KAS 2: To make a diagnosis of ADHD, the PCC should determine that DSM-5 criteria have been met, including documentation of symptoms and impairment in more than 1 major setting (ie, social, academic, or occupational), with information obtained primarily from reports from parents or guardians, teachers, other school personnel, and mental health clinicians who are involved in the child or adolescent’s care. The PCC should also rule out any alternative cause. (Grade B: strong recommendation.)

Aggregate evidence qualityGrade B
BenefitsUse of the DSM-5 criteria has led to more uniform categorization of the condition across professional disciplines. The criteria are essentially unchanged from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), for children up to their 18th birthday, except that DSM-IV required onset prior to age 7 for a diagnosis, while DSM-5 requires onset prior to age 12.
Risks, harm, costThe DSM-5 does not specifically state that symptoms must be beyond expected levels for developmental (rather than chronologic) age to qualify for an ADHD diagnosis, which may lead to some misdiagnoses in children with developmental disorders.
Benefit-harm assessmentThe benefits far outweigh the harm.
Intentional vaguenessNone.
Role of patient preferencesAlthough there is some stigma associated with mental disorder diagnoses, resulting in some families preferring other diagnoses, the need for better clarity in diagnoses outweighs this preference.
StrengthStrong recommendation.
Key referencesEvans et al25; McGoey et al42; Young43; Sibley et al46