Formal diagnosis of attention-deficit hyperactivity disorder (ADHD) or hyperkinetic disorder (HKD) is made when the nature, frequency and duration of the patient’s symptoms fulfil the criteria set out in Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5™) or the International Classification of Mental and Behavioural Disorders 10th revision (ICD-10).1-4
Assessment and diagnosis should only be made by appropriately qualified healthcare professionals, such as specialist psychiatrists, specialist nurses or other qualified healthcare professionals, who have training and expertise in the diagnosis of ADHD in children, adolescents and/or adults.1-4
There are two main classification systems for diagnosing ADHD:
The International Classification of Mental and Behavioural Disorders 10th revision (ICD-10)
The ICD-10 medical classification system refers to ADHD as hyperkinetic disorder (HKD), a term widely used in Europe and included in European clinical guidelines developed with the European Network for Hyperkinetic Disorders (EUNETHYDIS).5 This classification system defines HKD as a persistent and severe impairment of psychological development, characterised by “early onset; a combination of overactive, poorly modulated behaviour with marked inattention and lack of persistent task involvement; and pervasiveness over situations and persistence over time of these behavioural characteristics”.5
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5TM)
The DSM-5TM medical classification system for ADHD is published by the American Psychiatric Association and is used in the USA and the rest of the world. This classification system defines ADHD as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development”.6
DSM-5™ replaced the previous version (DSM-IV) in 2013.6,7 The National Institute for Health and Care Excellence (NICE)2 and other clinical guidelines1,3,4 still refer to DSM-IV, and clinical trials initiated before the new edition also refer to DSM-IV.
Regardless of which set of medical classification systems is used, the features of ADHD described are similar, with the exception that the ICD-10 classification system requires that all three features – inattention, hyperactivity and impulsiveness – be present,5 whereas the DSM-5™ diagnostic criteria describe a pattern of inattention and/or hyperactivity-impulsivity (combined, predominantly inattentive or predominantly hyperactive/impulsive presentations).6
These medical classification systems may be used alone or in conjunction with a range of rating scales, which often measure the impact of ADHD upon more specific areas of functioning or quality of life.1-4
- Taylor E, Döpfner M, Sergeant J, et al. European clinical guidelines for hyperkinetic disorder — first upgrade. Eur Child Adolesc Psychiatry 2004; 13(Suppl 1): I/7-I/30.
- National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management. Available at: https://www.nice.org.uk/guidance/cg72/resources/attention-deficit-hyperactivity-disorder-diagnosis-and-management-975625063621. Last updated 2016. Accessed 05 January 2017.
- Canadian ADHD Resource Alliance (CADDRA). Canadian ADHD Practice Guidelines. Toronto: CADDRA, 2011.
- Kooij SJ, Bejerot S, Blackwell A, et al. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry 2010; 10: 67.
- World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Available at: www.who.int/entity/classifications/icd/en/bluebook.pdf. Last updated 1993; 1: 1-263. Accessed 04 January 2017.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 2013.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association, 2004.