Diagnostic Criteria for ADHD (DSM 5)

This video discusses the criteria set forth in the DSM-5 for making a diagnosis of ADHD in children and adults. It discusses the changes that were made from DSM-IV to DSM-5. It also discusses the various unresolved issues that remain in using the DSM-5 criteria as written. These issues need to be addressed by clinicians in applying these criteria to clients.
You can find more information on this topic in my books, Taking Charge of ADHD: The Complete Authoritative Guide for Parents, and Taking Care of Adult ADHD.
American Psychiatric Association (2013). The Diagnostic and Statistical Manual for Mental Disorders - 5th Edition (DSM-5). Washington, DC: American Psychiatric Association Press.

[@therealme_pl]

Sir, this content is a definition of quality. It almost shouldn't be here on youtube as it doesn't fit with what you can find here generally. I've been struggling to find useful, fact-based and scientific information about ADHD as I want to go with the diagnosis of my son. Your content is the best I could find by such a margin it's not even comparable to others.

[@russellbarkleyphd2023]

Thank you!

[@JM-cf5yn]

Totally agree! Dr. Barkley is the “Notorious RBPhD” 🏆💯

[@adhd_coach_katherine]

@@JM-cf5ynwe need to make him a t-shirt with that on it!

[@zachhanks4399]

Agreed. Read his books. Be sure to get the most current editions. I tell people they have no business going down the “brighter side of having ADHD” rabbit hole until they’ve thoroughly absorbed Dr. Barkley’s perspectives.

[@JM-cf5yn]

Absolutely! I feel one of the most distressing aspects of adhd is the feelings of isolation and loneliness unless you are experiencing the disorder yourself, others have no idea what you are going through and that is the most difficult for me. Dr. B “notorious RBPhD” makes “us” feel understood and validated. I feel so much better after watching his videos and it is so wonderful that he created this channel after retirement from clinical research. How fortunate we are! 🏆🥇

[@AmandaJuneHagarty]

I remember telling someone about a symptom I had that was because of my ADHD and they said "oh well I get that sometimes too." I replied, "well it happens to me about a dozen times a day." And they said, "oh...well I don't get it that much."

[@hannahriss1349]

Same !!!!

[@s.m.4948]

I explain it to people by using the example of Depression. We are all sad and lethargic sometimes, but people with clinical Depression are sad and lethargic more often, more intensely and for a greater duration than those of us who just occasionally have these feelings.

[@AmandaJuneHagarty]

@@s.m.4948 that's a good way to put it

[@Fran-rv1wv]

exactly, the problemas caused are constant, not sporadic, that's what most people don't get

[@AllThingsConsidered333]

Yeah, that’s what I’m often told- oh everyone has that problem.. yeah but is it so often and severe that it negatively impacts your life? My life/job/home suffer bcs the frequency and severity of these symptoms for me.. but then I get the judgment that I should be able to get over it, manage it, etc and basically I’m a failure bcs I just can’t..

[@aparthia]

If you could do the same for ICD-11, that would be lovely.

[@publius9350]

While a new DSM is nowhere in the foreseeable future, APSARD has guidelines for diagnosis of ADHD in adults under development for 2024, I believe, as I'm sure you know, and though I don't recognize all the names involved, perhaps I should, as I definitely recognize some. It would be interesting to know where you expect that to be going, how much the international consensus statement will be incorporated, and if we patients should be overjoyed, concerned, or in any way involved. I was incredibly surprised to see guidelines did not already exist, and I'm sure it will affect standard of care and insurance coverage amongst other things. I am also curious how often revisions of that are planned as the DSM seems slow to incorporate new research, but any first set of guidelines will inevitably be met with various reactions. I am most concerned about how differential diagnosis will be treated, as so many who unknowingly have ADHD present complaining of depression or anxiety that has resulted from ADHD.

[@bombdatacenters]

Dr Barkley, Do you know of any research that explores the relationship between ADHD and borderline personality disorder? It seems as though there is some overlap in their symptoms. Love your videos!

[@russellbarkleyphd2023]

Yes, there are some studies you can find using Google Scholar to search the journals. About 15-20% of people with ADHD developed BPD by adulthood as well. A history of abuse, disrupted families, r antisocial behavior seems to predict its later likelihood. The impulsivity and inattention attributed to BPD is likely ADHD instead. It’s the affective symptoms that are most aligned with BPD. Be well.

