Challenges in diagnosing attention-deficit/hyperactivity disorder in pediatric practice: A regional and global perspective

Table 1 Comparison of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and International Classification of Diseases, 11^th Revision diagnostic criteria for attention-deficit/hyperactivity disorder

Feature	Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (American Academy of Pediatrics, 2013)	International Classification of Diseases, 11th Revision (World Health Organization, 2022)
Disorder name	Attention-deficit/hyperactivity disorder (ADHD)	Attention deficit hyperactivity disorder (ADHD)
Classification	Neurodevelopmental disorders	Neurodevelopmental disorders
Core symptom domains	Inattention, hyperactivity/impulsivity (two domains)	Inattention, hyperactivity/impulsivity (two domains)
Subtypes/presentations	Three presentations: Predominantly Inattentive; predominantly hyperactive/impulsive; combined	No subtypes; describes severity of symptoms and predominant pattern
Symptom criteria	≥ 6 symptoms (children)/≥ 5 (adolescents/adults) in each domain lasting ≥ 6 months	At least several symptoms from both domains are required (no strict numeric threshold)
Age of onset	Symptoms must be present before age 12	Symptoms must begin during the developmental period, typically before age 12
Impairment requirement	Symptoms must cause clear impairment in social, academic, or occupational functioning	Symptoms must interfere with personal, family, social, educational, or occupational life
Cross-situational presence	Symptoms must be present in two or more settings	Symptoms must be evident in more than one context
Comorbidity approach	Allows ADHD diagnosis with ASD and other psychiatric conditions	Also allows ADHD with comorbid conditions, including ASD
Severity specifiers	Mild, moderate, severe based on the number and impact of symptoms	Descriptive text is used to indicate severity and functional impact
Emphasis	Symptom count and strict threshold adherence	Clinical judgment, functional impairment, and contextual factors

Table 1 shows that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition is more quantitative and structured, using specific symptom counts and subtypes. In contrast, the International Classification of Diseases, 11^th Revision (ICD-11) adopts a more clinician judgment-based approach, emphasizing functional impairment without strict numeric thresholds. Both systems now recognize comorbidity with autism spectrum disorder, which was not allowed in earlier ICD versions. ADHD: Attention-deficit/hyperactivity disorder; ASD: Autism spectrum disorder.