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ADHD — Recognition & Diagnostic Criteria

Three presentations, DSM-5-TR criteria & severity

Field: Mental HealthCode: MH-01AUpdated: June 2026Reference: DSM-5-TR / AADPA 2022
All five criteria (A–E) must be met — not just a symptom count. Persistent inattention and/or hyperactivity-impulsivity before age 12, in ≥2 settings, causing real functional impairment: ≥6 symptoms if under 17, ≥5 if 17 or older, for ≥6 months.

Three DSM-5-TR presentations

  • Predominantly inattentive: careless mistakes, poor sustained attention, doesn't listen when spoken to, fails to finish tasks, disorganised, avoids sustained mental effort, loses things, easily distracted, forgetful.
  • Predominantly hyperactive-impulsive: fidgets/squirms, leaves seat when expected to remain seated, runs/climbs inappropriately, talks excessively, blurts answers, can't wait turn, interrupts others.
  • Combined: meets full criteria for both dimensions — the most common presentation, and the one most likely to prompt formal assessment.

Severity (DSM-5-TR)

  • Mild: few symptoms beyond threshold; minor impairment in only 1–2 settings.
  • Moderate: symptoms and impairment between mild and severe; noticeably affecting daily function.
  • Severe: many symptoms well beyond threshold; marked impairment across multiple settings — work, home, social, self-care.

Diagnostic criteria (A-E)

All five must be satisfied — none is optional.

A
Symptoms: ≥6 inattention or hyperactivity-impulsivity symptoms (under 17) or ≥5 (17 and over), for ≥6 months.
B
Onset: several symptoms present before age 12 — needs retrospective history; old school reports are invaluable.
C
Pervasiveness: symptoms in ≥2 settings (school, home, work, social) — collateral history is essential.
D
Impairment: clear functional interference in academic, occupational or social domains — without impairment, no diagnosis.
E
Exclusions: not occurring exclusively during psychosis, autism or another disorder, and not better explained by substance use or a medical condition.
Full DSM-5-TR text & coding. This sheet summarises the recognition framework — it is not a substitute for the full DSM-5-TR criteria or the Australian Evidence-Based Clinical Practice Guideline for ADHD (AADPA, 2022) at adhdguideline.aadpa.com.au. A formal diagnosis is made by a psychiatrist or paediatrician, not in general practice.

Safety

  • Don't diagnose from a symptom count alone — all five criteria (A–E) must be met, including onset before age 12 and impairment in at least two settings.
  • Collateral history (family, partner, old school reports) is often the only reliable evidence for Criterion B — self-report alone is not enough.
  • Don't attempt a formal ADHD diagnosis in general practice — this requires specialist assessment.

Red flags / refer

  • Recognition criteria appear to be met → proceed to screening and the referral pathway (MH-01B).
  • Comorbid mental health features present → screen alongside referral (MH-01C).
  • Suspected autism, learning disability, or treatment being considered → see pre-treatment workup (MH-01D).

MH-01A v1.0 · Reviewed Jun 2026 · Review Jun 2027

For health-professional use. Framework: DSM-5-TR (2022), Australian Evidence-Based Clinical Practice Guideline for ADHD (AADPA, 2022). Companion sheets: MH-01B Screening, Differentials & GP Referral; MH-01C Diagnostic Algorithm & Comorbidity; MH-01D Workup.