DSM-5 ADHD

ADHD can affect how someone pays attention, stays organised, or manages their impulses. But getting a clear diagnosis isn’t always straightforward. Terms like “DSM-5” often come up, and it’s not always obvious how they apply, especially if you’re based in the UK.

The DSM-5 is a diagnostic guide used by mental health professionals to help identify conditions like ADHD. Although it comes from the US, it’s often used in private assessments here in the UK too, alongside the NHS’s own system.

In this article, we’ll explain what the DSM-5 says about ADHD, how it compares with UK guidelines, and what the assessment process looks like for both children and adults. We’ll also look at the different types of ADHD, how clinicians assess symptoms, and how Oxford CBT can help if you’re thinking about getting a diagnosis or starting treatment. We offer private ADHD assessments to those in London, Oxford and surrounding areas. If you’re an adult female, you can read more about how leaving ADHD untreated could be impacting you in our article Untreated ADHD in Female Adults.

What Is ADHD and How Is It Diagnosed?

ADHD, or Attention Deficit Hyperactivity Disorder, is a condition that affects how a person concentrates, controls impulses, and manages their energy levels. While everyone can feel distracted or restless from time to time, ADHD involves these traits showing up consistently and having a noticeable impact on daily life.

To demonstrate some examples:

• Trying to read a book, but every few seconds your mind jumps to something else – a noise outside, a memory from yesterday, a notification on your phone.
• Sitting in a meeting and having to physically stop yourself from tapping your pen, getting up to walk around, or blurting something out before it’s your turn to speak. 

For someone with ADHD, situations like these aren’t occasional slips. They’re part of a daily pattern that can affect school, work, relationships, and self-esteem.

ADHD is typically diagnosed using a combination of clinical interviews, questionnaires, and observations. There isn’t a single test, like a blood test or brain scan, that can confirm it. Instead, specialist professionals look for a pattern of symptoms over time, usually starting in childhood, and consider how much they interfere with everyday life.

Symptoms usually fall into two main categories: inattentiveness (like forgetting tasks or losing focus) and hyperactivity-impulsivity (like fidgeting or interrupting others). Some people mainly experience one type, while others have a mix of both [1].

Getting a diagnosis can be a turning point. It helps explain long-standing difficulties and opens the door to support, strategies, and sometimes treatment. Whether through the NHS or a private provider like Oxford CBT, an accurate diagnosis begins with understanding your unique experiences, not just ticking boxes on a list.

What Are the DSM-5 Criteria for ADHD?

The DSM-5, short for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is a guide published by the American Psychiatric Association. It’s widely used by mental health professionals around the world to diagnose a range of psychological conditions, including ADHD.

It’s like a handbook that helps clinicians decide whether someone’s experiences match the official definition of a condition. For ADHD, the DSM-5 sets out a list of symptoms, how many must be present, for how long, and how they should affect everyday life. This is available in Section II –  Neurodevelopmental Disorders [2] 

To meet the criteria for ADHD, a person must show persistent symptoms of inattention and/or hyperactivity-impulsivity that:

• Have been present for at least six months
  
• Started before the age of 12
  
• Occur in two or more settings, such as home, school, or work
  
• Interfere with social, academic, or occupational functioning
  

The DSM-5 separates the symptoms into two categories:

Inattention (need at least 6 symptoms for children, 5 for adults):

• Often makes careless mistakes
  
• Has difficulty sustaining attention
  
• Does not seem to listen when spoken to directly
  
• Struggles to follow through on instructions or finish tasks
  
• Has trouble organising tasks and activities
  
• Avoids or dislikes tasks that require sustained mental effort
  
• Often loses things needed for tasks
  
• Is easily distracted by unrelated stimuli
  
• Is forgetful in daily activities
  

Hyperactivity and Impulsivity (need at least 6 symptoms for children, 5 for adults):

• Fidgets with hands or feet or squirms in seat
  
• Leaves seat when staying seated is expected
  
• Runs about or climbs in inappropriate situations (or feels restless in teens/adults)
  
• Is unable to play or engage quietly in activities
  
• Appears “on the go” or acts as if “driven by a motor”
  
• Talks excessively
  
• Blurts out answers before questions are completed
  
• Struggles to wait their turn
  
• Interrupts or intrudes on others
  

The number and type of symptoms present help determine which type of ADHD a person has – inattentive, hyperactive-impulsive, or combined. Diagnosis also involves ruling out other explanations, like anxiety or learning differences, which can sometimes look similar.

