Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes.

Abstract

DSM-IV criteria for ADHD specify two dimensions of inattention and hyperactivity-impulsivity symptoms that are used to define three nominal subtypes: predominantly hyperactive-impulsive type (ADHD-H), predominantly inattentive type (ADHD-I), and combined type (ADHD-C). To aid decision-making for DSM-5 and other future diagnostic systems, a comprehensive literature review and meta-analysis of 546 studies was completed to evaluate the validity of the DSM-IV model of ADHD. Results indicated that DSM-IV criteria identify individuals with significant and persistent impairment in social, academic, occupational, and adaptive functioning when intelligence, demographic factors, and concurrent psychopathology are controlled. Available data overwhelmingly support the concurrent, predictive, and discriminant validity of the distinction between inattention and hyperactivity-impulsivity symptoms, and indicate that nearly all differences among the nominal subtypes are consistent with the relative levels of inattention and hyperactivity-impulsivity symptoms that define the subtypes. In contrast, the validity of the DSM-IV subtype model is compromised by weak evidence for the validity of ADHD-H after first grade, minimal support for the distinction between ADHD-I and ADHD-C in studies of etiological influences, academic and cognitive functioning, and treatment response, and the marked longitudinal instability of all three subtypes. Overall, it is concluded that the DSM-IV ADHD subtypes provide a convenient clinical shorthand to describe the functional and behavioral correlates of current levels of inattention and hyperactivity-impulsivity symptoms, but do not identify discrete subgroups with sufficient long-term stability to justify the classification of distinct forms of the disorder. Empirical support is stronger for an alternative model that would replace the subtypes with dimensional modifiers that reflect the number of inattention and hyperactivity-impulsivity symptoms at the time of assessment.

Investigating late‐onset ADHD: a population cohort investigation

“…This is in keeping with research suggesting that reported ADHD symptom levels and ADHD subgroup membership (i.e. inattentive, hyperactive‐impulsive) can fluctuate over time (Willcutt et al., 2012). Moffitt et al.…”

Impairment in Young Preschool Children with Symptoms of Attention-Deficit/Hyperactivity Disorder and Co-occurring Oppositional Defiant Disorder and Conduct Disorder

“…Clinical diagnostic decisions are based on the assumptions that symptoms and impairment are related but separate constructs (10,38), and impairment could be regarded as an independent external validation of a disorder and as being essential to avoid tautology in which the same measures are used to define and externally validate a disorder (8). However, when the same rater evaluates both symptoms and impairment, this does not necessarily hold true, because rater bias may be a problem.…”

“…In addition, the predictive validity of ADHD, ODD, and CD symptoms has been found to be only moderate for 4-year-old preschool children (8,32,53), and no studies have tested the predictive validity of CD symptoms for children less than 4.5 years old. Thus, our knowledge of the developmental trajectories of CD symptoms is still limited.…”

“…Likewise, in a community-based sample, 4-year-old preschool children with ADHD-C were found by teachers' ratings to have more deficient social skills and to more often be receiving special educational services as compared with children with symptoms of either ADHD, inattentive type (ADHD-IA), or ADHD-HI (7). In a meta-analysis, Willcutt and colleagues found that children with symptoms of either ADHD-HI or ADHD-IA were less globally and socially impaired than those with ADHD-C across all age groups (8). However, this meta-analysis included only a few preschool studies, and the existing preschool studies mainly include referred samples.…”

Implicación de la memoria visoespacial y fonológica en la heterogeneidad clínica del Trastorno por Déficit de Atención con Hiperactividad (TDAH)

“…The validity of the bidimensional structure of the AttentionDeficit and Hyperactivity Disorder (ADHD) -defined by the "inattention" and "hyperactivity/impulsivity" dimensions -holds a broad empirical support (Willcutt et al, 2012). Nevertheless, the clinical heterogeneity of ADHD is patent in many different levels (Wåhlstedt, Thorell, & Bohlin, 2009), most notably at neuropsychological level (Coghill, Seth, & Matthews, 2014;Sjöwall, Backman, & Thorell, 2015;van Hulst, de Zeeuw, & Durston, 2015).…”