Suggested Diagnostic Criteria
For Attention Deficit Disorder in Adults

by Edward M. Hallowell, M.D. and John J. Ratey, M.D.
Copyright (c) 1992

The following criteria are suggested only. They are based upon our clinical experience and constitute what we consider to be the most commonly encountered symptoms in adults with Attention Deficit Disorder. These criteria have not been validated by field trials, and should be regarded only as a clinical guide.

NOTE: Consider a criterion met only if the behavior is considerably more frequent than that of most people of the same mental age.

1. A chronic disturbance in which at least twelve of the following are present:

   1. a sense of underachievement, of not meeting one's goals (regardless of how much one has actually accomplished)

      We put this symptom first because it is the most common reason an adult seeks help. "I just can't get my act together," is the frequent refrain. The person may be highly accomplished by objective standards, or may be floundering, stuck with a sense of being lost in a maze, unable to capitalize on innate potential.

   2. difficulty getting organized

      A major problem for most adults with ADD. Without the structure of school, without parents around to get things organized for him or her, the adult may stagger under the organizational demand of everyday life. The supposed "little things" may mount up to create huge obstacles. For the want of a proverbial nail -- a missed appointment, a lost check, a forgotten deadline--their kingdom may be lost.

   3. chronic procrastination or trouble getting started beginning a task, due to their fears that they won't do it right, that they put it off, and off, which, of course, only adds to the anxiety around the task

   4. many projects going simultaneously; trouble with follow through

      A corollary of #3. As one task is put off, another is taken up. By the end of the day, or week, or year, countless projects have been under- taken, while few have found completion.

   5. tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark

      Like the child with ADD in the classroom, the adult with ADD gets carried away in enthusiasm. An idea comes and it must be spoken, tact or guile yielding to child-like exuberance.

   6. a restive search for high stimulation

      The adult with ADD is always on the lookout for something novel, some- thing engaging, something in the outside world that can catch up with the whirlwind that's rushing inside.

   7. a tendency to be easily bored

      A corollary of #6. Boredom surrounds the adult with ADD like a sink- hole, ever ready to drain off energy and leave the individual hungry for more stimulation. This can easily be misinterpreted as a lack of interest; actually it is a relative inability to sustain interest over time. As much as the person cares, his battery pack runs low quickly.

   8. easy distractibility, trouble focusing attention, tendency to tune out or drift away in the middle of a page or a conversation, often coupled with an ability to hyperfocus at times

      The hallmark symptom of ADD. The "tuning out" is quite involuntary. It happens when the person isn't looking, so to speak, and the next thing you know, he or she isn't there. Their often extraordinary ability to hyperfocus is also usually present, emphasizing the fact that this is a syndrome not of attention deficit but of attention inconsistency.

   9. often creative, intuitive, highly intelligent

      Not a symptom, but a trait deserving of mention. Adults with ADD often have unusually creative minds. In the midst of their disorganization and distractibility, they show flashes of brilliance. Capturing this "special something" is one of the goals of treatment.

   10. trouble in going through established channels, following proper procedure

       Contrary to what one might think, this is not due to some unresolved problem with authority figures. Rather, it is a manifestation of boredom and frustration: boredom with routine ways of doing things and excite- ment around novel approaches, and frustration with being unable to do things the way they're supposed to be done.

   11. impatient; low tolerance for frustration

       Frustration of any sort reminds the adult with ADD of all the failures in the past. "Oh no," he thinks, "here we go again." So he gets angry or withdraws. The impatience has to do with the need for stimulation and can lead others to think of the individual as immature or insatiable.

   12. impulsive, either verbally or in action, as in impulsive spending of money, changing plans, enacting new schemes or career plans, and the like

       This is one of the more dangerous of the adult symptoms, or, depending on the impulse, one of the more advantageous.

   13. tendency to worry needlessly, endlessly; tendency to scan the horizon looking for something to worry about alternating with inattention to or disregard for actual dangers

       Worry is what attention turns into when it isn't focused on some task.

   14. sense of impending doom, insecurity, alternating with high-risk-taking

       This symptom is related to both the tendency to worry needlessly and the tendency to be impulsive.

   15. mood swings, depression, especially when disengaged from a person or a project

       Adults with ADD, more than children, are given to unstable moods. Much of this is due to their experience of frustration and/or failure, while some of it is due to the biology of the disorder.

   16. restlessness

       One usually does not see, in an adult, the full-blown hyperactivity one may see in a child. Instead one sees what looks like "nervous energy": pacing, drumming of fingers, shifting position while sitting, leaving a table or room frequently, feeling edgy while at rest.

   17. tendency toward addictive behavior

       The addiction may be to a substance such as alcohol or cocaine, or to an activity, such as gambling, or shopping, or eating, or overwork.

   18. chronic problems with self-esteem

       These are the direct and unhappy result of years of conditioning: years of being told one is a klutz, a spaceshot, an underachiever, lazy, weird, different, out of it, and the like. Years of frustration, failure, or of just not getting it right do lead to problems with self- esteem. What is impressive is how resilient most adults are, despite all setbacks.

   19. inaccurate self-observation

       People with ADD are poor self-observers. They do not accurately gauge the impact they have on other people. This can often lead to big mis- understandings and deeply hurt feelings.

   20. family history of ADD or manic-depressive illness -- or depression or substance abuse or other disorders of impulse control or mood

       Since ADD is genetically transmitted and related to the other conditions mentioned, it is not uncommon (but not necessary) to find such a family history.

2. Childhood history of ADD (It may not have been formally diagnosed, but in reviewing the history the signs and symptoms were there).

3. Situation not explained by other medical or psychiatric condition.

These Diagnostic Criteria are from Dr. Hallowell's and Dr. Ratey's book, Driven to Distraction, due out in 1993 from Pantheon Books.

Address Correspondences to:

Edward M. Hallowell, M.D.
328 Broadway
Cambridge, MA 02139

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Last Modified: Thursday, October 02, 1997 9:34:45 PM