By using this structured framework, clinicians can make a consistent and thorough diagnosis that goes beyond surface-level behaviours and looks at how those behaviours affect daily life.

ADHD Presentations in the DSM-5

The DSM-5 recognises that ADHD doesn’t look the same for everyone. Some people struggle mainly with focus and forgetfulness, while others are more visibly restless or impulsive. To reflect this, the DSM-5 describes three different presentations of ADHD, based on the pattern of symptoms a person experiences.

1. Predominantly Inattentive Presentation

This type is often harder to spot, especially in school or work settings where someone might not be disruptive but still struggles to stay on track. People with this presentation may:

• Frequently lose focus or get distracted
  
• Miss important details or instructions
  
• Appear to be daydreaming, even in conversations
  
• Forget daily tasks like returning calls or attending appointments
  

In situations where someone starts a task but quickly drifts off into another thought or switches to something else without finishing, this presentation can sometimes be mistaken for laziness or lack of effort, when in reality, it’s a difficulty with sustaining attention.

2. Predominantly Hyperactive-Impulsive Presentation

This type is more outwardly visible and is often identified earlier in childhood. It includes behaviours such as:

• Constant fidgeting or tapping
  
• Difficulty sitting still, especially in calm settings
  
• Interrupting or blurting out answers
  
• Talking excessively or acting without thinking
  

Examples of this might be a child who can’t sit through a meal without getting up multiple times, or an adult who finds meetings incredibly uncomfortable and struggles to stay silent during group discussions.

3. Combined Presentation

This is the most common type diagnosed among children [1], where a person has a mix of symptoms from both the inattentive and hyperactive-impulsive categories. For example, someone may struggle to stay organised and focused but also feel constantly restless or act impulsively in social situations.

The type of presentation can also shift over time. A child who is hyperactive might become less physically restless as they grow up but continue to struggle with focus and organisation into adulthood.

Understanding which presentation applies helps guide assessment and treatment. It gives a clearer picture of how ADHD affects someone’s day-to-day life, and which strategies or therapies might be most useful.

What Is the UK Equivalent of the DSM-5?

In the UK, the standard used by most NHS professionals for diagnosing ADHD is not the DSM-5, but the ICD, which stands for the International Classification of Diseases. It’s developed by the World Health Organization and is currently in its tenth edition (ICD-10), with ICD-11 gradually being adopted worldwide [3].

While both the DSM-5 and ICD-10/11 are used to diagnose ADHD, there are a few key differences between them.

Terminology and Criteria

In the DSM-5, the condition is referred to as Attention-Deficit/Hyperactivity Disorder (ADHD) and is broken down into three presentations: inattentive, hyperactive-impulsive, and combined.

In contrast, the ICD-10 uses the term Hyperkinetic Disorder. This diagnosis has stricter criteria. To receive a diagnosis under ICD-10, a person must show symptoms of both inattention and hyperactivity/impulsivity – there’s no equivalent of the predominantly inattentive or predominantly hyperactive types found in DSM-5 [4].

This means that under ICD-10, someone who only struggles with attention (without being especially impulsive or hyperactive) might not meet the criteria, even if those symptoms are having a big impact on their life.

ICD-11: A Step Closer to DSM-5

The newer ICD-11 moves closer to the DSM-5 model by using the term ADHD and allowing for subtypes similar to the DSM-5 presentations. This is likely to improve consistency across NHS and private diagnoses in the future [5].

Which System Do UK Clinicians Use?

In general:

• NHS clinicians follow ICD-10, although this may change as ICD-11 is adopted.
  
• Private clinics and some specialist services may use DSM-5, especially to help identify inattentive-type ADHD, which can otherwise be missed.
  

