Attention Deficit Hyperactivity Disorder Symptoms & Diagnosis

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Deciding if a child has ADHD is a several step process. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms.

The American Psychiatric Association’s Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV-TR) is used by mental health professionals to help diagnose ADHD.   This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD. Using the same standard across communities will help determine the prevalence and public health impact of ADHD.

The criteria are presented here in modified form in order to make them more accessible to the general public. They are listed here for information purposes and should be used only by trained health care providers to diagnose or treat ADHD.

DSM-IV Criteria for ADHD

I. Either A or B:

A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is inappropriate for developmental level:


  • Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
  • Often has trouble keeping attention on tasks or play activities.
  • Often does not seem to listen when spoken to directly.
  • 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).
  • Often has trouble organizing activities.
  • Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
  • Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
  • Is often easily distracted.
  • Is often forgetful in daily activities.


B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:


  • Often fidgets with hands or feet or squirms in seat when sitting still is expected.
  • Often gets up from seat when remaining in seat is expected.
  • Often excessively runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
  • Often has trouble playing or doing leisure activities quietly.
  • Is often “on the go” or often acts as if “driven by a motor”.
  • Often talks excessively.


  • Often blurts out answers before questions have been finished.
  • Often has trouble waiting one’s turn.
  • Often interrupts or intrudes on others (e.g., butts into conversations or games).

II. Some symptoms that cause impairment were present before age 7 years.

III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).

IV. There must be clear evidence of clinically significant impairment in social, school, or work functioning.

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

Based on these criteria, three types of ADHD are identified:

IA. ADHD, Combined Type: if both criteria IA and IB are met for the past 6 months

IB. ADHD, Predominantly Inattentive Type: if criterion IA is met but criterion IB is not met for the past six months

IC. ADHD, Predominantly Hyperactive-Impulsive Type: if Criterion IB is met but Criterion IA is not met for the past six months.

What Are Anxiety Disorders?

What are anxiety disorders?

Anxiety disorders range from feelings of uneasiness to immobilizing bouts of terror. This fact sheet briefly describes the different types of anxiety disorders. This fact sheet is not exhaustive, nor does it include the full range of symptoms and treatments. Keep in mind that new research can yield rapid and dramatic changes in our understanding of and approaches to mental disorders. If you believe you or a loved one has an anxiety disorder, seek competent, professional advice or another form of support.

Generalized Anxiety Disorder: Most people experience anxiety at some point in their lives and some nervousness in anticipation of a real situation. However if a person cannot shake unwarranted worries, or if the feelings are jarring to the point of avoiding everyday activities, he or she most likely has an anxiety disorder.

Symptoms: Chronic, exaggerated worry, tension, and irritability that appear to have no cause or are more intense than the situation warrants. Physical signs, such as restlessness, trouble falling or staying asleep, headaches, trembling, twitching, muscle tension, or sweating, often accompany these psychological symptoms.

Formal diagnosis: When someone spends at least six months worried excessively about everyday problems. However, incapacitating or troublesome symptoms warranting treatment may exist for shorter periods of time.

Treatment: Anxiety is among the most common, most treatable mental disorders. Effective treatments include cognitive behavioral therapy, relaxation techniques, and biofeedback to control muscle tension. Medication, most commonly anti-anxiety drugs, such as benzodiazepine and its derivatives, also may be required in some cases. Some commonly prescribed anti-anxiety medications are diazepam, alprazolam, and lorazepam. The non-benzodiazepine anti-anxiety medication buspirone can be helpful for some individuals.

Panic Disorder: People with panic disorder experience white-knuckled, heart-pounding terror that strikes suddenly and without warning. Since they cannot predict when a panic attack will seize them, many people live in persistent worry that another one could overcome them at any moment.

Symptoms: Pounding heart, chest pains, lightheadedness or dizziness, nausea, shortness of breath, shaking or trembling, choking, fear of dying, sweating, feelings of unreality, numbness or tingling, hot flashes or chills, and a feeling of going out of control or going crazy.

Formal Diagnosis: Either four attacks within four weeks or one or more attacks followed by at least a month of persistent fear of having another attack. A minimum of four of the symptoms listed above developed during at least one of the attacks. Most panic attacks last only a few minutes, but they occasionally go on for ten minutes, and, in rare cases, have been known to last for as long as an hour. They can occur at any time, even during sleep.

