Are all the 18 DSM-IV and DSM-5 criteria equally useful for diagnosing ADHD and predicting comorbid conduct problems?
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.
MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK. rosales.garcia@kcl.ac.uk.|Barnet, Enfield and Haringey Mental Health Trust, London, UK. rosales.garcia@kcl.ac.uk.
Alexandra
A
Garcia Rosales
Department of Biostatistics, Institute of Psychiatry, King's College London, London, UK.
Silia
S
Vitoratou
Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.|Department of Child and Adolescent Psychiatry, University of Göttingen, Göttingen, Germany.
Tobias
T
Banaschewski
MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK.
Philip
P
Asherson
Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.
Jan
J
Buitelaar
Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Essen, Germany.
Robert D
RD
Oades
Department of Child and Adolescent Psychiatry, University of Göttingen, Göttingen, Germany.
Aribert
A
Rothenberger
Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland.|Research Unit of Child and Adolescent Psychiatry, Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark.|Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.
Hans-Christoph
HC
Steinhausen
Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA.
Stephen V
SV
Faraone
MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK.|Division of Clinical Neuroscience, School of Medicine, University of Southampton, Southampton, UK.|Complex ADHD Service (CAHDS), Department of Health, Perth, WA, Australia.|Department of Child and Adolescent Psychiatry, School of Paediatrics and Child Health and School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, WA, 6840, Australia.
Wai
W
Chen
D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis*; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D000066553:Problem Behavior / Q000523:psychology*
Attention-deficit/hyperactivity disorder; Conduct disorder; DSM-IV; Diagnostic criteria; Impairment