Quick Reference

Code: F90 (with 4th character specifications)
Disorder: Attention-Deficit/Hyperactivity Disorder (ADHD)
Category: Neurodevelopmental Disorders
Billing Status: Active code for reimbursement (requires 4th character)
DSM-5 Equivalent: 314.0x (Attention-Deficit/Hyperactivity Disorder)
Common Comorbidities: Learning Disorders, Oppositional Defiant Disorder, Conduct Disorder, Anxiety Disorders, Depression, Autism Spectrum Disorder

Clinical Description

Attention-Deficit/Hyperactivity Disorder is a neurodevelopmental disorder characterized by persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning or development. Symptoms must be present before age 12, occur in multiple settings, and cause clinically significant impairment.

ICD-10 Coding Specifications

F90.0 - Attention-deficit hyperactivity disorder, predominantly inattentive type
F90.1 - Attention-deficit hyperactivity disorder, predominantly hyperactive type
F90.2 - Attention-deficit hyperactivity disorder, combined type
F90.8 - Attention-deficit hyperactivity disorder, other type
F90.9 - Attention-deficit hyperactivity disorder, unspecified type

Diagnostic Criteria

Inattention Symptoms (6+ required for children, 5+ for adolescents/adults):

• Often fails to give close attention to details or makes careless mistakes

• Often has difficulty sustaining attention in tasks or play activities

• Often does not seem to listen when spoken to directly

• Often does not follow through on instructions and fails to finish tasks

• Often has difficulty organizing tasks and activities

• Often avoids, dislikes, or is reluctant to engage in tasks requiring sustained mental effort

• Often loses things necessary for tasks or activities

• Is often easily distracted by extraneous stimuli

• Is often forgetful in daily activities

Hyperactivity-Impulsivity Symptoms (6+ required for children, 5+ for adolescents/adults):

Hyperactivity:

• Often fidgets with or taps hands or feet or squirms in seat

• Often leaves seat in situations when remaining seated is expected

• Often runs about or climbs in situations where it is inappropriate

• Often unable to play or engage in leisure activities quietly

• Is often "on the go," acting as if "driven by a motor"

• Often talks excessively

Impulsivity:

• Often blurts out answers before questions have been completed

• Often has difficulty waiting their turn

• Often interrupts or intrudes on others

Additional Criteria:

• Several symptoms present before age 12 (but not necessarily impairing)

• Symptoms present in 2+ settings (home, school, work)

• Clear evidence of clinically significant impairment

• Symptoms not better explained by another mental disorder

Presentation Types

Differential Diagnosis

Transdiagnostic Considerations

ADHD is part of the neurodevelopmental disorder spectrum and frequently co-occurs with other conditions. Several neuropsychological constructs are involved. In particular, executive functioning deficits are central to ADHD and impact multiple life domains. Treatment often requires addressing comorbid conditions and environmental factors.

Assessment Tools

Validated Screening & Assessment Instruments

Treatment Approaches

Evidence-Based Psychosocial Interventions

Behavioral interventions are the foundation of ADHD treatment, particularly for children. The combination of medication and behavioral therapy typically provides optimal outcomes.

Evidence-Based Medication Options

These tables include only a sample of available formulations. Please provide recommendations according to your patient’s specific clinical factors.

Stimulant medications are first-line treatment for ADHD, with non-stimulants as alternatives for those who cannot tolerate or do not respond to stimulants.

Stimulant Medications

Non-Stimulant Medications

Medication Management Considerations

Monitoring Parameters:

• Height and weight (growth charts)

• Blood pressure and heart rate

• Sleep patterns and appetite

• Mood and behavioral changes

• Academic/occupational functioning

• Side effect assessment

Common Side Effects:

• Appetite suppression and weight loss

• Sleep difficulties

• Mood changes (irritability, sadness)

• Growth suppression (temporary)

• Cardiovascular effects (mild)

• Rebound symptoms

Multimodal Treatment Approach

Children (6-11 years):

• Behavioral parent training (first-line)

• Behavioral classroom interventions

• Medication if behavioral interventions are insufficient

• School accommodations and supports

Adolescents (12-17 years):

• Combination of medication and behavioral therapy

• Academic accommodations and support

• Driver education and safety planning

• Transition planning for adulthood

Adults (18+ years):

• Medication management

• CBT focused on organization and time management

• Workplace accommodations

• Treatment of comorbid conditions

Addressing Common Treatment Challenges

Educational and Workplace Considerations

School-Based Interventions

Section 504 Accommodations:

• Extended time on tests and assignments

• Preferential seating (front of class, away from distractions)

• Break tasks into smaller segments

• Use of assistive technology

• Modified homework assignments

• Alternative testing formats

Individualized Education Program (IEP):

