Table 1

Salient differences between diagnostic criteria for ADHD and HKD

DomainICD-10DSM-IVDSM-5Notes
SymptomsA minimum of six symptoms of hyperactivity out of ten, five symptoms of inattention out of nine and one symptom of impulsivity out of threeSix out of nine symptoms of inattention and/or hyperactivity/impulsivity are required for the diagnosisSix out of nine symptoms of inattention and/or hyperactivity/impulsivity are required for the diagnosis in children.
Five out of nine symptoms of inattention and/or hyperactivity/impulsivity are required for the diagnosis in adults
ICD-10 requires the presence of symptoms in all the domains of hyperactivity, impulsivity and inattention.
DSM-5 reduces the symptom threshold for adults and adds examples to facilitate application across the lifespan
Age of onsetADHD onset is by definition in childhood (more specifically, before the age of 7)ADHD onset is by definition in childhood (more specifically, before the age of 7)ADHD onset is by definition in childhood (more specifically, before the age of 12)DSM-5 increases the upper limit of the age of onset of ADHD symptoms to 12 years
ComorbidityA comorbid diagnosis with autism, anxiety and affective disorders is not allowedA comorbid diagnosis with autism is not allowedA comorbid diagnosis with autism spectrum disorders is allowedDSM-5 allows the diagnosis in comorbidity with autism spectrum disorders
SettingsInattention and restlessness that are pervasive across situations at home and in school/nurserySymptoms are present in more than one setting (eg, academic, social and occupational) and lead to functional impairment in various domainsSeveral inattentive or hyperactive-impulsive symptoms are present in two or more settingsDSM-5 strengthens the cross-situational requirement to ‘several’ symptoms in each setting
SubtypesNoneThree subtypes: hyperactive/impulsive, inattentive, combinedThree ADHD clinical presentations based on symptom profile: combined, predominantly inattentive and predominantly hyperactive/impulsive presentationICD-10 definition of HKD overlaps with the predominantly combined ADHD subtype for DSM-IV and combined presentation for DSM-5. A person can change ‘presentations’ during their lifetime
  • ADHD, attention deficit/hyperactivity disorder; DSM, Diagnostic and Statistical Manual of Mental Disorders; HKD, hyperkinetic disorders; ICD, International Classification of Diseases.