[@publius9350]

​​​@@russellbarkleyphd2023- do the emotional components that are attributable to ADHD sometimes also simply overlap? I found that much of what I thought was borderline personality went away when I started taking guanfacine, and while I have always had some fear of abandonment and other related issues, I have never had the sensation of "switching" or "splitting" that people with borderline personality often describe.

[@llinnea4816]

Hi Dr. Barkley! Thank you for uploading and keeping us informed and updated! I wonder if you have any reaserch on ADHD and its relationship to burnout, and if you would consider doing a video on that topic? Thanks again for all the information and your work!

[@zainmushtaq4347]

I wish my introduction to psychologists was as great and informative as this. You explain wonderfully what the DSM is, what its purpose is, and when it should be used and when it shouldn't be. God bless you with the best 😇

[@jamiejohnson5748]

I have my diagnostic assessment today after work. I found your channel just after I booked it a few weeks ago. Your content has shifted my view from being reluctant to attend, to now looking forward to it. A month ago I would have not wanted to admit my failures. Now I'm looking at it in a more positive way - my life can get better with medication and therapy. What if life is a little easier after? That's a good thing :) Thanks for all your work on this channel, it's really made a difference to me (and others as well, I'm sure).

[@bomcimtube]

Professor, would you please make a video describing ADHD for kids with ADHD? so that parents can let their ADHD kids watch and be informed. Thank you ❤

[@chriscohlmeyer4735]

Great idea, I could see three - grade school, middle school and high school versions.

[@patriciajump9511]

I bet he is going to leave that to the children's doctors. But if your doctor doesn't educate your child enough, maybe it is possible to talk to other parents and find a better doctor for your child.

[@iliyanovslounge]

Can’t wait to see moose again, aha

[@SteveHupe]

An excellent analysis of the DSM pros and cons. Thank you so much Russ for fighting so hard for all of us. ❤

[@theforcefor]

Another amazing video Dr!!!! Thank you for your work!

[@hannahriss1349]

I can’t thank you enough!!! From the bottom of my heart thank you so much for your work and videos! They help more then you know!!!!!❤❤❤❤

[@susanthomas7585]

Thank you. I am learning so much from you.

[@oderey91]

Sometimes we Adhd people are so good at masking that it’s makes the criteria diagnosis harder to see. It’s going to affect the way that teacher or other people see us because we trying so much to fit and act normal to avoid rejection. Also the parents maybe don’t want to see a difference in their children so they don’t agree with the list of criteria, but the most I see is that the parents have undiagnosed Adhd, so for them it’s not a difference nor a problem because they literally think everyone is like that. And it’s affect us too, because we can believe it so much that when we have a diagnosis we don’t feel legitimate about it. I genuinely think that most of the undiagnosed adhd people just believe that everyone in the world are masking and have difficulty like them, and then when we learn that for neurotypical people it’s not the case it’s really hard to believe. Even we can be not sure if we fit the criteria, we are so used to mask the symptom that we don’t even know if they’re real or not.

[@arcanethievery]

I am wondering heavily the same question. Same is true for autism. I was diagnosed last year with ASD at the age of 40. My elder daughter with ADHD and autism (it turns out they co-occur quite frequently) after I insisted to have her diagnose at the age of 7 beacause she had obvious signs of having something weird going on (only for me though apparently and no one else in the family, what's more I was the one thinking the wrong way because she is very smart and verbally quite advanced). Funny thing, I was obsessed with this regarding our daughter, because I was so worried that her - often funny, but other times quite annoying - weirdness is going to cause her very bad experiences in life and rejection the kind I had. When I came to learn about ADHD a bit more after our daughter's diagnosis, it felt so familiar, even more than autism, but I mask heavily (as I learned) due to massive fear of rejection because of bad childhood experiences in school and in family as well up to a point where not only my environment but even I have doubts about anything "wrong" is going on with me. Haha. In the meantime, anxiety kills me.

