Adhd in adults dsm 5
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ADHD in Adults According to DSM-5: Prevalence, Diagnostic Criteria, and Implications
Prevalence of ADHD in Adults Using DSM-5 Criteria
The transition from DSM-IV to DSM-5 has led to a notable increase in the prevalence of ADHD diagnoses among adults. Studies indicate that the prevalence of ADHD in adults using DSM-5 criteria is higher compared to DSM-IV. For instance, one study found a 27% increase in the expected prevalence of ADHD among young adults when comparing DSM-IV to DSM-5 criteria, with DSM-5 showing a prevalence of 3.55% compared to 2.8% for DSM-IV. Another study reported that the prevalence of ADHD in adults was 2.1% using DSM-5 criteria, which would increase to 5.8% if the age-of-onset criterion was disregarded. This suggests that the DSM-5 criteria may capture a broader spectrum of ADHD symptoms in adults.
Diagnostic Criteria and Symptom Thresholds
The DSM-5 criteria for diagnosing ADHD in adults have been refined to better capture the adult phenotype of the disorder. The DSM-5 requires fewer symptoms for a diagnosis in adults compared to children, with a threshold of five symptoms in either the inattentive or hyperactive/impulsive domains, as opposed to six symptoms required by DSM-IV. This adjustment has led to a significant increase in the number of adults meeting the diagnostic criteria for ADHD, with one study reporting a 65% increase in the number of participants meeting the new cutoff.
Symptom Structure and Predictive Value
Research has shown that inattentive symptoms are the most significant predictors of impairment in adults with ADHD. Confirmatory factor analyses have revealed that a bifactor model, which includes a general factor and two specific factors (inattention and hyperactivity/impulsivity), provides the best fit for DSM-5 symptoms. Inattention symptoms are consistently found to be the most associated with clinical impairment in adults . Additionally, executive dysfunction and emotional dyscontrol are also central to the adult ADHD phenotype, with executive dysfunction being as important as DSM-5 symptoms.
Age-of-Onset Criterion and Functional Impairment
The DSM-5 has raised the age-of-onset criterion for ADHD from 7 to 12 years. Studies have shown that adults with late-onset ADHD (onset between 7 and 12 years) exhibit similar levels of functional impairment and decreased quality of life as those with early-onset ADHD (onset before 7 years). Both groups show deficits in attention, signal detectability, spatial working memory, and short-term spatial memory, although early-onset ADHD individuals may have additional deficits in alertness, set-shifting, and planning.
Screening Tools and Diagnostic Accuracy
The World Health Organization Adult ADHD Self-Report Scale (ASRS) has been updated to reflect DSM-5 criteria, improving its sensitivity and specificity for diagnosing adult ADHD. The revised ASRS is a short, easily scored tool that effectively distinguishes ADHD cases from non-cases in both general and clinical populations . The French version of the ASRS-5 has also shown good diagnostic accuracy, although its performance can vary depending on the presence of comorbid disorders.
Conclusion
The DSM-5 criteria for ADHD in adults have led to an increased prevalence of diagnoses, primarily due to the lowered symptom threshold and revised age-of-onset criterion. Inattentive symptoms remain the most significant predictors of impairment, and the updated screening tools have enhanced the ability to identify ADHD in adults accurately. These changes underscore the importance of considering the broader spectrum of ADHD symptoms and the need for comprehensive evaluation in adults presenting with ADHD-like symptoms.
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