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Are concerns about DSM-5 ADHD criteria supported by empirical evidence?

Are concerns about DSM-5 ADHD criteria supported by empirical evidence?
Are concerns about DSM-5 ADHD criteria supported by empirical evidence?
Thomas and colleagues are worried about the recent change in the maximum age of symptom onset in the diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD) from 7 years in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) to 12 years in DSM-5.1 2 3 They think that this change may increase “the risk of confusing ADHD with normal developmental processes, such as pubertal restlessness and distractibility.” Although it is a legitimate concern, I am not aware of any empirical evidence to support it.

Indeed, a study of 2232 British children showed that extending the age of onset from 7 to 12 years increases the prevalence of ADHD by only 0.1%.4 If this change had led to non-pathological behaviours being diagnosed as ADHD, a bigger increase in prevalence would be expected. Children diagnosed with ADHD before and after 7 years also had similar clinical profiles and ADHD risk factors.4

This recent change in the age of onset criterion was aimed at reducing false negative diagnoses in adults. Only half of adults assessed for ADHD recall onset of symptoms before age 7; 95% report onset before age 12.5 The UK study suggested that adults who retrospectively reported onset of ADHD between 7 and 12 years probably had symptoms before 7 years.4 Therefore, keeping the age of onset criterion at 7 years would contribute to underdiagnosis in a substantial number of adults.

Finally, to avoid labelling transitory processes as ADHD, DSM-5 criteria specify that “symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level.” DSM-5 criteria are therefore unlikely to increase the risk of misdiagnosing pubertal restlessness and distractibility as ADHD. However, as Thomas and colleagues note,1 pubertal restlessness and distractibility should be considered in the differential diagnosis of ADHD.
0959-8138
p.f7072
Cortese, S.
53d4bf2c-4e0e-4c77-9385-218350560fdb
Cortese, S.
53d4bf2c-4e0e-4c77-9385-218350560fdb

Cortese, S. (2013) Are concerns about DSM-5 ADHD criteria supported by empirical evidence? British Medical Journal, 347, p.f7072. (doi:10.1136/bmj.f7072).

Record type: Article

Abstract

Thomas and colleagues are worried about the recent change in the maximum age of symptom onset in the diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD) from 7 years in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) to 12 years in DSM-5.1 2 3 They think that this change may increase “the risk of confusing ADHD with normal developmental processes, such as pubertal restlessness and distractibility.” Although it is a legitimate concern, I am not aware of any empirical evidence to support it.

Indeed, a study of 2232 British children showed that extending the age of onset from 7 to 12 years increases the prevalence of ADHD by only 0.1%.4 If this change had led to non-pathological behaviours being diagnosed as ADHD, a bigger increase in prevalence would be expected. Children diagnosed with ADHD before and after 7 years also had similar clinical profiles and ADHD risk factors.4

This recent change in the age of onset criterion was aimed at reducing false negative diagnoses in adults. Only half of adults assessed for ADHD recall onset of symptoms before age 7; 95% report onset before age 12.5 The UK study suggested that adults who retrospectively reported onset of ADHD between 7 and 12 years probably had symptoms before 7 years.4 Therefore, keeping the age of onset criterion at 7 years would contribute to underdiagnosis in a substantial number of adults.

Finally, to avoid labelling transitory processes as ADHD, DSM-5 criteria specify that “symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level.” DSM-5 criteria are therefore unlikely to increase the risk of misdiagnosing pubertal restlessness and distractibility as ADHD. However, as Thomas and colleagues note,1 pubertal restlessness and distractibility should be considered in the differential diagnosis of ADHD.

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More information

Published date: 27 November 2013
Organisations: Clinical Neuroscience

Identifiers

Local EPrints ID: 380180
URI: https://eprints.soton.ac.uk/id/eprint/380180
ISSN: 0959-8138
PURE UUID: 5b1f9d63-400f-4cb2-a6fc-22df196a255e
ORCID for S. Cortese: ORCID iD orcid.org/0000-0001-5877-8075

Catalogue record

Date deposited: 20 Aug 2015 15:26
Last modified: 19 Jul 2019 20:37

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