title: ADHD in DSM-5: a field trial in a large, representative sample of 18- to 19-year-old adults.
abstract: BACKGROUND
  The DSM criteria for adult attention-deficit/hyperactivity disorder (ADHD) have not been tested in American Psychiatric Association (APA) field trials for either DSM-IV or DSM-5. This study aimed to assess: (a) the prevalence of ADHD according to DSM-5 criteria; (b) the factor solution that provides the best fit for ADHD symptoms; (c) the symptoms with the highest predictive value for clinical impairment; and (d) the best symptomatic threshold for each ADHD dimension (inattention and hyperactivity/impulsivity).
  
  
  METHODS
  Trained psychologists evaluated 4000 young adults from the 1993 Pelotas Birth Cohort Study with an instrument covering all DSM-5 ADHD criteria. A series of confirmatory factor analyses (CFAs) tested the best factor structure. Complex logistic regressions assessed differential contributions of each symptom to clinical impairment. Receiver-operating characteristic (ROC) analyses tested which would be the best symptomatic cut-off in the number of symptoms for predicting impairment.
  
  
  RESULTS
  The prevalence of DSM-5 ADHD was 3.55% [95% confidence interval (CI) 2.98-4.12]. The estimated prevalence of DSM-IV ADHD was 2.8%. CFA revealed that a bifactor model with a single general factor and two specific factors provided the best fit for DSM-5 symptoms. Inattentive symptoms continued to be the most important predictors of impairment in adults. The best cut-offs were five symptoms of inattention and four symptoms of hyperactivity/impulsivity.
  
  
  CONCLUSIONS
  Our results, combined with previous findings, suggest a 27% increase in the expected prevalence of ADHD among young adults, comparing DSM-IV to DSM-5 criteria. The DSM-5 symptomatic organization derived a similar factor structure for adults as DSM-IV symptoms. Data using DSM-5 criteria support lowering the symptomatic threshold for diagnosing ADHD in adults.
authors: ADHD Out-patient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry,Federal University of Rio Grande do Sul,Brazil.
authors: B
authors: B
authors: Matte
authors: ADHD Out-patient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry,Federal University of Rio Grande do Sul,Brazil.
authors: L
authors: L
authors: Anselmi
authors: ADHD Out-patient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry,Federal University of Rio Grande do Sul,Brazil.
authors: G A
authors: GA
authors: Salum
authors: ADHD Out-patient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry,Federal University of Rio Grande do Sul,Brazil.
authors: C
authors: C
authors: Kieling
authors: Post-Graduate Program in Epidemiology,Federal University of Pelotas,Brazil.
authors: H
authors: H
authors: Gonçalves
authors: Post-Graduate Program in Epidemiology,Federal University of Pelotas,Brazil.
authors: A
authors: A
authors: Menezes
authors: ADHD Out-patient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry,Federal University of Rio Grande do Sul,Brazil.
authors: E H
authors: EH
authors: Grevet
authors: ADHD Out-patient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry,Federal University of Rio Grande do Sul,Brazil.
authors: L A
authors: LA
authors: Rohde
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D012372:ROC Curve; D012720:Severity of Illness Index; D055815:Young Adult
keywords: ADHD; DSM-5; diagnostic performance; epidemiology; prevalence