Both systems are based on expert research and evidence, but the choice of framework can affect whether someone is diagnosed and what support they’re offered. This is one reason why private assessments – such as those offered by Oxford CBT – often use a blend of both approaches to get a more complete picture.

Diagnosis of ADHD in Children vs Adults

ADHD doesn’t only affect children. While it’s often picked up in early childhood, many people aren’t diagnosed until adulthood, sometimes after years of wondering why they’ve struggled with focus, organisation, or impulsivity. The core symptoms may be the same, but how they show up and how they’re assessed can differ depending on age.

How ADHD Looks in Children

In children, ADHD is often more visible. They may have trouble sitting still in class, following instructions, or waiting their turn. These behaviours often stand out in school settings, which is why teachers and parents are usually the first to raise concerns.

At Oxford CBT, the process begins with a 60-minute initial consultation involving the child, their parents or carers, and a Clinical Psychologist. This isn’t just a conversation, it’s a structured session where the psychologist observes your child’s communication, interaction, and general behaviour, while also listening to your concerns as a parent.

During the session, the clinician gathers information about your child’s medical background and overall health, and administers the RCADS questionnaire (Revised Children’s Anxiety and Depression Scale), which helps screen for any related conditions such as anxiety or depression.

Following this consultation, the psychologist prepares a detailed report outlining their initial findings, which is then shared with parents. If ADHD traits are identified, further assessments can be scheduled to build a fuller clinical picture.

How ADHD Looks in Adults

In adults, ADHD can be harder to spot. Hyperactivity often becomes more internalised, showing up as restlessness or racing thoughts rather than obvious movement. Adults may struggle with time management, meeting deadlines, or switching off from distractions. Some may not realise they have ADHD until their child is diagnosed, prompting them to reflect on their own experiences.

Adult diagnosis often involves detailed questionnaires, discussions about life history, and exploration of how symptoms have shown up over time. At Oxford CBT, this process is tailored to the individual, taking into account work, relationships, academic background, and emotional wellbeing.

Whether for a child or an adult, a clear and compassionate assessment is the first step. Oxford CBT clinicians work carefully to understand each person’s unique challenges, making sure that any diagnosis – if given – is supported by evidence and followed by helpful recommendations.

The Importance of Clinical Assessment and Observation

Diagnosing ADHD isn’t as simple as ticking a few boxes or completing a quick online quiz. It requires careful clinical judgement, built on a combination of structured tools and professional observation. This is where trained psychologists play a vital role, not just in gathering the facts, but in understanding how those facts affect someone’s day-to-day life.

At Oxford CBT, assessments involve several key components:

Structured Interviews

These conversations go beyond general chatting. Clinicians use standardised questions designed to explore specific behaviours, thought patterns, and developmental history. For children, parents are usually involved in these interviews to provide additional insight. For adults, questions often focus on school years, past coping strategies, and current challenges in work, relationships, or routines.

Questionnaires and Screening Tools

Standardised questionnaires are used to measure symptoms and compare them against diagnostic criteria. One example is the RCADS questionnaire, which screens for anxiety and depression in children, helping to identify if any overlapping or coexisting conditions are present.

For adults and older adolescents, other tools might be used to explore attention, impulsivity, emotional regulation, and related issues. These questionnaires help ensure the assessment is thorough and not based purely on observation.

Behavioural Observation

Sometimes, the most telling information comes from simply watching how someone behaves during a session. A psychologist may notice things like difficulty staying seated, missing key details in conversation, interrupting frequently, or fidgeting – all of which might support the diagnostic process.

Observation is especially helpful for younger children, who may not be able to articulate their thoughts as clearly. It also gives the psychologist a sense of how the person engages socially, responds to questions, and copes with structure or unstructured moments.

Bringing all of this together allows for a more accurate and personalised diagnosis. Rather than relying on a single measure, Oxford CBT takes a balanced, evidence-based approach to understanding ADHD in the context of each person’s real-life experiences.

How Oxford CBT Can Help with ADHD Assessment and Treatment

Whether you’re seeking clarity about your child’s behaviour or exploring a possible diagnosis for yourself, Oxford CBT offers a supportive and professional environment to guide you through the process. Our team of qualified Clinical Psychologists specialises in the assessment and treatment of ADHD for both children and adults.