[@PVVI2015]

Informative and interesting as always! Thank you😊 You have helped me understand myself. As a 75 year old, I have matured and mellowed, but now I manage both my actions and my thoughts better. I’ve been on Bupropion for a year or so, which helps with emotional challenges and, although I have always been very active (various sports) and a musician of sorts, I now see their value in my life beyond just being fun. My diagnosis came late in life, but it has meaning and value. Knowledge is definitely valuable at any age🙏🏼

[@Timewaits4no1]

@PVVI2015 What has your experience with Bupropion been like? Pros/Cons? I've been considering trying it, but it's nice to get some insight first. Thanks

[@takiyaazrin7562]

Great info!

[@drgillykahn]

Thank you - if I could give this more thumbs up, I would 👍🏻👍🏻👍🏻

[@puppypoet]

This keeps reminding me of how a psychiatrist said I had absolutely no signs of ADHD, that all I had was anxiety. Every time I'd ask a question, she cut me off and kept repeating the same thing. She made me feel like I was wasting her time. I spent $800 I didn't have to be dismissed and actually snapped at several times by a supposed professional.

[@zainmushtaq4347]

I'm so sorry you had to go through that -- such an experience, even if it's "minor" or a "one-off" can be traumatizing and leave scars for a long time :/ Just remember that this is just a stepping stone to something greater in the grand plan that's assigned for you. Use this experience to acquire more knowledge, to reflect on it and understand more, and learn from it for the next time and advice others about what to watch out for. I hope you get the help you need 😇⭐

[@frankcarpinelli5207]

Sir. So what IS the best comprehensive ADHD and Combative Behavioral tests for adults? Thank you.

[@Fran-rv1wv]

Thank you Russell, sincerely thank you for everything you have done for the adhd and add community.

[@thyagu.udayakumar]

We need an objective diagnostic test ASAP.

[@thebeachhousebasel]

Thank you so much for your updates and findings. You are one main reason why i decided to go back to college next january to become an adhd coach in switzerland.

[@babybaby5893]

Dr Barkley, thank you for educating us parents to understand our kids with knowledge,you are the best! I have listening to your lectures from other podcast ans channels,and i am so excited that you have your own channel too.

[@cdorman11]

8:25 Changes since IV 10:45 Emotional diyregulation still missing from V

[@samantha-lee7294]

Another great video thank you. I was diagnosed with adhd at the age of around 48. Before that i was always told that i am just “highly strung” and “too emotional” following in the steps of my mother and older sister. Unfortunately they have both passed away now and were never diagnosed. Gee i am so glad that (even if it took 50 years) women are now diagnosed and treated, instead of just being dismissed as “hysterical“. I think that is mostly due to you and your wonderful research on this topic. You are truly wonderful. Thank you so much Doctor. 😀😀😀

[@stevepeterson5943]

Man ,all im trying to do is find a list of the nine criteria. This was very good but why not include 1-9 ? Ive learned much from your content, appreciate it.

[@foxclower]

Always love watching your videos, and feels great to get a special welcome as a subscriber. I was wondering, is there any studies on comorbid disorders masking the adhd symptoms? I was extremely conscious of other people ever since I was very little, i have memory of wetting my pants because I just couldn't ask to go to the bathroom (several instances). This got worse (mentally) as I grew up. I am able to control myself before and after a social interaction, but if I put my guard down just a bit, it's like floodgates opening and I overshare or talk too much going on tangents. Because of this, I have half of my brain managing my manners when I talk so I can't think at all, or when I think, my manners go out the window, and if i focus on both, I'm tripping over my words because I didn't formulate the sentences properly in my head before speaking. There is a warning light in my head whenever I'm around someone, and this drains my energy even if I am not doing anything. But this also means most social interaction related symptoms of adhd are not present with me. I am moving around getting distracted or momentarily inspired by everything when I'm at home, but outside, I'm frozen, overthinking and being overly conscious of everyone around me. (I think about how I can move naturally or look nonchalant and basically act out being relaxed) I can't relax during work breaks because now that there isn't a task at hand, I'm even more conscious of others. So work felt like a long gruelling hours of my energy flowing down the drain. Even if people are out of sight, knowing someone could come around the corner, I couldn't relax at all. (I work from home now as a freelancer) (Also, aside from people, when I'm not constantly attending to my surroundings, I get into dangerous situations like almost getting run over by a car when crossing the street etc, to the point I tense up when I just imagine having to cross a road, and gets mentally exhausted preparing for amount of roads I have to cross to get to certain destination etc) Does this affect how the criteria is applied or does another problem kinda managing the other make it not a valid symptom?

