The new Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) has a number of changes to attention deficit hyperactivity disorder (ADHD, sometimes referred to as just attention deficit disorder). This article outlines some of the major changes to this condition.
According to the American Psychiatric Association (APA), the publisher of the DSM-5, the working groups decided to eliminate the DSM-IV chapter that included all diagnoses usually first made in infancy, childhood, or adolescence. Therefore ADHD was moved within the manual and can now be found in the “Neurodevelopmental Disorders” chapter to reflect brain developmental correlates with ADHD.
The same primary 18 symptoms for ADHD that are used as in DSM-IV are used in the DSM-5 to diagnose ADHD. They continue to be divided into two major symptom domains: inattention and hyperactivity/impulsivity. And, like in the DSM-IV, at least six symptoms in one domain are required for an ADHD diagnosis.
However, several changes have been made in DSM-5 to the ADHD category, according to the APA:
- Examples have been added to the criterion items to facilitate application across the life span
- The cross-situational requirement has been strengthened to “several” symptoms in each setting
- The onset criterion has been changed from “symptoms that caused impairment were present before age 7 years” to “several inattentive or hyperactive-impulsive symptoms were present prior to age 12”
- Subtypes have been replaced with presentation specifiers that map directly to the prior subtypes
- A co-morbid diagnosis with autism spectrum disorder is now allowed
- A symptom threshold change has been made for adults, to reflect their substantial evidence of clinically significant ADHD impairment. For an adult diagnosis to be made, the patient only needs to meet five symptoms — instead of six required for younger persons — in either of the two major domains: inattention and hyperactivity/impulsivity
While much ado has been made about this last change, it seems unlikely there was this large population of adults who had sub-clinical ADHD who failed to receive a diagnosis and treatment. Rather, this change reflects clinical experience and real-world practice, where adults with ADHD often experience it in a slightly different way than teens and children do.