title: Validity of proposed DSM-5 ADHD impulsivity symptoms in children.
abstract: The American Psychiatric Association (APA) working group on Attention-Deficit/Hyperactivity Disorder (ADHD) proposed the inclusion of four new impulsivity symptoms. However, they were not included in DSM-5 due to the lack of sufficient evidence. The aim of this study is to investigate the performance of the proposed four ADHD impulsivity symptoms with respect to: (a) ADHD factor structure; (b) performance in predicting clinical impairment; (c) specificity for ADHD diagnosis and (d) best symptomatic threshold to predict clinical impairment. The sample comprised 416 children (31 ADHD subjects according to both DSM-IV and proposed DSM-5, 20 ADHD subjects according to just one diagnostic system and 365 controls) from 12 schools. Diagnoses were derived using semi-structured interviews and ADHD rating scales. Results from confirmatory factor analysis indicate that addition of the four new impulsivity items provided a slightly better factor structure if compared to models including only 18 items. Regression analyses showed that only one of the new impulsivity symptoms (impatient) was part of the list of best predictors of impairment. None of the four new impulsivity items was specifically associated with ADHD diagnosis. The best cutoff point in the hyperactivity/impulsivity dimension for predicting impairment did not change significantly. Overall, our findings suggest that the determination on how to best capture impulsivity dimension as part of the ADHD construct needs more investigation and that there is not enough evidence to include these four assessed impulsivity symptoms as part of the ADHD criteria.
authors.affiliation: Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey. gul.unsel.bolat@gmail.com.
authors.forename: Gül
authors.initials: G
authors.lastname: Ünsel Bolat
authors.affiliation: Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey.
authors.forename: Eyüp Sabri
authors.initials: ES
authors.lastname: Ercan
authors.affiliation: ADHD Outpatient Program, Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.|National Institute of Developmental Psychiatry for Children and Adolescents, Sao Paulo, Brazil.
authors.forename: Giovanni Abrahão
authors.initials: GA
authors.lastname: Salum
authors.affiliation: Department of Child and Adolescent Psychiatry, Manisa Mental Health Hospital, Manisa, Turkey.
authors.forename: Öznur
authors.initials: Ö
authors.lastname: Bilaç
authors.affiliation: ADHD Outpatient Program, Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Rafael
authors.initials: R
authors.lastname: Massuti
authors.affiliation: Isparta Maternity and Children Hospital, Isparta, Turkey.
authors.forename: Taciser
authors.initials: T
authors.lastname: Uysal Özaslan
authors.affiliation: Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, Turkey.
authors.forename: Hilmi
authors.initials: H
authors.lastname: Bolat
authors.affiliation: ADHD Outpatient Program, Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.|National Institute of Developmental Psychiatry for Children and Adolescents, Sao Paulo, Brazil.
authors.forename: Luis Augusto
authors.initials: LA
authors.lastname: Rohde
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000523:psychology; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D006948:Hyperkinesis / Q000175:diagnosis* / Q000523:psychology; D007175:Impulsive Behavior / Q000502:physiology*; D008297:Male; D012574:Schools; D063189:Symptom Assessment
keywords: ADHD; Confirmatory factor analysis; DSM-5; Impulsivity