Clinical guidelines for recognizing and diagnosing ADHD

While you may be familiar with the ADHD diagnostic criteria, there are new SDBP guidelines to help in diagnosing complex ADHD.1


Diagnostic Criteria

Finding an ADHD diagnosis

To be diagnosed with one of three types of ADHD, individuals must meet the following criteria, adapted from DSM-5™ 2

Six or more symptoms of inattention and/or hyperactivity/impulsivity must have persisted for at least six months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. For older adolescents and adults (age 17 and older), at least five symptoms are required.2

Diagnostic Criteria Update

ADHD symptoms of inattention2

  • Makes careless mistakes/lacks attention to detail
  • Lacks sustained attention in tasks or play activities
  • Poor listener, even in the absence of obvious distraction
  • Fails to follow through on tasks and instructions
  • Difficulty with organization, time management, and deadlines
  • Avoids tasks requiring sustained mental effort
  • Loses things necessary for tasks or activities
  • Easily distracted (including unrelated thoughts)
  • Forgetful in daily activities

ADHD symptoms of hyperactivity/impulsivity2

  • Fidgets, taps hands, or squirms in seat
  • Leaves seat in situations when remaining seated is expected
  • Excessive running/climbing, or feelings of restlessness
  • Difficulty with quiet, leisure activities
  • Often “on-the-go”; acting as if “driven by a motor”
  • Excessive talking
  • Blurts out answers before questions are even completed
  • Difficulty waiting turn
  • Interrupts or intrudes on others

Combined (inattentive/hyperactive-impulsive)

Shows symptoms of both inattentive and hyperactive-compulsive ADHD2


Several ADHD symptoms must be present in 2 or more settings2

In order to diagnose ADHD, symptoms must be persistent; confirmation of substantially impacting symptoms across settings typically cannot be accurately assessed without consulting observers who have seen the individual in the setting.2

Symptoms typically vary depending on setting/context. Below you will find some examples of how ADHD may affect children and adolescents at home, at school, and in social settings2:

Icon AtHome

At home2

  • Is forgetful doing chores
  • Has difficulty keeping materials and belongings in order
  • Is reluctant to engage in tasks that require sustained mental effort such as homework
Icon AtSchool

At school2

  • Does not follow through on instructions and fails to complete assignments
  • Overlooks or misses details in homework or schoolwork
  • Often squirms in seat and leaves seat in classroom inappropriately
Icon In Social Setting

In social settings2

  • Does not seem to listen when spoken to directly
  • Cannot wait for turn in conversations
  • May intrude into or take over what others are doing during play activities

These are not the complete diagnostic criteria

Please see DSM-5 for full diagnostic criteria. It is important to note that diagnosis should be based on a complete history of the patient.

SDBP Guideline

SDBP clinical practice guideline represents a new paradigm in complex ADHD management1

In January 2020, the Society for Developmental and Behavioral Pediatrics (SDBP), a panel of developmental-behavioral pediatricians, psychologists, and nurse practitioners, introduced the first-ever clinical practice guideline for patients with complex ADHD.1

The guideline was developed specifically to help guide diagnosis and treatment decisions in complex ADHD1:

  • It provides a broader perspective on conditions that define complex ADHD:
    • Neurodevelopmental disorders
    • Mental health disorders
    • Socioeconomic factors
  • It also helps identify current gaps in disease research and management1
Image of Frank A. Lopez, MD From TEAM ADHD

“The SDBP guideline is intended to complement the 2019 AAP guideline and to be useful for clinicians from multiple disciplines, as well as for educational professionals who have specialized training and/or expertise that equips them to provide care for children and adolescents with complex ADHD.”

–Frank Lopez, MD3



Development of a multimodal treatment plan for children and adolescents with suspected complex ADHD initiated by clinicians with specialized expertise/training

Strength of Evidence

Grade B—Strong Recommendation


Use of an evidence-based approach to assess for comorbid conditions, including their severity and associated functional impairment

Strength of Evidence

Grade B—Strong Recommendation


Psychoeducation to address all functional domains (behavioral, social, and academic)

Strength of Evidence

Grade B—Strong Recommendation


Treatment of complex ADHD focused not only on symptom management, but on prevention of adverse outcomes (eg, depression and anxiety)

Strength of Evidence

Grade C to B—Recommendation to Strong Recommendation


Monitoring of patients throughout their lives, with emphasis on key developmental periods (eg, school transitions), given chronic nature of ADHD

Strength of Evidence

Grade B—Strong Recommendation

“We need a paradigm shift, and it is my hope that the Guideline and the continued efforts of everyone who cares for and about children and adolescents with ADHD will help to make this change for the benefit of children and their families.”4

– William J Barbaresi, MD

Ico Guidelines

How will this new SDBP guideline inform your practice?

The SDBP guideline underscores that assessment and treatment of children with complex ADHD require a multimodal approach from multiple systems (eg, healthcare, education, etc) to ensure the best possible outcomes.1

Learn more about psychiatric comorbidities here  

Telehealth: Diagnosing From a Distance

Advances in telehealth technology and changes in regulations governing personal health information (PHI) have made it possible to diagnose and treat patients even when not in the same room.

Telemedicine in ADHD

While face-to-face visits are often preferred, especially for initial evaluations, telemedicine is emerging as a viable option for ADHD consults:

  • Telemedicine has been successfully employed in several medical specialties, with favorable patient outcomes5
  • A growing body of evidence suggests that telemedicine has a significant potential to expand the delivery of clinical services to patients and families with ADHD in a cost-effective manner5

Key Takeaways

  • Symptoms of ADHD vary depending on setting and context2
  • 2020 SDBP Guideline introduced to help diagnosis and treatment decisions3
  • Telemedicine is emerging as an option for ADHD consults5

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  1. Barbaresi WJ, Campbell L, DiekrogerEA, et al. The Society for Developmental and Behavioral Pediatrics Clinical Practice Guidelines for the Assessment and Treatment of Children and Adolescents With Complex Attention-Deficit/HyperactivityDisorder: Process of Care Algorithms. J Dev Behav Pediatr. 2020;41 Suppl 2S:S58-S74.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Publishing; 2013.
  3. Data on file. Supernus Pharmaceuticals.
  4. Barbaresi WJ. The SDBP Complex ADHD Clinical Practice Guideline: It’s About Time. J Dev Behav Pediatr. 2020;41 Suppl 2S:S33–S34.
  5. Spencer T, Noyes E, Biederman J. Telemedicine in the management of ADHD: literature review of telemedicine in ADHD. J Atten Disord. 2020;24(1):3-9.