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What is ADHD according to the DSM?


There’s no doubt that ADHD is one of the most controversial disorders around. Some people even go as far as denying its existence. Even though there are other opinions about this condition, this article discusses its official definition in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM).


What is the DSM?

The DSM, first published in 1952, is a manual that covers all mental health disorders for both children and adults. It assists doctors in diagnosing patients by giving them a list against which they can compare symptoms.

Although the DSM is recognized by health professionals around the world, it has been subject to criticism because it attempts to draw a clear line between normal and abnormal behavior. In other words, it is trying to manualize the distinction between those who are healthy and those who are mentally ill. For many people, this is an alarming approach.
The following quote in Harper’s Magazine by L.J. Davis illustrates the controversial nature of this position:

“According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition… human life is a form of mental illness.”
L.J. Davis

Another rather curious fact is that the number of mental illnesses recorded in the DSM has more than tripled in the last 50 years (from 112 in 1952 to 374 in the last revision of 1994). This makes accurate diagnosis increasingly difficult for doctors, who have to sift through endless lists of symptoms with cross-over symptoms for many illnesses and disorders adding to the confusion.


What Is ADHD …

…according to the Diagnostic and Statistical Manual of the American Psychiatric Association:

Attention Deficit Hyperactivity Disorder is a specific mental illness with a genetic and biochemical cause. The disorder consists of a characteristic pattern of behavior and cognitive functioning that is present in different settings where it gives rise to social and educational or work performance difficulties.

The manifestations of the disorder and the difficulties that they cause are subject to gradual change being typically more marked during times when the person is studying or working and lessening during vacation.

Superimposed on these short-term changes are trends that may signal some deterioration or improvement with many symptoms becoming less common in adolescence. Although irritable outbursts are common, abrupt changes in mood lasting for days or longer are not characteristic of ADHD and will usually be a manifestation of some other distinct disorder.


The Three Types of ADHD

  • Type 1: The Predominantly Inattentive Type
  • Type 2: The Predominantly Hyperactive-Impulsive Type
  • Type 3: The Combined Type


The Predominantly Inattentive Type

The symptoms of this type are primarily related to inattention and there is little or no hyperactive and impulsive behavior.

The Inattentive Type may have trouble paying attention, finishing tasks, or following directions. They are often easily distracted, forgetful and frequently lose things. People with this type may also seem slow to respond and process information.

They often seem as though they are in a fog and are prone to daydreaming. They are usually shy and withdrawn. Because of this, people with the Inattentive Type, often go undiagnosed. This happens mainly because they do not display the hyperactive, impulsive attention drawing behavior of the other subtype. The official standard for Attention Deficit Hyperactive Disorder as defined by the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association requires six of the following items listed for the Inattentive Type (sometimes referred to as ADD):

  • fails to give close attention to details
  • difficulty sustaining attention
  • does not appear to listen
  • has difficulty following instructions
  • difficulty with organization
  • avoids tasks requiring sustained attention
  • often loses things
  • easily distracted
  • forgetful in daily activities


The Predominantly Hyperactive-Impulsive Type

The symptoms of this type are primarily related to hyperactivity and impulsivity. Individuals display little or no significant attention problems.

A child/adult with this type may appear restless, fidgety, overactive and impulsive. They often act and speak before thinking, blurting out thoughts and interrupting others.

They have difficulty sitting still, talk excessively, and may have trouble waiting turns. They may seem to be perpetually “on the go.” As an adult, their physical restlessness is usually internalized. This manifests as nervousness and a lack of inner peace.

The official standard for Attention Deficit Hyperactive Disorder as defined by the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association requires six of the following items listed for the Hyperactive Impulsive Type:

  • fidgets or squirms
  • difficulty staying seated
  • runs or climbs inappropriately
  • difficulty engaging in activities quietly
  • always “on the go”, “driven by a motor”
  • talks excessively
  • blurts out answers
  • difficulty in waiting their turn
  • interrupts or intrudes upon others


The Combined Type

Individuals display both inattentive and hyperactive-impulsive symptoms. The majority of children/adults are diagnosed with the Combined Type.

In Addition, the following Conditions must be met:

  • Several inattentive or hyperactive-impulsive symptoms were present before the age of 12 years.
  • Several symptoms are present in two or more settings (i.e. home, work,…)
  • There is clear evidence that the symptoms interfere with, or reduce the quality of social, school, or work functioning.
  • The symptoms do not happen only during the courseof schizophrenia or another psychotic disorder.
  • The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder
  • Symptoms must be present for over 6 months


Coping Mechanisms

Children do not outgrow ADHD. But since many of its symptoms are considered to be undesirable or unacceptable, as a child grows up he/she will most likely develop coping mechanisms to control, avoid or suppress them.

Without proper understanding of these mechanisms, a child can develop a variety of strategies that ultimately undermine his/her potential. Because they lose a vital connection with their underlying identity, many young people with ADHD suffer from self-esteem issues – this can lead to confusion, unhappiness and frustration in adulthood.


Is There a Difference Between ADD and ADHD?

For the record, there is essentially no difference between ADD and ADHD. ADD is the older term used in the DSM while ADHD is the updated version.

Attention Deficit Hyperactivity Disorder is now the official name used by the American Psychiatric Association, and it encompasses hyperactive, impulsive and inattentive behaviors. However, in some cases the term ADD is used for people who have the Predominantly Inattentive Type, since hyperactivity plays a smaller role.