A. Either (1) or (2)

(1) Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Inattention

(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
(b) often has difficulty sustaining attention in tasks or play activities.
(c) often does not seem to listen when spoken to directly.
(d) often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
(e) often has difficulty organizing tasks and activities.
(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework).
(g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools).
(h) is often easily distracted by extraneous stimuli.
(i) is often forgetful in daily activities.

(2) Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level.

Hyperactivity

(a) often fidgets with hands or feet or squirms in seat.
(b) often leaves seat in classroom or in other situations in which remaining seated is expected.
(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness).
(d) often has difficulty playing or engaging in leisure activities quietly.
(e) is often "on the go" or often acts as if "driven by a motor".
(f) often talks excessively.

Impulsivity

(g) often blurts out answers before questions have been completed.
(h) often has difficulty awaiting turn.
(i) often interrupts or intrudes on others (e.g., butts into conversations or games).

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Code based on type:

Attention-Deficit/Hyperactivity Disorder, Combined Type: if both Criteria A1 and A2 are met for the past 6 months.

Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type: if Criterion A1 is met but Criteria A2 is not met for the past 6 months.

Attention Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type: if Criteria A2 is met but Criterion A1 is not met for the past 6 months.

(Enhanced Version)

by Edward M. Hallowell, MD and John J. Ratey, MD

Note: These criteria are based on extensive clinical experience but have not yet been statistically validated by field trials. Consider a criterion met only if the behavior is considerably more frequent than that of most people of the same mental age. A chronic disturbance in which at least twelve of the following are present:

1. A sense of underachievement, of not meeting one's goals (regardless of how much one has accomplished).
   We put this symptom first because it is the most common reason an adult seeks help. "I just can't get my act together," is the frequent refrain. The person may be highly accomplished by objective standards, or may be floundering, stuck with a sense of being lost in a maze, unable to capitalize on innate potential.
   
   
2. Difficulty getting organized.
   A major problem for most adults with ADD. Without the structure of school, without parents around to get things organized for him or her, the adult may stagger under the organizational demands of everyday life. The supposed "little things" may mount up to create huge obstacles. For the want of a proverbial nail -- a missed appointment, a lost check, a forgotten deadline -- their kingdom may be lost.
   
   
3. Chronic procrastination or trouble getting started.
   Adults with ADD associate so much anxiety with beginning a task, due to their fears that they won't do it right, that they put it off, and off, which, of course, only adds to the anxiety around the task.
   
   
4. Many projects going simultaneously; trouble with follow-through. A corollary of #3. As one task is put off, another is taken up. By the end of the day, or week, or year, countless projects have been undertaken, while few have found completion.
   
   
5. Tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark.
   Like the child with ADD in the classroom, the adult with ADD gets carried away in enthusiasm. An idea comes and it must be spoken, tact or guile yielding to child-like exuberance.
   
   
6. An ongoing search for high stimulation.
   The adult with ADD is always on the lookout for something novel, something in the outside world that can catch up with the whirlwind that's rushing inside.
   
   
7. A tendency to be easily bored.
   A corollary of #6. Boredom surrounds the adult with ADD like a sinkhole, ever ready to drain off energy and leave the individual hungry for more stimulation. This can easily be misinterpreted as a lack of interest; actually it is a relative inability to sustain interest over time. As much as the person cares, his battery pack runs low quickly.
   
   
8. Easy distractibility, trouble focusing attention, tendency to tune out or drift away in the middle of a page or a conversation, often coupled with an ability to hyperfocus at times.
   The hallmark symptom of ADD. The "tuning out" is quite involuntary. It happens when the person isn't looking, so to speak, and the next thing you know, he or she isn't there. The often extraordinary ability to hyperfocus is also usually present, emphasizing the fact that this is a syndrome not of attention deficit but of attention inconsistency.
   
   
9. Often creative, intuitive, highly intelligent.
   Not a symptom, but a trait deserving of mention. Adults with ADD often have unusually creative minds. In the midst of their disorganization and distractibility, they show flashes of brilliance. Capturing this "special something" is one of the goals of treatment.
   
   
10. Trouble going through established channels, following proper procedure.
    Contrary to what one might think, this is not due to some unresolved problem with authority figures. Rather it is a manifestation of boredom and frustration: boredom with routine ways of doing things and excitement around novel approaches, and frustration with being unable to do things the way they're supposed to be done.
    
    
11. Impatient, low tolerance for frustration.
    Frustration of any sort reminds the adult with ADD of all the failures in the past. "oh no," he thinks, "here we go again." So he gets angry or withdraws. The impatience has to do with the need for stimulation and can lead others to think of the individual as immature or insatiable.
    
    
12. Impulsive, either verbally or in action, as in impulsive spending of money, changing plans, enacting new schemes or career plans, and the like.
    This is one of the more dangerous of the adult symptoms, or, depending on the impulse, one of the more advantageous.
    
    
13. Tendency to worry needlessly, endlessly; tendency to scan the horizon looking for something to worry about alternating with inattention to or disregard for actual dangers.
    Worry becomes what attention turns into when it isn't focused on some task.
    
    
14. Sense of impending doom, insecurity, alternating with high-risk-taking.
    This symptom is related to both the tendency to worry needlessly and the tendency to be impulsive.
    
    
15. Mood swings, depression, especially when disengaged from a person or a project.
    Adults with ADD, more than children, are given to unstable moods. Much of this is due to their experience of frustration and/or failure, while some of it is due to the biology of the disorder.
    
    
16. Restlessness.
    One usually does not see, in an adult, the full-blown hyperactivity one may see in a child. Instead one sees what looks like "nervous energy": pacing, drumming of fingers, shifting position while sitting, leaving a table or room frequently, feeling edgy while at rest.
    
    
17. Tendency toward addictive behavior.
    The addiction may be to a substance such as alcohol or cocaine, or to an activity, such as gambling, or shopping, or eating, or overwork.
    
    
18. Chronic problems with self-esteem.
    These are the direct and unhappy result of years of conditioning: years of being told one is a klutz, a spaceshot, an underachiever, lazy, weird, different, out of it, and the like. Years of frustration, failure, or of just not getting it right to do lead to problems with self-esteem. What is impressive is how resilient most adults are, despite all the setbacks.
    
    
19. Inaccurate self-observation.
    People with ADD are poor self-observers. They do not accurately gauge the impact they have on other people. This can often lead to big misunderstandings and deeply hurt feelings.
    
    
20. Family history of ADD or manic-depressive illness or depression or substance abuse or other disorders of impulse control or mood. Since ADD is genetically transmitted and related to the other considerations mentioned, it is not uncommon (but not necessary) to find such a family history.