Suggested Diagnostic Criteria For Attention Deficit Disorder In Adults

From Driven to Distraction, by Edward M. Hallowell, M.D., and John J. Ritey, M.D. , M.D.

NOTE: Consider a criterion met only if the behavior is considerably more frequent than that of most people the same mental age.

A. A chronic disturbance in which at least fifteen of the following are present:

1. A sense of underachievement, of not meeting one's goals (regardless of how much one has actually accomplished). We put this symptom first because it is the most common reason an adult seeks help. "I just can't get my act together" is the frequent refrain. The person may be highly accomplished by objective standards, or may be floundering, stuck with a sense of being lost in a maze, unable to capitalize on innate potential.

2. Difficulty getting organized. A major problem for most adults with ADD. Without the structure of school, without parents around to get things organized for him or her, the adult may stagger under the organizational demands of everyday life. The supposed "little things" may mount up to create huge obstacles. For the want of a proverbial nail -- a missed appointment, a lost check, a forgotten deadline -- their kingdom may be lost.

3. Chronic procrastination or trouble getting started. Adults with ADD associate so much anxiety with beginning a task, due to their fears that they won't do it right, that they put it off, and off, which, of course, only adds to the anxiety around the task.

4. Many projects going simultaneously; trouble with following through. A corollary of number 3. As one task is put off, another is taken up. By the end of the day, week, or year, countless projects have been undertaken, while few have found completion.

5. Tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark. Like the child with ADD in the classroom, the adult with ADD gets carried away in enthusiasm. An idea comes and it must be spoken -- tact or guile yielding to childlike exuberance.

6. A frequent search for high stimulation. The adult with ADD is always on the lookout for something novel, something engaging, something in the outside world that can catch up with the whirlwind that's rushing inside.

7. An intolerance of boredom. A corollary of number 6. Actually the person with ADD seldom feels bored. This is because the millisecond he senses boredom, he swings into action and finds something new; he changes the channel.

8. Easy distractibility, trouble focusing attention, tendency to tune out or drift away in the middle of a page or a conversation, often coupled with an ability to hyperfocus at times. The hallmark symptom of ADD. The tuning out is quite involuntary. It happens when the person isn't looking, so to speak, and the next thing you know he or she isn't there. The often extraordinary ability to hyperfocus is also usually present, emphasizing the fact that this is a syndrome not of attention deficit but of attention inconsistency.

9. Often creative, intuitive, highly intelligent. Not a symptom, but a trait deserving of mention. Adults with ADD often have unusually creative minds. In the midst of their disorganization and distractibility, they show flashes of brilliance. Capturing this special something is one of the goals of treatment.

10. Trouble in going through established channels, following proper procedure. Contrary to what one might think, this is not due to some unresolved problem with authority figures. Rather it is a manifestation of boredom and frustration: boredom with routine ways of doing things and excitement around novel approaches, and frustration with being unable to things the way they're "supposed" to be done.

11. Impatient; low tolerance for frustration. Frustration of any sort reminds the adult with ADD of all the failures in the past. "oh, no," he thinks, "here we go again." So he gets angry or withdraws. The impatience derives from the need for constant stimulation and can lead others to think of the individual as immature or insatiable.

12. Impulsive, either verbally or in action, as in impulsive spending of money, changing plans, enacting new schemes or career plans, and the like. This is one of the more dangerous of the adult symptoms, or, depending on the impulse, one of the more advantageous.

13. Tendency to worry needlessly, endlessly; tendency to scan the horizon looking for something to worry about, alternating with inattention to or disregard for actual dangers. Worry becomes what attention turns into when it isn't focused on some task.

14. Sense of insecurity. Many adults with ADD feel chronically insecure, no matter how stable their life situation may be. They often feel as if their world could collapse around them.

15. Mood swings, mood lability, especially when disengaged form a person or project. The person with ADD can suddenly go into a bad mood, then into a good mood, then into a bad mood all in the space of a few hours and for no apparent reasons. These mood swings are not as pronounced as those associated with manic-depressive illness or depression. Adults with ADD, more than children, are given to unstable moods. Much of this is due to their experience of frustration and/or failure, while some of it is due to the biology of the disorder.

16. Restlessness. One usually does not see, in an adult, the full-blown hyperactivity one may see in a child. Instead one sees what looks like "nervous energy": pacing, drumming of fingers, shifting position while sitting, leaving a table or room frequently, feeling edgy while at rest.

17. Tendency towards addictive behavior. The addiction may be to a substance such as alcohol or cocaine, or to an activity, such as gambling, or shopping, or eating, or overwork.

18. Chronic problems with self-esteem. These problems are the direct and unhappy result of years of frustration, failure, or of just not getting it right. Even the person with ADD who has achieved a great dealusually feels in some way defective. What is impressive is how resilient most adults are, despite all the setbacks.

19. Inaccurate self-observation. People with ADD are poor self-observers. They do not accurately gauge the impact they have on other people. They usually see themselves as less effective or powerful than other people do.

20. Family history of ADD, or manic-depressive illness, or depression, or substance abuse, or other disorders of impulse control or mood. Since ADD is probably genetically transmitted and related to the other conditions mentioned, it is not uncommon (but not necessary) to find such a family history.

B. Childhood history of ADD. (It may not have been formally diagnosed, but in reviewing the history, the signs and symptoms must have been there.)

C. Situation not explained by other medical or psychiatric condition.