[@foxclower]

Sorry for the wall of text.

[@treaclecustard]

​@@foxclowerI know exactly how you feel, I do the same and it's exhausting..

[@DadThrowawayADHD]

Greetings! Thanks again for the valuable information, as always. I was wondering... For rigidity (specifically, rigid thinking), are there any studies that show certain medications helping with flexibility better than others? (i.e. Does Adderall tend to make thinking more or less rigid? Vyvanse? Etc.?) Thank you!

[@hideokojima2395]

Russell - another amazing upload! Thank you for all you do for the ADHD community. A completely random question, but I am wondering, have you heard the thoughts of “World Leading Physician Gabor Mate view on ADHD” and if so would you be one day perhaps willing to debunk or respond to his statements? I love both of your response videos to Jordan Peterson, and I believe Dr. Mate has just as an impactfully incorrect opinion on ADHD that is spread around like wildfire on social media. I also know you do so much for the ADHD community & it’s certainly not your “job” to respond to all the naysayers, but I figured it might be an interesting future video for you to film if you were to choose! I believe your voice should be the one spread around social media about ADHD, and I know a good way to access the misinformed is to address the sources of their misinformation! Take care ❤

[@russellbarkleyphd2023]

Although I do speak about the wrongfulness of his ideas in my videos on ADHD and trauma, I may need to create one separately just about his ideas as others have also asked to be done. Thanks!

[@hideokojima2395]

⁠@@russellbarkleyphd2023 you are such a valuable ally, all of us in & around the adhd community are so fortunate to still have you here as passionate as ever, still dedicating time to educate & inform!! i seriously don’t mean to be a, pardon my french, ~”kiss ass”~ but seriously… words cannot express enough how much of a positive impact you continue to leave on the world as a whole & just so many individual lives. :) signed, a 24 year old typical “male-presenting” woman who is predominately hyperactive ADHDer who, apparently to jordan peterson and gabor mate, didn’t get enough “rough play” (even though i was a toddler running around the store leaving my mother behind, in kindergarten i was the only kid in my class who has their desk moved to the front of the class to be near the teacher d/t my behavior. who got her own color chart taped to her desk that was separated from her peers before finally, in the middle of third grade, after many report cards of “needs to stay seated in class. needs to pay attention in class. needs to stop talking during class.” my teacher set up an after school meeting with my mother and bluntly told her “i believe you daughter may have ADHD.” which was at first met with apprehension & defense, but by the start of 4th grade i was on concerta and went from the hyperactive, inattentive, isolated “bad” child in class to getting A’s & B’s, becoming the “quiet, nice girl” in class, and getting report cards full of “pleasure to have in class!”

[@hideokojima2395]

just trauma dumped on you with that last comment, but i’m sure you’re no stranger to people doing that to you haha! the effect you have on people d/t your healing, trustworthy nature :) thank you russell… from the bottom of my heart.

[@Deviliza]

At first, I wasnt really that interested in this one. I mean, I am diagnosed, I have looked at this before and the DSM5 isn't used in my country. But this is actually interestimg because you also go over where these criteria is off (in your opinion) and why. It's actually very interesting for an adult woman such as my self. I kind of knew there was something about "based on boys", but not how much it is influenced by that. Now I just really want to hear more about these statistics for adult women - who seems to be the ones who are furthest from the DSM5. Even as we know there's something about this, we are still often struck be the way that the general talk about ADHD is just very much about little hyperactive boys. Or that the fact the we are not men are also posing some difficulties when we talk about our difficulties. If a man had the same problems, in some aspects he might not stand out that much. But we do when we compare to other women. But our might lead to not understanding the big deal when a man says "I do that sometimes too". Yes, but I stand out because I am a woman that is met with other expectations.

[@Miata17634]

Hi! Thank you for your videos... I'm a therapist and work primarily with people who have ADHD. One question that has come up for me a lot is, how do you tell the difference between FASD (esp. executive functioning/memory), BPD (esp. social difficulties, impulsivity & emotional dysregulation), and ADHD? I find that these diagnoses are often assigned for very similar presentations/symptom clusters but different demographics (socioeconomic, ethnicity, gender, etc.). Obviously this has huge impacts on treatment (DBT therapy for BPD vs. stimulant medication for ADHD). In particular in my experience, in my area which is a low SES area, females are more likely to be diagnosed with BPD vs ADHD and the reverse is true for males. And people from high SES are more likely to get an ADHD vs FASD diagnosis. I would love to hear your thoughts on this.

