by Mayer, Gwendolyn ¹, Perlea, Victor ¹

• ¹ Universitätsklinikum Heidelberg

This is the abridged version, for the extended version click here
The introduction and overview can be found here

Disclaimer:We have compiled this information to the best of our knowledge based on current scientific literature (as of May 2026). However, we do not provide diagnosis or treatment recommendations. If you notice any mental health concerns in yourself or in a child or adolescent in your care, please consult a medical doctor.

Diagnostic criteria

• According to the DSM-5 and ICD-11, Attention-Deficit/Hyperactivity Disorder (ADHD) is defined as a persistent pattern of inattention and/or hyperactivity–impulsivity, with several symptoms present before age 12 and in at least two settings (home, school, peers): Eom & Kim (2024): https://doi.org/10.3345/cep.2021.01466
  
• Symptoms cause clinically significant impairment in academic, social, or occupational functioning and are not better explained by another disorder: Warren & Arayamparambil (2023): https://www.ncbi.nlm.nih.gov/books/NBK441838/
  
• The DSM-5 distinguishes between three types of ADHD (Warren & Arayamparambil, 2023):
  
  • Predominantly inattentive
    
  • Predominantly impulsive or hyperactive
    
  • Combination of the above
  
  
• The 2019 American Academy of Pediatrics (AAP) guideline recommends a structured, stepwise diagnostic process consisting of several key action statements (KAS): Wolraich et al. (2019): https://doi.org/10.1542/peds.2019-2528
  
  • Initial Presentation: If a child or adolescent between 4 and 18 years of age shows academic or behavioural problems along with symptoms of inattention, hyperactivity, or impulsivity, the paediatrician or primary care clinician (PCC) should initiate an evaluation for ADHD (KAS 1).
    
  • Diagnostic Evaluation: The diagnostic workup includes identifying the chief concerns and obtaining a thorough history of symptoms, family and medical background, and psychosocial factors. It also requires a diagnostic interview, reports from school and other sources, and a review of academic records. DSM-5–based rating scales should be used.
    
  • To confirm an ADHD diagnosis (KAS 2), the PCC must determine whether the DSM-5 criteria are met. This involves documenting symptoms and impairment in more than one major setting (e.g., social, academic, or occupational). Information should rely primarily on reports from parents or guardians, teachers or other school personnel, and mental health clinicians involved in the child’s or adolescent’s care. The PCC must also rule out alternative explanations for the symptoms.
    
  • Assessment of DSM-5 Criteria: If the child does not meet DSM-5 criteria for ADHD, the clinician should instead provide guidance on age-appropriate development, support relevant management strategies, and ensure ongoing enhanced surveillance.
    
  • Screening for Comorbid Conditions: If ADHD criteria are met, the PCC should screen for comorbid conditions as part of the evaluation (KAS 3) including emotional or behavioural conditions (e.g., anxiety, depression, oppositional defiant disorder, conduct disorder, substance use), developmental conditions (e.g., learning or language disorders, autism spectrum disorders), and physical conditions (e.g., tics, sleep apnoea).
    
  • Determining Need for Specialist Care: After screening, the clinician must determine whether any identified comorbidities require specialist involvement. If the PCC is trained or experienced in diagnosing and managing these comorbidities, they may begin treatment or refer the patient to an appropriate subspecialist (KAS 7). If the PCC lacks training or experience with a particular comorbidity, referral to an appropriate subspecialist is required.

Prevention measures

• Screening and monitoring of high‑risk children (e.g., with strong family history, prematurity) in primary care and school settings: Australian ADHD Professionals Association (AADPA): https://adhdguideline.aadpa.com.au/wp-content/uploads/2022/10/ADHD-Clinical-Practice-Guide-041022.pdf
  
• Parenting programs that teach positive behavior management, classroom-based behavioral strategies, and educational support: Shah et al. (2019): https://doi.org/10.4103/psychiatry.IndianJPsychiatry_543_18

Risk factors

• Genetic/familial loading, prenatal exposure to tobacco, alcohol, or drugs, prematurity or very low birth weight, exposure to environmental risks (e.g., lead) during pregnancy or at a young age, brain injury, and psychosocial adversity: Patel et al. (2016): https://doi.org/10.1596/978-1-4648-0426-7; Ernstmayer et al. (2022): https://www.ncbi.nlm.nih.gov/books/NBK590039/
  
• High rates of comorbidity with learning disorders, anxiety, depression, and autism spectrum disorder (Eom & Kim, 2024; Ernstmayer et al., 2022).

Treatment approaches

• First‑line: multimodal treatment combining psychoeducation, behavioural interventions (parent training, classroom management, organizational skills training), and, where indicated, stimulant or non‑stimulant medication: Jerome & Jerome (2020): https://www.cfp.ca/content/cfp/66/10/732.full.pdf; Shah et al. (2019), Eom & Kim (2023).
  
• Parenting programs that teach positive behavior management, classroom-based behavioral strategies, and educational support. (Shah et al., 2019; Eom & Kim, 2023).

References for this article are here