• May qualify under "Other Health Impairment" category

• Requires documented adverse impact on educational performance

• Includes specialized instruction and related services

• Annual goals and progress monitoring

Classroom Strategies:

• Clear, consistent routines and expectations

• Visual schedules and reminders

• Frequent feedback and reinforcement

• Movement breaks and fidget tools

• Minimize distractions in environment

Workplace Accommodations

Common ADA Accommodations:

• Flexible scheduling and break times

• Quiet workspace or noise-canceling headphones

• Written instructions and task lists

• Extended deadlines for projects

• Technology aids (reminder apps, organizers)

• Regular check-ins with supervisor

Documentation, Coding, and Reimbursement

ICD-10 Coding Tips

• F90 requires a 4th character to specify presentation type

• Document specific symptoms from both inattention and hyperactivity-impulsivity criteria

• Include age of onset (must be before age 12)

• Specify settings where impairment occurs

• Document functional impairment in academic, social, or occupational domains

• Consider coding comorbid conditions separately

Medical Necessity Documentation Language

Example statements to support medical necessity:

• "Patient exhibits [X] symptoms of inattention and [X] symptoms of hyperactivity-impulsivity present since age [X]"

• "ADHD symptoms cause significant impairment in academic performance as evidenced by [specific examples]"

• "Functional impairment documented across multiple settings including home and school/work"

• "Previous interventions attempted include [list] with limited success"

• "Current [rating scale] scores indicate [severity level] ADHD symptoms requiring treatment"

Other Documentation Requirements for Reimbursement

• Comprehensive developmental history

• Multi-informant assessment (parent, teacher, self-report)

• Evidence of symptoms before age 12

• Documentation of impairment in 2+ settings

• Differential diagnosis ruling out other conditions

• Treatment plan with specific, measurable goals

• Regular monitoring and adjustment documentation

Specific Payer Considerations

Patient Education Resources

Handouts for Patients and Families

• NIMH Information Sheet

• ADHD Medication Guide for Families

• CHADD Fact Sheets

• Understood.org Resources

• ADHD Medication Effects Log

Digital Resources

Recommended Apps:

• Forest: Focus and productivity timer

• Todoist: Task management and organization

• Brain Focus: Pomodoro technique timer

• Habitica: Gamified habit tracking

• Freedom: Website and app blocker

Online Communities:

• CHADD (Children and Adults with ADHD) support groups

• ADDitude Magazine online community

Psychoeducational Talking Points

• ADHD as a neurodevelopmental difference: ADHD involves differences in brain structure and function, particularly in areas responsible for executive functioning, attention regulation, and impulse control. Neuroimaging studies show differences in the prefrontal cortex, basal ganglia, and cerebellum. These brain differences explain why people with ADHD struggle with tasks that others may find automatic, like sustained attention, organization, and impulse control. Understanding ADHD as a neurobiological condition helps reduce blame and stigma while supporting the need for appropriate accommodations and treatment.
  
  
  

• Executive functioning deficits and their real-world impact: Executive functions are the mental skills that include working memory, flexible thinking, and self-control. ADHD primarily affects these "CEO" functions of the brain. This explains why someone with ADHD might be intelligent and capable but struggle with seemingly simple tasks like remembering instructions, managing time, or organizing materials. These aren't character flaws or laziness but genuine neurological challenges that require specific strategies and sometimes accommodations to overcome.
  
  
  

• The role of dopamine and motivation: ADHD brains have differences in dopamine pathways, which affect motivation, reward processing, and the ability to sustain attention on less immediately rewarding tasks. This explains why people with ADHD can hyperfocus on interesting activities but struggle with routine or boring tasks. It's not about willpower or caring less; it's about neurochemical differences that make some activities feel unrewarding or even physically uncomfortable to pursue.
  
  
  

• Medication myths and realities: ADHD medications don't "cure" ADHD but help normalize brain chemistry to improve attention, reduce impulsivity, and enhance executive functioning. Stimulant medications are among the most well-researched and effective treatments in all of medicine, with decades of safety data. They don't change personality or turn children into "zombies" when properly prescribed and monitored. The goal is to help the person access their natural abilities and potential by reducing the neurological barriers that ADHD creates.
  
  
  

• Strengths and positive aspects of ADHD: While ADHD presents challenges, it also comes with potential strengths including creativity, out-of-the-box thinking, high energy, resilience, hyperfocus abilities, and entrepreneurial thinking. Many successful individuals in various fields have ADHD. Treatment isn't about eliminating all ADHD traits but about managing the problematic aspects while preserving and channeling the positive characteristics. Understanding this helps maintain self-esteem and motivation for treatment.
  
  
  

• Lifelong nature and changing presentations: ADHD is a lifelong condition, though symptoms and their impact change across development. Hyperactivity often decreases with age while attention and executive functioning challenges may persist or become more apparent as life demands increase. Adult ADHD may look different from childhood ADHD, often presenting as chronic disorganization, procrastination, relationship difficulties, or career underachievement. Recognizing these changing presentations helps with appropriate treatment adjustments throughout life.

