ATTENTION RESEARCH UPDATE – June 2013 New Diagnostic Criteria for ADHD – Subtle but Important Changes

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Core symptoms
A common criticism of the ADHD diagnostic criteria has been that the core symptoms reflect how the disorder presents in school age children and does not capture how it presents in older adolescents and adults. Because of this, some have argued that different symptom sets should be developed for different age groups. However, the new diagnostic criteria essentially retain the same symptoms as before.

The 9 inattentive symptoms are:

– often fails to give close attention to details or makes careless mistakes in schoolwork, work, or during other activities (e.g. overlooks or misses details, work is inaccurate).

– often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).

– often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).

– often does not follow through on instructions and fails to finish school work, chores, or duties in the work place (e.g., starts tasks but quickly loses focus and is easily sidetracked).

– often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).

– often avoids 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, reviewing lengthy papers). – often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

– is often easily distracted by extraneous stimuli (e.g., for older adolescents and adults may include unrelated thoughts). – is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).

The 9 hyperactive-impulsive symptoms are:

– often fidgets with or taps hands or squirms in seat.

– often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).

– often runs about or climbs in situations where it is inappropriate (e.g., in adolescents or adults, may be limited to feeling restless). – often unable to play or engage in leisure activities quietly; – is often “on the go” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with). – often talks excessively.

– often blurts out answers before questions have been completed (e.g., completes people’s sentences; cannot wait for turn in conversation). – often has difficulty awaiting turn (e.g., while waiting in line).

– often interrupts or intrudes on others (e.g. butts into conversations,games, or activities. may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).

These are only slightly modified versions of the hyperactive-impulsive symptoms from DSM-IV. As was done for the inattentive symptoms, however, the new DSM-V generally includes developmentally appropriate exemplars of these symptoms in older adolescents and adults.

Number of symptoms required and duration of symptoms

To possibly warrant a diagnosis of ADHD, individuals younger than 17 must display at least 6 of 9 inattentive and/or hyperactive impulsive symptoms. This is the same number as was required in DSM-IV.

For individuals 17 and above, however, only 5 or more symptoms are needed. This change from DSM-IV was made because of the reduction in symptoms that tends to occur with increasing age. The explanation for this change provided on the DSM-V web site is that a slightly lower symptom threshold is sufficient to make a reliable diagnosis in adults.

As in DSM-IV, the symptoms must be present for at least 6 months to a degree that is judged to be inconsistent with an individual’s developmental level.

And, yes, I can click off each and every symptom for both inattentive and hyperactive adult ADHD.  However, I have found some measure of controls and work arounds for the most bothersome of these symptoms.  They do not go away, it is a constant and every day trial on my patience, but, for the most part, I’m not that difficult to be around.  

That’s my story and I’m sticking to it:)


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