[@russellbarkleyphd2023]

FASD is an etiology or possible biological contributor to ADHD, so it belongs at a different leelof analysis than does ADHD or BPD, which are psychiatric syndromes. So FASD can lead to an ADHD presentation, but can also interact with maternal risk for ADHD to worsen the genetic risk to a child for having ADHD. About 15-20% of people growing up with ADHD may develop BPD, typically they have had conduct disorder by adolescence as well as exposure to more adverse life events. They are not the same disorder. Some studies suggest that the impulsivity seen in BPD is really due to its comorbidity with ADHD. Controlling for that, people with BPD are not so impulsive. What remains is the heightened emotional sensitivity to relationship (social) issues and over-reaction to social interactions. We do need more research on their overlap but they are not the same thing. Be well

[@Miata17634]

​@russellbarkleyphd2023 Wow thank you so much for your reply!! This is fascinating, I would love to learn more about these overlaps if you ever do a video on them!

[@alejandroestevez8561]

Thanks for the video. But you haven't shown the actual list of symtons. It would be nice to get a clarification on the list. Some of these look very same to me, just describing the same thing with other words.

[@russellbarkleyphd2023]

Due to copyright by the APA I can’t show the exact list of symptoms as they are worded in the manual. But I’ll bet someone else has put the, up somewhere on the web.

[@arcanethievery]

Any insight on masking? By adulthood one frequently manages to counteract symptoms one way or another and it leads to anxiety for example because of holding up, and the only very apparent symptom is let's say hardship in emotional self regulation? Most notably sudden outbursts of anger. By adulthood other symptoms like inattentiveness and distractability are only here and there, they do occur, but less obtrusively because of masking. The affected person clearly has difficulties, but what is "in front of the eye" would not constitute a diagnosis. Also the sex difference: is there anything like in autism, such as a "female phenotype" which presents mostly but not exclusively in girls and women? I mean, a male patient can present a female phenotype of ADHD? Because if sex matters and being taken into account, a female presentation would not meet diagnostic criteria in males. I feel I am missing or misinterpreting something.

[@davidp3566]

Why is the DSM-5 TR not being discussed when its the latest version (2022)?

[@russellbarkleyphd2023]

Because the diagnostic criteria remain identical and that is what is discussed in the video, not text revisions. Thanks for watching.

[@irisviel_Einzbern]

What if someone just difficulty with time blindness and time management, but it's severe enough to interfere with functioning? Like someone who starts the task or even before task thinking its easy will cover in 10 minutes so i have 50 minutes to waste in an hour, but it does take more time and so often missing deadlines or doing at the last few hours, and is effecting career and life, but other then this there isnt emotional dysregulation. So is emotional dysregulation a central part of adhd? Does every adhdier has some sort of emotional dysregulation?

[@russellbarkleyphd2023]

70-80% or more of those with ADHD have the emotional dysregulation but certainly not all. The case you describe would be part of an ADHD spectrum phenotype but not a disorder yet given the lack of impairment. Thanks!

[@semraakdeniz3619]

İngilizce bilmiyorum o nedenle anlamıyorum.nasil cevirebilirim

[@sking51]

At 5’ 11,” it states “…of either….”! Does that mean that your reference to 12 is not correct?

[@russellbarkleyphd2023]

It’s six on either list or five for adults for either the inattentive or hyperactive presentations, , or 12 for kids and 10 for adults for the combined presentation. I know, it’s confusing.

[@satyrkrieg]

How often is often?

[@stevepeterson5943]

More often than the majority. . . . More than most people. He went through that.

[@patriciajump9511]

I bet a lot of adults don't "remember" age of onset simply because they don't have the experience or the "mental thinking style" to realize any of their behaviors at a young age were adhd symptoms. So I bet this "not remembering" gets noted in newly diagnosed adults with busy lives and no time to spend thinking back on their childhoods, and then further on, the issue is neither re-examined or the original barriers still exist.

[@paintediva]

Yeah. Your vids are meant for other drs and educators. Not for people with this disorder who are trying to help themselves.

[@maddiekits]

Why do you say that?