Reference Materials and Further Reading

Clinical Practice Guidelines

• American Academy of Pediatrics ADHD Clinical Practice Guidelines (2019)

• Canadian ADHD Resource Alliance Guidelines (2018)

Emerging Research

Precision medicine approaches to ADHD treatment

• Buitelaar J, Bölte S, Brandeis D, Caye A, Christmann N, Cortese S, Coghill D, Faraone SV, Franke B, Gleitz M, Greven CU, Kooij S, Leffa DT, Rommelse N, Newcorn JH, Polanczyk GV, Rohde LA, Simonoff E, Stein M, Vitiello B, Yazgan Y, Roesler M, Doepfner M, Banaschewski T. Toward Precision Medicine in ADHD. Front Behav Neurosci. 2022 Jul 6;16:900981. doi: 10.3389/fnbeh.2022.900981. PMID: 35874653; PMCID: PMC9299434.

Digital therapeutics and technology-based interventions

• Kollins SH, DeLoss DJ, Cañadas E, Lutz J, Findling RL, Keefe RSE, Epstein JN, Cutler AJ, Faraone SV. A novel digital intervention for actively reducing severity of paediatric ADHD (STARS-ADHD): a randomised controlled trial. Lancet Digit Health. 2020 Apr;2(4):e168-e178. doi: 10.1016/S2589-7500(20)30017-0. Epub 2020 Feb 24. PMID: 33334505.

Adult ADHD recognition and treatment

• Young S, Bramham J, Gray K, Rose E. The experience of receiving a diagnosis and treatment of ADHD in adulthood: a qualitative study of clinically referred patients using interpretative phenomenological analysis. J Atten Disord. 2008 Jan;11(4):493-503. doi: 10.1177/1087054707305172. Epub 2007 Aug 21. PMID: 17712173.

Neuroplasticity and cognitive training

• Cortese S, Ferrin M, Brandeis D, Buitelaar J, Daley D, Dittmann RW, Holtmann M, Santosh P, Stevenson J, Stringaris A, Zuddas A, Sonuga-Barke EJ; European ADHD Guidelines Group (EAGG). Cognitive training for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. J Am Acad Child Adolesc Psychiatry. 2015 Mar;54(3):164-74. doi: 10.1016/j.jaac.2014.12.010. Epub 2014 Dec 29. Erratum in: J Am Acad Child Adolesc Psychiatry. 2015 May;54(5):433. PMID: 25721181; PMCID: PMC4382075.

Inflammation and ADHD

• Dunn GA, Nigg JT, Sullivan EL. Neuroinflammation as a risk factor for attention deficit hyperactivity disorder. Pharmacol Biochem Behav. 2019 Jul;182:22-34. doi: 10.1016/j.pbb.2019.05.005. Epub 2019 May 16. PMID: 31103523; PMCID: PMC6855401.

Specialized Books for Clinicians

"Taking Charge of ADHD: The Complete, Authoritative Guide for Parents" by Russell A. Barkley

• The gold standard resource for understanding ADHD in children and adolescents. Dr. Barkley, a leading ADHD researcher, provides comprehensive coverage of assessment, treatment, and management strategies. Essential for clinicians working with families affected by ADHD.

"ADHD in Adults: What the Science Says" by Russell A. Barkley, Kevin R. Murphy, and Mariellen Fischer

• The definitive clinical guide to adult ADHD, covering assessment, diagnosis, and treatment. Provides detailed protocols for evaluating adults and addresses the unique challenges of ADHD across the lifespan.

“ADHD 2.0: New Science and Essential Strategies for Thriving with Distraction - from Childhood through Adulthood” by Edward M. Hallowell and John J. Ratey

• A strengths-oriented overview of ADHD featuring insights from cutting-edge research.

"Attention-Deficit Hyperactivity Disorder: A Clinical Workbook" by Russell A. Barkley and Kevin R. Murphy

• A comprehensive clinical workbook providing assessment forms, rating scales, and treatment protocols. Includes reproducible materials and step-by-step guidance for clinical practice.

"Smart but Scattered: The Revolutionary 'Executive Skills' Approach to Helping Kids Reach Their Potential" by Peg Dawson and Richard Guare

• Focuses on executive functioning deficits in ADHD and provides practical strategies for building these crucial skills in children and adolescents. Excellent resource for clinicians, parents, and educators.

"The ADHD Effect on Marriage: Understand and Rebuild Your Relationship in Six Steps" by Melissa Orlov

• Addresses the impact of ADHD on relationships and provides practical strategies for couples. Essential reading for clinicians treating adults with ADHD and relationship difficulties.

Last Updated: June 2025