Treatment: Cognitive behavioral therapy and medications such as high-potency anti-anxiety drugs like alprazolam. Several classes of antidepressants (such as paroxetine, one of the newer selective serotonin reuptake inhibitors) and the older tricyclics and monoamine oxidase inhibitors (MAO inhibitors) are considered “gold standards” for treating panic disorder. Sometimes a combination of therapy and medication is the most effective approach to helping people manage their symptoms. Proper treatment helps 70 to 90 percent of people with panic disorder, usually within six to eight weeks.

Phobias: Most of us steer clear of certain, hazardous things. Phobias however, are irrational fears that lead people to altogether avoid specific things or situations that trigger intense anxiety. Phobias occur in several forms, for example, agoraphobia is the fear of being in any situation that might trigger a panic attack and from which escape might be difficult. Social phobia is a fear of being extremely embarrassed in front of other people. The most common social phobia is fear of public speaking.

Symptoms: Many of the physical symptoms that accompany panic attacks – such as sweating, racing heart, and trembling – also occur with phobias.

Formal Diagnosis: The person experiences extreme anxiety with exposure to the object or situation; recognizes that his or her fear is excessive or unreasonable; and finds that normal routines, social activities, or relationships are significantly impaired as a result of these fears.

Treatment: Cognitive behavioral therapy has the best track record for helping people overcome most phobic disorders. The goals of this therapy are to desensitize a person to feared situations or to teach a person how to recognize, relax, and cope with anxious thoughts and feelings. Medications, such as anti-anxiety agents or antidepressants, can also help relieve symptoms. Sometimes therapy and medication are combined to treat phobias.

Post-traumatic Stress Disorder: Researchers now know that anyone, even children, can develop PTSD if they have experienced, witnessed, or participated in a traumatic occurrence-especially if the event was life threatening. PTSD can result from terrifying experiences such as rape, kidnapping, natural disasters, or war or serious accidents such as airplane crashes. The psychological damage such incidents cause can interfere with a person’s ability to hold a job or to develop intimate relationships with others.

Symptoms: The symptoms of PTSD can range from constantly reliving the event to a general emotional numbing. Persistent anxiety, exaggerated startle reactions, difficulty concentrating, nightmares, and insomnia are common. People with PTSD typically avoid situations that remind them of the traumatic event, because they provoke intense distress or even panic attacks.

Formal Diagnosis: Although the symptoms of PTSD may be an appropriate initial response to a traumatic event, they are considered part of a disorder when they persist beyond three months.

Treatment: Psychotherapy can help people who have PTSD regain a sense of control over their lives. They also may need cognitive behavior therapy to change painful and intrusive patterns of behavior and thought and to learn relaxation techniques. Support from family and friends can help speed recovery and healing. Medications, such as antidepressants and anti-anxiety agents to reduce anxiety, can ease the symptoms of depression and sleep problems. Treatment for PTSD often includes both psychotherapy and medication.

Anxiety and Panic

What is anxiety?

Anxiety can be a normal “alarm system” alerting you to danger. Imagine coming home and finding a burglar in your living room. Your heart beats fast. Your palms get sweaty. Your mind races. In this situation, anxiety can provide an extra spark to help you get out of danger. In more normal but busy situations, anxiety can give you the energy to get things done.

But sometimes anxiety can be out of control, giving you a sense of dread and fear for no apparent reason. This kind of anxiety can disrupt your life.

Are there different types of anxiety?

Yes. Anxiety can be a general feeling of worry, a sudden attack of panicky feelings, or a fear of a certain situation or object.

What is generalized anxiety disorder?

Generalized anxiety disorder is ongoing worry or fear that isn’t related to a particular event or situation, or is out of proportion to what you would expect–for instance, constantly worrying about a child who is perfectly healthy.

Symptoms of generalized anxiety disorder include muscle tension, trembling, shortness of breath, fast heartbeat, dry mouth, dizziness, nausea, irritability, loss of sleep and not being able to concentrate.

What is panic disorder?

Panic disorder is another type of anxiety. It occurs when you have repeated periods of extreme panic, called panic attacks.

Suppose one day you’re getting out of your car to go to work. Suddenly, your chest feels tight. Your heart races. You begin to feel dizzy and faint. You start to choke. You feel as if you could be dying. Was it all in your head? No. Most likely, you had a panic attack.

