ADHD 101: DSM5 Criteria for ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is a mental health disorder that impacts approximately 5% of children and 2.5% of adults. In North America the most common diagnostic criteria used to diagnose ADHD is outlined in the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM5).

As the diagnostic criteria can be a bit confusing, this blog post will hopefully help demystify some of the medical terminology included in the criteria through some memes and personal examples.

Note: The DSM5 criteria has been widely criticized by ADHD practitioners and researchers as there are many symptoms missing from the criteria and the criteria has not been standardized for a variety of populations. While this blog post will not go into depth about the issues with the criteria or missing symptoms, Keep an eye on this space for a future blog post on this topic!

DSM5 Criteria for ADHD

To be diagnosed with ADHD individuals must experience 6 or more hyperactivity/impulsivity symptoms or inattentive symptoms which are present in multiple settings prior to age 12. The symptoms must reduce the individual’s quality of life by having a direct impact on the persons social life, education and work life.

Inattentive Symptoms of ADHD

a.      Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities.

In other words: individuals with ADHD often cannot slow down enough to carefully read paperwork or instructions. When filling out forms they may forget to fill out sections or make simple errors such as in their spelling. I can't count how many times on a form I have put my last name in the first name section.

b.      Often has difficulty sustaining attention in tasks or play activities.

In other words: It is very hard for ADHD individuals to keep their focus during boring things that require them to pay attention and sit still for more than a few minutes.  For example, it is hard for people to remain focused during reading, lectures or conversations. This does not mean that the individual does not care about these things: it is that their brain wanders easily and it is hard to stay focused on one thing for very long.

c.      Often does not seem to listen when spoken to directly.

In other words: Individuals with ADHD have a very active brain. Their brain is constantly going a million miles a minute and, in their head, they may be trying to follow several trains of thought at the same time. I often describe it as having 20 lanes of traffic in my head all at once. Also, Individuals with ADHD have a tendency to daydream more than others, which makes it look like they are not paying attention. Inside our heads we are often: analyzing the conversation, thinking about what to do next, planning our next move, reciting what was just said to us, or just getting distracted by thoughts, feelings and sensory information. It is not that we do not want to listen, it’s that our brain is just going very fast and getting distracted.

d.      Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace.

In other words: ADHD folks have a hard time wrapping up tasks and completing final details: especially once the novelty and excitement of the task has worn off. Also, ADHD individuals have deficit in their memory processing abilities so often they will forget any instructions beyond the first few steps. If given a 5 step process, it is hard for ADHD individuals to keep all 5 instructions in their working memory so they may miss things. Finishing projects off is very difficult, usually because it includes the boring parts that are not rewarding. Looking around this room I currently see 9 projects that are 95% finished.

e.      Often has difficulty organizing tasks and activities.

In other words: Individuals with ADHD have difficulty keeping things in order and managing sequential tasks such as following a recipe. This is due to the brain operating so fast that it can’t slow down enough to put things in order and the deficit in working memory. Individuals with ADHD experience time very different than others so they will often over estimate or under estimate the amount of time it takes to do a task, resulting in poor time management and missing deadlines.

f.       Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort.

In other words: If the task is boring, if the individual is not interested in it, if it is too challenging or not challenging enough then it is really hard for people with ADHD to get motivated to do it. The ADHD brain has a lack of dopamine, which is a neurotransmitter responsible for reward and pleasure. So if the task is not immediately rewarding: it is very difficult to motivate ourselves to do them. Reading textbooks, doing taxes, writing lengthy reports or essays are all examples of things that may be difficult.

g.      Often loses things necessary for tasks or activities.

In other words: ADHD individuals lose their stuff. Keys, wallets, paperwork, phones: it is hard to remember where we put things because there are too many fun things to do in the world and we don’t have time to slow down enough to put them in their proper place or organize them. Even if we do put them down in their home or a safe place, we often will forget where that place is.

h.      Is often easily distracted by extraneous stimuli.

In other words: Anything can distract us very easily and pull our attention away from what we are doing. This does not just include clocks ticking or other annoying sounds. Us ADHD individuals can get distracted by anything: sounds, light, temperature changes, catching something out of the corner of our eye: even our own thoughts and feelings. While writing this blog post I started 3 more, answered a bunch of emails, took my dog for a walk, pet the cat, ate some popcorn and intensely focused on how annoying the water cooler sound is for about 10minutes.

i.       Is often forgetful in daily activities.

