Are all the 18 DSM-IV and DSM-5 criteria equally useful for diagnosing ADHD and predicting comorbid conduct problems?

A. Garcia Rosales, S. Vitoratou, T. Banaschewski, P. Asherson, J. Buitelaar, R.D. Oades, A. Rothenberger, H.C. Steinhausen, S.V. Faraone, Wai Chen

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    10 Citations (Scopus)

    Abstract

    © 2015, Springer-Verlag Berlin Heidelberg. In view of ICD-11 revision, we evaluate whether the 18 DSM-IV diagnostic items retained by DSM-5 could be further improved (i) in predicting ADHD ‘caseness’ and ‘impairment’ and (ii) discriminating ADHD without CD (ADHD − CD) cases from ADHD with CD (ADHD + CD) cases. In a multi-centre study sample consisting of 1497 ADHD probands and 291 unaffected subjects, 18 diagnostic items were examined for redundancy; then each item was evaluated for association with caseness, impairment and CD status using Classical Test Theory, Item-Response Theory and logistic regression methods. First, all 18 DSM-IV items contributed significantly and independently to the clinical diagnosis of ADHD. Second, not all the DSM-IV items carried equal weighting. “Often loses things”, “forgetfulness” and “difficulty sustaining attention” mark severity for Inattentiveness (IA) items and “often unduly noisy”, “exhibits a persistent pattern of restlessness”, “leaves seat in class” and “often blurts out answers” for Hyperactivity/Impulsivity (HI) items. “Easily distracted”, “inattentive to careless mistakes”, “often interrupts” and “often fidgets” are associated with milder presentations. In the IA domain, “distracted” yields most information in the low-severity range of the latent trait, “careless” in the mid-severity range and “loses” in the high-severity range. In the HI domains, “interrupts” yields most information in the low-severity range and “motor” in the high-severity range. Third, all 18 items predicted impairment. Fourth, specific ADHD items are associated with ADHD + CD status. The DSM-IV diagnostic items were valid and not redundant; however, some carried more weight than others. All items were associated with impairment.
    Original languageEnglish
    Pages (from-to)1325-1337
    JournalEuropean Child and Adolescent Psychiatry
    Volume24
    Issue number11
    DOIs
    Publication statusPublished - 2015

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