Attention Deficit Hyperactivity Disorder: Classification

Hyperkinetic disorder (F90.-) is defined by ICD-10 as a disorder involving inattention, hyperactivity, and impulsivity with:

  • Early onset, usually in the first five years of life.
  • A lack of perseverance in occupations that require cognitive effort and a tendency to switch from one activity to another without finishing anything
  • Relationship with adults often characterized by a distance disorder and a lack of normal caution and restraint. With other children, they are unpopular and can be isolated.
  • Frequent impairment of cognitive functions; specific delays in motor and language development occur disproportionately.
  • Dissocial behavior and low self-esteem as secondary complications.

Wender-Utah criteria

The Utah criteria specifically were developed for adult ADHD patients (modified from):

Criteria Symptoms
1. attention deficit in the absence of stimulation. Inability to follow conversations; distractibility; difficulty concentrating on written material; forgetfulness; frequently losing objects
2. motor hyperactivity Feeling of inner restlessness; inability to relax or persist in sedentary activities; dysphoric mood when inactive
3. affect lability Frequent and rapid mood changes within hours and days
4. disorganized behavior Inadequate planning and organization of work, school, or household activities; moving haphazardly from one task to the next without actually completing a task; time management problems
5. impaired affect control Permanent irritability; low frustration tolerance; outbursts of anger.
6. impulsivity Talking out of turn; impatience; actions that are hardly thought through.
7. emotional overreactivity Failure to deal adequately with everyday stressors; exaggerated or anxious reaction

Diagnosis is made according to Utah criteria if:

  • 1. and 2. + two criteria from 3. to 7. are fulfilled

The Utah criteria take into account the mood swings often pronounced in ADHD much more than ICD-10 or DSM-IV.

Severity classification of ADHD

The severity classification (mild, moderate, and severe) was based on DSM-5. Both symptom expression and degree of functional impairment are used to define severity.

Severity Definition
Slightly
  • There are few or no symptoms in addition to those required to make the diagnosis and
  • The symptoms result in only minor impairments in social, educational, or occupational functioning.
Medium
  • The degree of symptomatology and functional impairment is between “mild” and “severe,” i.e., despite only mild symptomatology, there is significant functional impairment due to symptomatology, or despite currently only minor impairment in social, educational, or occupational areas of function, the degree of symptomatology clearly exceeds that required for diagnosis.
Severe
  • The number of symptoms significantly exceeds that required for diagnosis, or several symptoms are particularly severe and the symptoms significantly impair social, educational, or occupational functioning.