasive are those who show that for years there were many children and adults alike were being labeled as careless, slow, dumb, forgetful, and fidgity who were never given any help. In general it is a good idea to follow the money. But be careful when you see or read about someone being critical, they may be selling something themselves such as herbal remedies, a cook book, or a special program. The facts are since 1990 there has been a dramatic increase in the research and knowledge of how the brain works and one would expect the medical community to respond with more insight into how these illnesses can be managed.

Most importantly, if you or someone you know is asking "do I have ADHD?" and demonstrating impaired behaviors impacting 2 or more settings of their life, and find that life, work or school is suffering because of those symptoms and behaviors, there are many treatment options which can help ADHD sufferers live a very normal and productive life. A TOTAL approach is likely the best, that is reviewing diet and exercise, considering natural and herbal remedies, consulting with a physician and reviewing the benefits of taking a medication, and taking full advantage of behavioral and cognitive therapy.

Diagnosing ADHD

The DSM-V DHD Criteria defines what is needed for the diagnosis of ADHD and assumes that the patients attention deficits:

  • (1) are a distinct, differentiated condition;
  • (2) can be reliably measured using objective, behavioral measures; and
  • (3)are abnormalities resulting from organic/biological origins.

IA. To meet the diagnostic criteria for DSM V ADHD in children there needs to be six or more of the following signs of inattention that have been present for at least 6 months to a point that is disruptive and inappropriate for their developmental level (for diagnosing in adults there needs to be 5 or more):

DSM IV ADHD Signs of Inattention:

  • Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
  • Often has trouble keeping attention on tasks or play activities.
  • Often does not seem to listen when spoken to directly.
  • Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
  • Often has trouble organizing activities.
  • Often avoids, dislikes, or does not want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
  • Often loses things needed for tasks and activities (such as toys, school assignments, pencils, books, or tools).
  • Is often easily distracted.
  • Often forgetful in daily activities.
Stress From Lack Of Focus

IB. And to meet the diagnostic criteria for DSM V ADHD there needs to be six or more of the following signs of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:

Signs of Hyperactivity:

  • Often fidgets with hands or feet or squirms in seat.
  • Often gets up from seat when remaining in seat is expected.
  • Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
  • Often has trouble playing or enjoying leisure activities quietly.
  • Is often "on the go" or often acts as if "driven by a motor".
  • Often talks excessively
  • Impulsiveness:
  • Often blurts out answers before questions have been finished.
  • Often has trouble waiting one's turn.
  • Often interrupts or intrudes on others (example: butts into conversations or games).
Class Clown

DSM V ADHD Adds:

  • II. Some signs that cause impairment were present before age 12 years.
  • III. Some impairment from the signs is present in two or more settings (such as at school/work and at home).
  • IV. There must be clear evidence of significant impairment in social, school, or work functioning.
  • V. The signs do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The signs are not better accounted for by another mental disorder (such as Mood Disorder, Anxiety Disorder, Dissociative Identity Disorder, or a Personality Disorder).

This DSM V ADHD Criteria adapted from Wikipedia report on ADHD.

Other Important Guidelines

The American Academy of Pediatrics Clinical Practice Guidelines for Children with ADHD, stresses that in order to obtain an accurate and reliable diagnosis you must meet three criteria:

  • Meeting the Criteria noted in the DSM V ADHD
  • Ability to obtain specific information showing the patient shows significant signs in more than one setting
  • Adequate search for any coexisting condition that mimics their signs or may complicate treatment.

These three criteria are uncovered using the patients history and physical and talking to parents, teachers, co-workers, the patient, and any other available resources. Adults and children are diagnosed using the same criteria including the presence of symptoms prior to the age of seven. Adults often will show more symptoms of self control, motivation and executive functioning compared to younger patients and children.

Differential Diagnosis

Other medical conditions that must be ruled out include: issues with thyroid, anemia, poisoning such as with lead, nutritional concerns or allergies, other chronic illnesses, hearing or vision impairment, substance abuse, side effects from other medications, significant sleep impairment, and/or child abuse. This is not an exhaustive list, but indicates the importance of taking a whole approach and seeking professional help and advice.


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