When I was first diagnosed it was hard to find a comprehensive list of ADHD symptoms. Today you’ll find symptom lists and screener quizzes in magazines, newspapers, and online.

But the gold standard that doctors start with are the 18 symptoms found in the formidable reference book, the Diagnostic & Statistical Manual V. This latest edition, the 5th, was published in 2013.

And while the symptom list is very useful, there DSM also lays out a number of factors and conditions that must be met. The wording can be confusing but let’s look at what they mean and what they say about ADHD.

Hi I’m Rick Green, I’m a comedian who has a degree in science, and Attention Deficit Hyperactivity Disorder (ADHD).

Are you someone who in hindsight realized you had ADHD but you were misdiagnosed with something else?

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Can’t Be ADHD – I’m Doing Fine!

Or perhaps you might think, well I might have a bit of that but I’m doing fine, even though you’re clearly not, just ask your spouse, teachers, or consider your career path, and report cards… if you still have them, which is unlikely because who wants to keep a reminder of how confused and alone you felt as a kid,,, ouch.

I’m always surprised though at how many people dismissed the possibility of attention deficit hyperactivity disorder after researching the standard list of 18 symptoms, okay they weren’t researching, they were they skimmed through it for 7 seconds.

I’m referring to the checklist found in the diagnostic and statistical manual, which is a kind of medical encyclopedia that covers every major mental health issue, it’s produced by committees of experts from the American Psychiatric Association, and it’s of course always being revised and updated as new research and new information increases the understanding and complexity of mental health issues.

The fifth edition which came out in 2013 finally acknowledged that adults can have ADHD. I mean everybody already knew this for a decade or more but the DSMs very conservative, it’s not a groundbreaker, it’s only updated after enough research and practical experience definitely, definitely confirms the new information.

So ADHD is complicated, the brain is complicated, but the symptom checklist or any checklist can make it sound like it’s simple to diagnose.

Now nobody is keen to be labeled with a mental illness, which it is not as I explained in my short video ADHD is Not an Illness.

So fearing the diagnosis it’s understandable that we arrive at the specialist’s office hoping as I did for assurance that there’s nothing wrong with me, or in my case with my son.

My diagnosis followed shortly after his, and I already knew there was something wrong with me.

Desperate For Normal

So desperate to feel normal we skim through the symptom list seeking anything that doesn’t apply to ourselves, and the DSM lists nine symptoms for inattention issues and nine that apply to the domain of hyperactivity and impulsivity, specifically there’s six for hyperactivity and three for impulsivity.

However this comprehensive sounding list is not the whole story, there are a bunch of additional conditions that have to be met, which in our haste to prove no no I’m fine we may skip altogether, and we shouldn’t.

To start with it says to meet DSM5 criteria for ADHD in childhood a child must have at least six responses of often, or very often, scored two or three to either the nine inattentive symptoms, or the nine hyperactive impulsive items 10 – 18 or both. What now? Yeah I know it’s a lot let’s break it down.

A child must have at least six responses, so you don’t have to have all nine, people who are determined to prove that they are perfectly normal thank you very much, will focus on one or two symptoms that they don’t struggle with, oh well I don’t leave my seat when I’m supposed to be sitting so I’m fine.

So 17 of these are disrupting your life and one isn’t and you’re fine with that?

It also says six responses of often or very often as opposed to occasionally or rarely, and it’s not always or never, we all lose things, interrupt, have trouble organizing now and then, and sometimes we don’t lose our keys, like well if you don’t own a car.

That’s the criteria for kids, but for older adolescents and adults age 17 and older at least five symptoms are required.

Only five? Why?

Because as the years pass we may find ways to cope, structures, systems, good habits.

Coping as an Adult

For example as a child you felt compelled to move, to rock, to fidget, to get out of your seat, and as an adult you’re more in control of yourself, you’re acting like an adult.

At a management training course you manage to stay seated, avoid rocking, and you even appear to be listening, while inside you’re going come on, come one!

Appearing to be listening is a valuable skill, saved my marriage, (Ava) what did you say? (Rick) I I said uh I said hooray for marriage!

Or maybe you’re interested and engaged in the course and you only need to bounce a leg to stay focused.

Next it says the clinician may consider ADHD as a possible diagnosis if five or more of the symptoms are scored two or three in either one or both domains, that’s right both domains, or either one. Welcome to the subtypes of ADHD.

Depending on the domains affected ADHD of the predominantly inattentive subtype, ADHD of the predominantly hyperactive impulsive type, or ADHD of the combined type may be considered. Aha!