In other words: Things that others seem to do easily such as paying bills on time, returning phone calls, running errands and doing chores are difficult for folks with ADHD. Daily activities require a lot of planning and organization, which is very difficult (see criteria e). Because the ADHD brain has memory deficits it is very difficult to remember to do these things, and because of the lack of dopamine in the ADHD brain it is difficult to get motivated to do these non-dopamine releasing tasks such as remembering to clean the toilet regularly.

ADHD Hyperactivity and Impulsivity Symptoms

a.      Often fidgets with or taps hands or feet or squirms in seat.

In other words: We are very wiggly individuals. Sitting for long periods of time is difficult and uncomfortable. Our bodies want to move constantly so we get out that extra energy often by fidgeting or squirming, especially if we are required to stand still in one place or sit for more than a few minutes.

b.      Often leaves seat in situations when remaining seated is expected.

In other words: The internal hyperactivity that individuals with ADHD experience often drives them to actually get up out of their seat in the classroom or in meetings. This criteria is based on the stereotyped presentation of hyper boys under the age of 12 running around the classroom so it may not be as relevant for adults as many adults have trained themselves to remain seated when expected to do so. Instead for adults this may instead manifest in internal torture with remaining seated, and more fidgeting. However since I work from home and no one is making me sit at this computer while writing this blog post I have gotten up more than 10 times so far.

c.      Often runs about or climbs in situations where it is inappropriate.

In other words: This is similar to criteria b in that the extra energy that individuals with ADHD have may result in them being compelled to get that energy out. This criteria is also very stereotypical of young boys with ADHD, and not adults, so in adults this may look like an internal hyperactivity or restlessness.

d.      Often unable to play or engage in leisure activities quietly.

In other words: When working or playing, it is often hard for ADHD individuals to keep their mouth from moving. Children and adults may babble to themselves or talk out loud when doing something. This can be exacerbated in situations where we are expected to remain seated or keep our attention for a long period of time, as the internal restlessness and energy that ADHD individuals feel must come out somehow (whether through fidgeting or babbling).

e.      Is often “on the go,” acting as if “driven by a motor”.

In other words: ADHD individuals are very busy. To “relax” in the traditional sense by sitting down and doing nothing is very uncomfortable. It is hard to do just one thing at a time or sit for extended periods. Us ADHD folks typically have a lot of energy, and we thrive in situations where there is a lot going on or when we are very busy. Often individuals with ADHD will be involved in a lot of activities and have very little “down time”, as it can be uncomfortable to be doing “nothing”.

f.       Often talks excessively.

In other words: We talk a LOT. Anyone with ADHD can probably relate to the feeling of wanting their mouth to stop moving but being unable to make it do so. Individuals with ADHD may ramble or overshare, especially if they are nervous or anxious.

g.      Often blurts out an answer before a question has been completed.

In other words: It is really hard for ADHD individuals to wait their turn in conversation. Because our brains are moving so fast: when we have an answer, we feel like we have to get it out immediately or we will lose it and our brain will be on to the next thing before we have the chance to say it. In conversations with ADHD individuals, you may notice that they have tendency to finish sentences before they are completed or have a hard time waiting their turn to speak: we are excited and our hyper brains make everything feel like it has to be urgently shared or the opportunity will be missed.

h.      Often has difficulty waiting his or her turn.

In other words: Waiting for our turn to do something, waiting in line, or waiting until the appropriate time to speak in a conversation is very hard. Waiting is hard in general because for ADHD individuals everything is urgent and the world moves very slowly compared to how fast we want it to move. Lines are torture. Red lights are torture. Waiting politely while someone rambles on and finishes their point while we have already finished the conversation in our head is torture.

i.       Often interrupts or intrudes on others.

In other words: This is similar to criteria h, in that it is hard for ADHD individuals to wait thier turn so instead they will often interrupt or intrude. Butting into conversations or activities when someone is clearly busy instead of waiting for the right time is very common.

Hopefully this blog post has clarified the symptoms of ADHD in the DSM5 in more practical terms. ADHD looks very different in each individual, and not everyone with ADHD will connect to all of these symptoms. If you or someone you know is experiencing these symptoms and you would like to know more about how to manage them: please feel free to reach out and book an appointment today to learn more!