You assess a 45-year-old woman for ADHD. She reports four symptoms of hyperactivity-impulsivity and five symptoms of inattention as causing functional impairment over the last six months. She also reports ADHD-related difficulties as a child, but was never diagnosed. Assuming she meets DSM-5 criteria B-E, what diagnosis could she receive?

Question

BlackTom AI · Accepted Answer

DSM-5 requires at least five symptoms in one symptom domain for adults (age ≥17) to meet the current symptom threshold for ADHD presentations.

1) Relevant knowledge points and concepts
- DSM-5 ADHD diagnostic thresholds differ by age: for children (up to age 16) the cutoff is ≥6 symptoms in a domain; for ages 17 and older the cutoff is ≥5 symptoms in a domain.  
- Presentations: Predominantly inattentive, predominantly hyperactive-impulsive, or combined presentation (combined requires meeting the symptom count threshold in both domains).  
- History: Some symptoms must have been present before age 12 (criterion B) — this case reports childhood difficulties. Criteria B–E are assumed met.

2) Step-by-step reasoning
- Patient age: 45 (so adult criteria apply; threshold = 5 symptoms).  
- Current symptom counts reported: inattention = 5 symptoms; hyperactivity-impulsivity = 4 symptoms.  
- Check presentations: inattentive presentation requires ≥5 inattentive symptoms — she has 5, so she meets this. Hyperactive-impulsive presentation requires ≥5 hyperactive-impulsive symptoms — she has only 4, so she does not meet this. Combined presentation would require ≥5 symptoms in both domains — she lacks the required hyperactive/impulsive count.

3) Intermediate steps and checks
- Inattention: 5 ≥ 5 → criterion for inattentive domain met.  
- Hyperactivity-impulsivity: 4 < 5 → criterion for hyperactive-impulsive domain not met.  
- Childhood history present → age-of-onset criterion satisfied as assumed.

4) Why the correct answer is correct
Because she meets the adult threshold for inattentive symptoms (5) but does not meet the adult threshold for hyperactive-impulsive symptoms (only 4), the correct DSM-5 presentation is ADHD, predominantly inattentive presentation (ADHD inattentive type).

5) Why other options are incorrect
- (a) Incorrect: she does meet criteria (given B–E assumed met and symptom counts reach adult thresholds for inattention).  
- (c) Incorrect: hyperactive-impulsive type requires ≥5 hyperactive-impulsive symptoms; she has only 4.  
- (d) Incorrect: “in partial remission” is used when full criteria were previously met but are no longer met; here current criteria for inattentive presentation are met.

6) Conclusion/confirmation
Therefore the correct diagnosis is ADHD Inattentive type, matching the provided answer.

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