Private ADHD Assessments

We provide thorough, evidence-based ADHD assessments that combine clinical interviews, structured observation, and recognised screening tools. For children, this begins with a detailed 60-minute consultation involving both the child and their parents. For adults, we explore current symptoms as well as how they’ve shown up throughout life.

Our goal is not just to tick off a checklist, but to understand the full picture – how ADHD traits affect focus, relationships, emotions, and everyday responsibilities.

If a diagnosis is confirmed, you’ll receive a full report and personalised recommendations for next steps.

CBT for ADHD

Cognitive Behavioural Therapy (CBT) is one of the most effective forms of treatment for ADHD, particularly for managing the emotional and behavioural side of the condition [6]. At Oxford CBT, we tailor CBT for ADHD sessions to help individuals:

• Improve organisation and time management
  
• Develop strategies for reducing distractions
  
• Manage impulsive behaviour
  
• Improve self-esteem and emotional regulation
  
• Cope with anxiety or low mood that often accompany ADHD
  

Rather than focusing purely on the challenges, CBT helps you build practical tools to take control of daily life.

Ongoing Support and Care

We understand that ADHD is more than a diagnosis. It’s something that can affect many areas of life. That’s why we offer ongoing therapy and follow-up sessions to help you or your child stay on track, adjust strategies as needed, and feel supported through every step of the journey.

Whether you’re just starting to explore the possibility of ADHD or looking for long-term support after a diagnosis, Oxford CBT is here to help with clear guidance, compassionate care, and evidence-based treatment.

Conclusion

Understanding ADHD through the lens of the DSM-5 can help make sense of behaviours that may have felt confusing or overwhelming – whether in yourself, your child, or someone close to you. While the diagnostic process might seem clinical on paper, at its heart it’s about recognising how someone experiences the world and offering the right support to help them thrive.

At Oxford CBT, we combine structured assessments with genuine, human understanding. Whether you’re navigating a potential diagnosis, seeking therapy, or simply wanting to learn more, our team is here to help you take the next step with confidence.

If you think ADHD might be part of your story, you don’t have to figure it all out alone. We’re here when you’re ready to contact us.

References

1. Erica Roth, Kerry Weiss (2013) Types of ADHD: Inattentive, Hyperactive-Impulsive, and More. healthline.com. https://www.healthline.com/health/adhd/three-types-adhd 
2. American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
3. Gaebel et al. (2020) Changes from ICD-10 to ICD-11 and future directions in psychiatric classification
. Dialogues in clinical neuroscience. https://pubmed.ncbi.nlm.nih.gov/32699501/ 
4. Tripp et al. (1999) DSM-IV and ICD-10: a comparison of the correlates of ADHD and hyperkinetic disorder. Journal of the American Academy of Child and Adolescent Psychiatry. https://pubmed.ncbi.nlm.nih.gov/9951214/ 
5. Gomez et al. (2023) Differences between DSM-5-TR and ICD-11 revisions of attention deficit/hyperactivity disorder: A commentary on implications and opportunities. World journal of psychiatry. https://pubmed.ncbi.nlm.nih.gov/37303925/ 
6. Lopez et al. (2018) Cognitive-behavioural interventions for attention deficit hyperactivity disorder (ADHD) in adults. The Cochrane database of systematic reviews. https://pubmed.ncbi.nlm.nih.gov/29566425/ 

Author – Tom Murfitt

With over a decade’s experience in providing Cognitive Behavioural Therapy, Tom has worked in both the NHS and private sector to help adults and children to overcome a range of difficulties and improve their mental wellbeing. In addition to being an experienced CBT therapist, Tom is also an accredited Mindfulness teacher, providing courses locally, in businesses and schools. You can read more about us here. 

DISCLAIMER: The information provided in this article is intended for general informational purposes only and should not be construed as medical advice, diagnosis, or treatment. The products and methods mentioned are not a substitute for professional medical advice from a trained healthcare specialist. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding your health or a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Use of the information and products discussed is at your own risk.