ADHD in DSM-5

Proposed Changes for DSM-5

The diagnostic criteria of six symptoms of either categroy lasting at least six months is not different compared to the current DSM-IV-TR. However, they have increased the number of potential symptoms that could be present. Additionally, the DSM-5 committee is proposing that there be four subtypes of ADHD, rather than the current three.

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.

A2. Hyperactivity and Impulsivity: 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.

Specify Based on Current Presentation

Combined Presentation: If both Criterion A1 (Inattention) and Criterion A2 (Hyperactivity-Impulsivity) are met for the past 6 months.

Predominantly Inattentive Presentation: If Criterion A1 (Inattention) is met but Criterion A2 (Hyperactivity-Impulsivity) is not met and 3 or more symptoms from Criterion A2 have been present for the past 6 months.

Inattentive Presentation (Restrictive): If Criterion A1 (Inattention) is met but no more than 2 symptoms from Criterion A2 (Hyperactivity-Impulsivity) have been present for the past 6 months.

Predominantly Hyperactive/Impulsive Presentation: If Criterion A2 (Hyperactivity-Impulsivity) is met and Criterion A1 (Inattention) is not met for the past 6 months” (APA, 2012).

Visual Changes in the DSM as it has evolved over the years / Created by David J Kupfer in Psychiatric News

Rationale of Proposed DSM-5 Changes

By increasing the number of possible symptoms as well as the amount of information given for each symptom, this allows for a diagnosis of ADHD even if the child already has a diagnosis of Autism Spectrum Disorder (ASD) (Coghill & Seth, 2011). Additionally, the DSM will provide a typical age range for possible symptoms. This in turn will benefit the clinicians when diagnosing teenagers and adults with ADHD because they are often using diagnostic tools that were developed to diagnose ADHD in children (Coghill & Seth, 2011).

The new subtype “inattentive presentation (restrictive)” (p. 77) will apply for people who have enough symptoms for an inattentive subtype but also have had two or less of the hyperactive/impulsive criteria in the past six months (Coghill & Seth, 2011). However, there are some criticisms for this new subtype, as there is no evidence that supports the inclusion of the inattentive presentation (restrictive) subtype.

The final proposed change to the DSM-5’s criteria for a diagnosis of ADHD is the age at which the symptoms first appeared. The DSM-5 committee proposes a range of 7-12 years of age at which the symptoms first began. The idea was that the current age of seven was arbitrarily picked without any particular evidence suggesting a significance to that particular age (Coghill & Seth, 2011). Coghill and Seth (2011) are against the proposed changes that do not have any scientific basis for their changes, such as the inclusion of a fourth ADHD subtype.

 

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