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The Diagnostic and Statistical Manual of Mental Disorders – 4th edition (DSM-IV)1 was developed by the American Psychiatric Association and was used in the USA and the rest of the world for the formal diagnosis of attention-deficit hyperactivity disorder (ADHD) before it was replaced by the 5th edition (DSM-5TM) in 2013.2

Overview of the DSM-IV medical classification system for ADHD1

  • Six or more symptoms of inattention and/or six or more symptoms of hyperactivity-impulsivity, present for at least 6 months prior to assessment
    • Symptoms should be more frequently displayed and more severe than is typically observed in individuals at a comparable level of development
  • Hyperactive-impulsive or inattentive symptoms prior to 7 years of age
  • Impairment present in two or more settings (e.g. at home and at school or at work)
  • Clinically significant impairment in social, academic or occupational environments
  • Symptoms do not occur exclusively in pervasive developmental disorder, schizophrenia or other psychotic disorder, or are not better accounted for by another mental disorder.

Presentations of ADHD

Individuals with ADHD may present with both inattention and hyperactivity/impulsivity, or one symptom pattern may predominate.1 In adults and adolescents, hyperactivity may present as feelings of restlessness and difficulty engaging in quiet, sedentary activities.1

Three subtypes of ADHD are commonly referred to: combined type, inattentive type and hyperactive/impulsive type. According to the DSM-IV classification system, the appropriate subtype of ADHD should be indicated based on the predominant symptom pattern for the last 6 months.1

The DSM-IV diagnostic criteria for each ADHD subtype are identical to those described for DSM-5™.

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association, 2004.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 2013.
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