title: Exploring DSM-5 ADHD criteria beyond young adulthood: phenomenology, psychometric properties and prevalence in a large three-decade birth cohort.
abstract: BACKGROUND
  There are still uncertainties on the psychometric validity of the DSM-5 attention deficit hyperactivity disorder (ADHD) criteria for its use in the adult population. We aim to describe the adult ADHD phenotype, to test the psychometric properties of the DSM-5 ADHD criteria, and to calculate the resulting prevalence in a population-based sample in their thirties.
  
  
  METHODS
  A cross-sectional evaluation using the DSM-5 ADHD criteria was carried out in 3574 individuals from the 1982 Pelotas Birth Cohort. Through receiver operator curve, latent and regression analyses, we obtained parameters on construct and discriminant validity. Still, prevalence rates were calculated for different sets of criteria.
  
  
  RESULTS
  The latent analysis suggested that the adult ADHD phenotype is constituted mainly by inattentive symptoms. Also, inattention symptoms were the symptoms most associated with impairment. The best cut-off for diagnosis was four symptoms, but sensitivity and specificity for this cut-off was low. ADHD prevalence rates were 2.1% for DSM-5 ADHD criteria and 5.8% for ADHD disregarding age-of-onset criterion.
  
  
  CONCLUSIONS
  The bi-dimensional ADHD structure proposed by the DSM demonstrated both construct and discriminant validity problems when used in the adult population, since inattention is a much more relevant feature in the adult phenotype. The use of the DSM-5 criteria results in a higher prevalence of ADHD when compared to those obtained by DSM-IV, and prevalence would increase almost threefold when considering current ADHD syndrome. These findings suggest a need for further refinement of the criteria for its use in the adult population.
authors.affiliation: Department of Psychiatry,ADHD Out-patient Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul,Porto Alegre,Brazil.
authors.forename: E S
authors.initials: ES
authors.lastname: Vitola
authors.affiliation: Department of Psychiatry,ADHD Out-patient Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul,Porto Alegre,Brazil.
authors.forename: C H D
authors.initials: CH
authors.lastname: Bau
authors.affiliation: Department of Psychiatry,ADHD Out-patient Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul,Porto Alegre,Brazil.
authors.forename: G A
authors.initials: GA
authors.lastname: Salum
authors.affiliation: Post-Graduate Program in Epidemiology, Federal University of Pelotas,Pelotas,Brazil.
authors.forename: B L
authors.initials: BL
authors.lastname: Horta
authors.affiliation: Post-Graduate Program in Epidemiology, Federal University of Pelotas,Pelotas,Brazil.
authors.forename: L
authors.initials: L
authors.lastname: Quevedo
authors.affiliation: Post-Graduate Program in Epidemiology, Federal University of Pelotas,Pelotas,Brazil.
authors.forename: F C
authors.initials: FC
authors.lastname: Barros
authors.affiliation: Post-Graduate Program in Epidemiology, Federal University of Pelotas,Pelotas,Brazil.
authors.forename: R T
authors.initials: RT
authors.lastname: Pinheiro
authors.affiliation: Department of Psychiatry,ADHD Out-patient Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul,Porto Alegre,Brazil.
authors.forename: C
authors.initials: C
authors.lastname: Kieling
authors.affiliation: Department of Psychiatry,ADHD Out-patient Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul,Porto Alegre,Brazil.
authors.forename: L A
authors.initials: LA
authors.lastname: Rohde
authors.affiliation: Department of Psychiatry,ADHD Out-patient Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul,Porto Alegre,Brazil.
authors.forename: E H
authors.initials: EH
authors.lastname: Grevet
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D011594:Psychometrics / Q000295:instrumentation*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Adults; DSM-5; attention deficit hyperactivity disorder; prevalence; psychometry.