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WHAT THE DSM-5 SAYS ABOUT ADHD 51

Rapid Reference 2.1

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Sample Manifestations of ADHD Symptoms

DSM-5 Symptom (paraphrased) Examples of How It Might Appear

1a. Attention to details • Wrong operation in math, particularly
on mixed operation worksheets
• Misses key words/phrases, like “not” or
“use a #2 pencil”
• Skips items, sections, or pages on work
and tests
• Omits a step in longer math processes
or science experiments
• Misses key rules for a sport or board
game
1b. Sustained attention • Learns better in short bursts than in a
marathon study session
• Struggles to read an entire chapter
• Gets to end of the page and doesn’t
know what she just read
• Has difficulty staying on task; needs
reminders and prompts
• Can look like procrastination (i.e., avoid-
ance of tasks requiring sustained effort)
• Sometimes attention gets stuck; he can
have difficulty shifting attention to
another task
• Can’t stay with games, movies, or TV
shows as long as peers
• Takes longer than it should to complete
homework, chores, or other effortful
tasks
1c. Listening • Zones out instead of listening
• Responds with “Hunh? What do you
want me to do?”
• Needs a physical cue to look when
someone is speaking
• Does not respond even when asked a
question several times (and really has
no clue someone is talking to him)
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52 ESSENTIALS OF ADHD ASSESSMENT

(Continued )
1d. Follow-through
1e. Organization (tasks,
materials, time)
1f. Sustained mental effort
• Needs directions repeated because she
missed them the first time
• Seems unaware that line is moving, has
to be reminded to walk forward
• Can take the form of hyperfocus (i.e.,
over-focused on one thing to the point
that she is not aware of other things)
• Jumps from task to task
• Starts more things than can be finished
• Loses interest quickly
• Begins an assignment or chore with
enthusiasm but quickly peters out
• Has difficulty completing homework,
chores, and other effortful tasks
• Doesn’t know where to start a task
• Room, locker, and binders are a mess;
needs external structure and guidance
to tackle them
• Even after someone helps organize
materials, they quickly become jumbled
again
• Work has incomplete erasures, words
squeezed in at the ends of lines, food
stains
• Does not anticipate how long a task will
take
• Leaves one place at the time she should
be arriving at the next place
• Turns in assignments after they are due
• Misses the point of an assignment (e.g.,
spends 4/5 of a five-paragraph essay on
a single point rather than covering the
required three points)
• Has trouble keeping track of materials
needed for school and other activities
• Does not consider how best to
sequence the steps that comprise a task
• It is like “pulling teeth” to sit down and
start on a paper or project (even
though she knows the material and is
capable of doing it)
• Easily overwhelmed by anything that
takes more than a few minutes
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WHAT THE DSM-5 SAYS ABOUT ADHD 53

• Effortful to pool cognitive resources to

1g. Loses necessary items
1h. Distractibility (external
sights, sounds, and sensations
and/or internal thoughts)
1i. Forgetful
accomplish a task requiring concentra-
tion; exhausted after completion
• Spends significant effort trying to find
the easy way out (sometimes to the
point that it would have been easier to
do the task); frequently seeks shortcuts
• Procrastinates by finding anything else
that can be done instead of the dreaded
assignment
• Jackets, lunchboxes, gym clothes have
been left behind multiple times
• Cannot keep up with mobile phone,
wallet, keys
• Spends a lot of time looking for the
same things on a regular basis (rather
than having a set place where they go
every time)
• Develops compulsive routines (fre-
quent checking and rechecking) to
avoid losing important materials
• Looks up whenever anyone passes by
or moves
• Complains about the clock ticking,
teacher rustling papers, pencil scratch
noises, people breathing
• Irritated by tags in clothing, does not
adjust to the physical sensation
• Daydreams when a tangential or
unrelated thought pops up; difficult to
make a conscious decision to stay on
task
• Essays ramble; may start on topic but
then be easily led astray as different
ideas pop up
• Becomes side-tracked while speaking,
leading to awkward pauses or going off
on tangents
• Assignments not turned in, even when
complete
• Brings home assignment but not the
required textbook (or vice versa)
• Goes to the driveway (as directed) but
forgets why she is there
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54 ESSENTIALS OF ADHD ASSESSMENT