So there are three subtypes, the predominantly in attentive subtype, what’s that? Well some people just struggle with focus, with distraction, with tuning out, zoning out, spacing out, losing things, forgetting stuff, or forgetting what they were doing, or what they’re supposed to be doing, but they’re not feeling that driven ants in their pants impatience.

Then there are the people, it’s a small percentage, who only have problems with hyperactivity and impulsivity, they’re restless, driven, talking too much, interrupting.

A few ADHD specialists have told me they don’t really consider that to be true ADHD, at this point the DSM says it is.

Now finally there’s the most common version, the combined subtype of ADHD, where you’ve got it all, you’re struggling with attention and focus, plus restlessness, blurting out, impatience, people who fall into this category are handsome and sexy and and modest, or so they say.

The next requirement for ADHD is that you have had these challenges before the age of 12. This precondition points to the fact that ADHD is highly heritable, it’s driven by your genes as in plural, in fact the last time I looked researchers had identified over 100 genes that were either strongly or weakly linked to ADHD, strongly linked meaning a lot of folks with ADHD have this far more than average, and weekly linked means yeah slightly higher rate of this particular gene turned on.

The first gene that was identified is DRD4.7, the d stands for dopamine and I’m not sure which D, it’s one of the D’s it’s not the R.

Whereas if they weren’t present, if you’ve been struggling with ADHD symptoms ever since say the pandemic started that’s probably not ADHD, unless you had been coping barely and something like a pandemic, divorce, job loss, death, pushed you over the top, or is it under the bottom?

Another important criteria is that it has to be disruptive in multiple situations, at work, at home, with friends, with enemies.

So saying I feel overwhelmed and agitated, and impatient, and fidgety, and restless, whenever my mom comes to stay with us, or when I have to stand in the line at the DMV every four years, I really find myself getting agitated and I don’t know why, that’s why the diagnostician, is that right? Diagnos didn’t sound right, they have to eliminate other possible conditions or causes, brain injury, depression, anxiety, PTSD, thyroid disease, dyslexia, there’s a long list.

All that said, even if it’s been ongoing since childhood, if you’re meeting the criteria, it’s impairing you in multiple situations, the DSM is clear using a rating scale such as this however is not sufficient in and of itself to diagnose ADHD, oh great.

Your results may suggest ADHD is a likely candidate but other sources of information should be considered, and that refers to parents, siblings, friends, people who’ve known you since childhood, this is where report cards are a big help, and an appropriate health professional should be consulted.

So you can see why it’s best to obtain a professional opinion from a psychiatrist or a psychologist who has access to the screener tests like the brown rating scale, the Wender Utah rating scale, and so on.

You’ve probably seen Patrick and Janice McKenna going through those tests together in our documentary ADD and Loving It?! “As a child in school I was overall a good student and fast” “no”. “I get so wrapped up in what I’m doing that I lose track of everything else” “you want to Circle that one for me?” “I’m” “I saw you laughing I saw that”, “okay” “true”, “I generally don’t like people who have different ideas from me” “true, no sense lying you’re right here you’ll this you’ll squeal on me”.

You’ll find lots of quizzes and short checklists and some like our Unofficial Quiz or 10 Signs You Don’t Have ADHD, which are a little tongue and cheek, can really help clarify, but they can only suggest ADHD is a possibility.

This is what’s so frustrating, it’s like okay say you’re wondering is that guy Italian, well does he like pizza? Yeah he does, does he have dark hair? Yeah yeah, does he speak Italian? Oh fluently, does he call you Goomba? Yeah yeah. Sounds likely right? Whereas if they hate Pizza, have silky blonde hair, only speak English with an Australian accent, and call you mate, not conclusive, but Italians definitely not likely. That was the worst Austrail… probably wasn’t even, New Zealand? I don’t know what that was.

Finally some doctors have told me, and this is the most important step, there is the interview, looking back over your lifespan with a professional to see the patterns ones that you probably won’t notice, oh yeah I don’t think I’m driven or fidgety, right but you have moved 12 times in the last decade, and had nine jobs which you left because you grew bored. Oh is that, is that, is that, oh.

So you can see why a proper diagnosis with someone who knows what they’re doing is valuable, and if you want to try medication well it’s a must.

In the meantime while you’re on the waiting list to see a doctor, or you’re saving up to pay for a diagnosis, if where you live you have to pay, it doesn’t hurt to assume you are part of the tribe, in that case learn all you can about what makes attention deficit hyperactivity disorder a disorder and then start experimenting with some ADHD friendly tools, apps, and hacks, and see if they help.

All right please share your thoughts your experiences in the comments, and you can help me reach more of the tribe by liking, by sharing, and even joining the amazing community of supporters through Patreon they’re just the coolest group of people.