title: Diagnosis of ADHD in adults: what is the appropriate DSM-5 symptom threshold for hyperactivity-impulsivity?
abstract: OBJECTIVE
  To empirically identify the appropriate symptom threshold for hyperactivity-impulsivity for diagnosis of ADHD in adults.
  
  
  METHODS
  Participants were 88 adults (M [SD] age = 41.69 [11.78] years, 66% female, 16% minority) meeting formal DSM-IV criteria for ADHD combined or predominantly inattentive subtypes based on a structured diagnostic interview keyed to DSM-IV (Conners' Adult ADHD Diagnostic Interview for DSM-IV [CAADID]). All participants also completed the Conners' Adult ADHD Rating Scale (CAARS), which was normed on the general adult population and includes subscales for DSM-IV inattentive and DSM-IV hyperactive-impulsive symptoms. A T-score threshold of 65 (at least 1.5 SD above population mean) on the CAARS DSM-IV hyperactive-impulsive dimension was used to identify participants with empirically elevated symptom severity.
  
  
  RESULTS
  Of 88 participating adults, 48 (55%) had a T-score of at least 65 (1.5 SD) on the CAARS DSM-IV Hyperactive-Impulsive scale. Of these, only 25 (52%) met the DSM-IV cutoff of six hyperactive-impulsive symptoms on the CAADID. Thus, approximately half of those who reported empirically elevated hyperactive-impulsive complaints on the CAARS did not concurrently meet the six-symptom DSM-IV cutoff on the CAADID. An alternative cutoff of four hyperactive-impulsive symptoms on the CAADID captured 39 (81%) cases identified by the CAARS.
  
  
  CONCLUSIONS
  In adults, mandating at least six hyperactive-impulsive symptoms excludes a significant percentage (almost half) of adults who are at least 1.5 SD above the population mean on a dimensional measure of hyperactivity-impulsivity. These data provide a compelling basis for lowering the symptom threshold of hyperactivity-impulsivity for adults in the DSM-5.
authors: The Mount Sinai School of Medicine, New York, NY 10029, USA. Mary.Solanto@mssm.edu
authors: Mary V
authors: MV
authors: Solanto
authors: Jeanette
authors: J
authors: Wasserstein
authors: David J
authors: DJ
authors: Marks
authors: Katherine J
authors: KJ
authors: Mitchell
mesh_terms: D000328:Adult; D001288:Attention; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D006948:Hyperkinesis / Q000175:diagnosis*; D007175:Impulsive Behavior / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index