Attention-deficit/hyperactivity disorder (ADHD)
Abstract
The proposed revision of the diagnostic criteria in DSM-5 for attention-deficit/hyperactivity disorder (ADHD) will not fundamentally change the concept of ADHD. This is mainly due to the fact that, DSM-5 will retain the exact DSM-IV wording of all 18 symptoms, but will add new examples that make the criteria more appropriate for children, adolescents and adults. The age of onset will also be changed from 7 to 12 years, the subtyping of the disorder will change, and pervasive developmental disorders will no longer be an exclusion criterion. Although the main concept is unchanged, the suggested changes will most likely increase the prevalence of ADHD, especially in adults and adolescents, but maybe also in children. The added examples will also result in necessary revisions and new validations of rating scales and diagnostic interviews. This review will examine each of the proposed DSM-5 changes and the impact they may have, and in addition, the paper will make an overview of the main characteristics of some of the international and national guidelines for assessment and treatment of ADHD and how these impact the clinical practice.
Keywords
Attention-deficit/hyperactivity disorder (ADHD) Diagnostic classification Pervasive developmental disorder Clinical guidelines
Introduction
This paper will examine each of the proposed changes in the diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD) in the fifth version of the diagnostic and statistical manual of mental disorders (DSM) and will discuss for each of these proposed changes the impact they may have. In addition, the paper will make an overview of the main characteristics of some of the international and national guidelines for assessment and treatment of ADHD and how these impact the clinical practice. The criteria for ADHD proposed in DSM-5 are shown in Table 1.
The proposed revision of ADHD
The revision the ADHD criterion have been developed by the ADHD and Disruptive Behavior Disorders Work Group [1], and the latest update on the revision of the chapter on ADHD was published by APA on May 1st 2012. The four most important points in the suggested DSM-5 revision of ADHD include (1) changing the description of the examples for each symptom, (2) changing the age of onset, (3) changing the subtyping of ADHD, and (4) removing autism spectrum disorder (ASD) from the exclusion criteria. In addition, the proposal suggests a new overall diagnostic category, namely neurodevelopmental disorders, under which ADHD will be listed (rather than in the DSMIV category, disorders usually first diagnosed in infancy, childhood, or adolescence). In the DSM-IV, the diagnosis of ADHD-not otherwise specified (ADHD-NOS) was used for a subgroup of patients who either had below threshold symptoms of inattention or hyperactivity/impulsivity, (otherwise) fulfilled criteria for ADHD-predominantly inattentive type, but had an age of onset later than 7 years or had a behavioral pattern marked by sluggishness, daydreaming, and hypoactivity, but below diagnostic threshold for ADHD-predominantly inattentive type. DSM-5 will
Table 1 A 06 attention-deficit/hyperactivity disorder—diagnostic criteria proposed for DSM-5
AD/HD consists of a pattern of behavior that is present in multiple settings where it gives rise to social, educational, or work performance difficulties.
A. Either (A1) and/or (A2).
A1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that impact directly on social and academic/occupational activities.
a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).
b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or reading lengthy writings).
c. Often does not seem to listen when speaking directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked; fails to finish schoolwork, household chores, or tasks in the workplace).
e. Often has difficulty organizing tasks and activities (e.g., difficulty in managing sequential tasks; difficulty in keeping the materials and belongings in order; messy, disorganized, and work; poor time management; tends to fail to meet deadlines).
f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, or reviewing lengthy papers).
g. Often loses things necessary for tasks or activities (e.g., school