International Classification of Diseases, Eleventh Revision (ICD-11) diagnostic criteria for attention deficit hyperactivity disorder

Essential features

Persistent pattern of inattention symptoms or a combination of hyperactivity and impulsivity symptoms
Symptoms have onset before age 12* years and are:
- Outside the limits expected for age and level of intellectual development
- Persistent (≥6 months) and severe enough to have a negative effect on academic, occupational, or social functioning
- Evident across multiple situations or settings (eg, home, school, work, with friends or relatives), but may vary with the structure and demands of the setting
Symptoms are not:
- Due to the effects of a substance (eg, cocaine) or medication (eg, bronchodilators, thyroid replacement medication) on the CNS, including withdrawal effects
- Due to a disease of the nervous system
- Better accounted for by another mental disorder (eg, anxiety or fear-related disorder, neurocognitive disorder such as delirium)

Inattention symptoms (requires several symptoms from the following clusters)^¶

Difficulty sustaining attention to tasks that do not provide a high level of stimulation or reward or require sustained mental effort
Lacking attention to detail
Making careless mistakes in school or work assignments
Not completing tasks

Easily distracted by extraneous stimuli or thoughts not related to the task at hand
Often does not seem to listen when spoken to directly
Frequently appears to be daydreaming or to have mind elsewhere

Loses things
Is forgetful in daily activities
Has difficulty remembering to complete upcoming daily tasks or activities
Difficulty planning, managing, and organizing schoolwork, tasks, and other activities

Hyperactivity/impulsivity symptoms (requires several symptoms from the following clusters)

Excessive motor activity
Leaves seat when expected to sit still
Often runs about
Has difficulty sitting still without fidgeting (younger children)
Feelings of physical restlessness, a sense of discomfort with being quiet or sitting still (adolescents and adults)

Difficulty engaging in activities quietly
Talks too much

Blurts out answers in school, comments at work
Difficulty waiting turn in conversation, games, or activities
Interrupts or intrudes on other's conversations or games

A tendency to act in response to immediate stimuli without deliberation or consideration of risks and consequences (eg, engaging in behaviors with potential for physical injury; impulsive decisions; reckless driving)

ADHD symptoms may vary with chronologic age and ADHD severity.

CNS: central nervous system.

* Some individuals may first come to clinical attention later in adolescence or as adults, often when demands exceed their capacity to compensate for limitations.

¶ Inattention symptoms may not be evident when the individual is engaged in activities that provide intense stimulation and frequent rewards.

Adapted from: International Classification of Diseases, Eleventh Revision (ICD-11), World Health Organization, 2019.

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International Classification of Diseases, Eleventh Revision (ICD-11) diagnostic criteria for attention deficit hyperactivity disorder