(Continued )
• Misses sports practice because forgets
to stay at school instead of catching the
bus home
• Agrees to meet friends for dinner, but
forgets the plan when another opportu-
nity arises
• Needs reminders about daily routines
(e.g., where do I put my backpack, do I
take my homework folder home, what
should I do with this worksheet, I don’t
have a pencil)
• Jackets, hats, and sweaters left at school,
friend’s houses, or on the bus
• Relies heavily on smartphone reminders
or Post-it notes to compensate for
frequent forgetting
• Oversleeps because she forgets to set
the alarm
2a. Fidget/squirm • Drums fingers on table, uses pencils as
drumsticks on chairbacks and books
• Rolls pencil back and forth on desk
• Rubs face with fingers, hair, waterbottle,
pencil
• Wriggles around, as if needs to use the
bathroom
• Frequently shifts in seat, as if cannot get
comfortable
• Constantly changing position, sitting in
chair backwards and sideways, standing
or kneeling at desk or in chair
• Foot or leg in constant motion while
sitting
2b. Stay seated • Cannot sit through a full-length movie
or church service
• Eats on the run, grazing rather than
sitting down for a meal
• Moving around the room while watch-
ing television
• Wanders around classroom
• Makes excuses to frequently leave his seat
2c. Run/climb (restless) • Runs through grocery store aisles
• Climbs bookshelves in library
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WHAT THE DSM-5 SAYS ABOUT ADHD 55

• Bounds up and down retaining walls

and park benches rather than walking
along a path
• Seems as if she cannot wait to get out
of the situation, antsy
• Can’t follow “walk, don’t run” rules at
school
2d. Quiet • Lots of sound effects and comments
• Seeks active tasks rather than “quiet”
work
• Responds aloud to television shows and
videos rather than watching quietly
• “Self-talk” is aloud rather than internal
• Talks when other students are working
quietly
• Hums or sings absentmindedly while
doing seatwork, chores, or other tasks
2e. On the go, driven • Just doesn’t stop, seems to have
boundless energy
• Can be exhausting to be around
• Frequently walking ahead of and moving
faster than others
2f. Talks too much • Very few breaks on her side of
conversation, “hard to get a word in
edgewise,” “motor-mouth”
• Gives lengthy responses when a single
word or phrase would suffice
• Comments and answers are unfocused
and can be tangential
• Can involve sharing inappropriate infor-
mation, “TMI” (too much information)
• Fails to adjust how much and how
loudly she speaks based on the situation
(e.g., library vs. recess)
2g. Blurts out • Says the punchline to someone else’s
joke
• Discloses plot twists in movies before
they are revealed
• Shouts out answer in class without raising
his hand or waiting to be called upon
• Answers questions before they are
completed
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56 ESSENTIALS OF ADHD ASSESSMENT

(Continued )
• Shares personal information about
others without their permission
• Makes inappropriate comments
2h. Waiting turn • Jumps in line
• Rolls dice before it is his turn in game
• Talks over someone in conversation
because cannot wait for her turn to talk
• Grabs two brownies before teacher
explains there are enough for each
student to have one
• Reaches for testing materials before
instructions are completed
• Starts timed tasks before “go” signal is
given
• Highly impatient when driving (e.g.,
switching lanes, waiting at traffic light)
2i. Interrupt/intrude • Misses cues for graceful social entry in
conversations and activities, jumps into
other people’s conversations
• Interrupts directions with questions,
comments, or assumptions
• Grabs toys, art supplies, and work
materials without asking first, some-
times taking them from someone’s hand
while in use
• “Borrows” things without realizing he
should ask permission first
• Hijacks an established activity with new
rules, without consideration of others
involved
• Appears oblivious to the fact that
others were immersed in conversation
when she began talking

Presentations of DSM-5 ADHD

For a diagnosis of ADHD to be considered, children 16 years and younger must have
at least six symptomatic criteria from a category. If a child “often” has at least six of
the inattention symptoms, the Predominantly Inattentive presentation (314.00,
F90.0) may be considered. Likewise, if he “often” has at least six of the hyperactivity