Unlike ADHD, a diagnosis of hyperkinetic disorder requires that the clinician directly observes the symptoms (rather than relying only on parent and teacher reports); that onset must be by age 6 not 7;[4] and that at least six inattention, three hyperactivity and one impulsivity symptom be present in two or more settings. While ADHD may exist comorbid with (in the presence of) mania or a depressive or anxiety disorder, the presence of one of these rules out a diagnosis of hyperkinetic disorder.[2] Most cases of hyperkinetic disorder appear to meet the broader criteria of ADHD.[5]