Panic attacks typically last about 5 to 30 minutes and may include any of the symptoms listed in the box below. Panic attacks can lead to phobias if they aren’t treated.

Panic attack symptoms

  • Feeling like you’re going to choke
  • Chest pressure or chest pain
  • Pounding heart
  • Racing pulse
  • Dizziness or lightheadedness
  • Shortness of breath or tightness in the throat
  • Sweating
  • Trembling or shaking
  • Nausea
  • Tingling or numbness in the hands or feet
  • Hot flashes or chills
  • Sense of unreality or dreamlike sensations
  • Extreme fear of losing control, doing something embarrassing, going “crazy” or dying

What is a phobia?

A phobia is an extreme, unreasonable fear in response to something specific. There are lots of different phobias, including fear of crowds, bridges, snakes, spiders, heights, open places or social embarrassment.

A phobia is only considered a problem when it keeps you from living a normal life. An example is being afraid to leave home because you are afraid of one of the things listed above.

What causes anxiety disorders?

Suppose the fire alarm goes off in your home. You race around frantically to find the fire. Instead, you find that there is no fire–the alarm just isn’t working properly.

It’s the same with anxiety disorders. Your body mistakenly triggers your alarm system when there is no danger. This may be due to a chemical imbalance in your body. It may also be related to an unconscious memory, to a side effect of a medicine or to an illness.

Can anxiety disorders be treated?

Yes. Talk to your family doctor if you think you have an anxiety disorder. He or she can help you form a plan to develop skills to cope with your anxiety. Your doctor may also suggest counseling and prescribe medicine if needed. The following are some tips on coping with anxiety:

Control your worry.
Choose a place and time to do your worrying. Make it the same place and time every day. Spend 30 minutes thinking about your concerns and what you can do about them. Try not to dwell on what “might” happen. Focus more on what’s really happening. Then let go of the worry and go on with your day.

Steps to deep breathing

  1. Lie down on a flat surface.
  2. Place one hand on your stomach, just above your navel. Place the other hand on your chest.
  3. Breathe in slowly and try to make your stomach rise a little.
  4. Hold your breath for a second.
  5. Breathe out slowly and let your stomach go back down.

Learn ways to relax. These may include muscle relaxation, yoga, or deep breathing (see box to the right).

Muscle relaxation is simple. Start by choosing a muscle and holding it tight for a few seconds. Then relax the muscle. Do this with all of your muscles, one part of your body at a time. Try starting with your feet muscles and working your way up your body.

Exercise regularly. People who have anxiety often quit exercising. But exercise can give you a sense of well-being and help decrease feelings of anxiety.

Get plenty of sleep. Sleep rests your brain as well as your body, and can improve your general sense of wellbeing as well as your mood.

Avoid alcohol and drug abuse. It may seem that alcohol or drugs relax you. But in the long run they make anxiety worse and cause more problems.

Avoid caffeine. Caffeine is found in coffee, tea, soft drinks and chocolate. Caffeine may increase your sense of anxiety because it stimulates your nervous system. Also avoid over-the-counter diet pills, and cough and cold medicines that contain a decongestant.

Confront the things that have made you anxious in the past. Begin by just picturing yourself confronting these things. By doing this, you can get used to the idea of confronting the things that make you anxious before you actually do it. After you feel more comfortable picturing yourself confronting these things, you can begin to actually face them.

If you feel yourself getting anxious, practice a relaxation technique or focus on a simple task, such as counting backward from 100 to 0.

Although feelings of anxiety are scary, they won’t hurt you. Label the level of your fear from 0 to 10 and keep track as it goes up and down. Notice that it doesn’t stay at a very high level for more than a few seconds. When the fear comes, accept it. Wait and give it time to pass without running away from it.

Use medicine if it helps. Your doctor may give you medicine to help reduce your anxiety while you learn new ways to respond to the things that make you anxious. Many types of medicine are available. Your doctor will decide which medicine is right for you.

Talk about your anxiety with your doctor. Your doctor can help you make a plan to cope with anxiety. Counseling can help you learn to express your needs and wants so you can feel more in control and hold in less of your anger and anxiety.

The most important thing is to take action. Action can help you gain a sense of control over your anxiety.