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ADHD Update

The definition of attention-deficit/hyperactivity disorder (ADHD) has been updated in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to more accurately characterize the experience of affected adults. This revision is based on nearly two decades of research showing that
ADHD, although a disorder that begins in childhood, can continue through adulthood for some people.

Previous editions of DSM did not provide appropriate guidance to clinicians in diagnosing adults with
the condition. By adapting criteria for adults, DSM-5 aims to ensure that children with ADHD can con-
tinue to get care throughout their lives if needed.

Changes to the Disorder
ADHD is characterized by a pattern of behavior, present in multiple settings (e.g., school and home),
that can result in performance issues in social, educational, or work settings. As in DSM-IV, symptoms
will be divided into two categories of inattention and hyperactivity and impulsivity that include behaviors like failure to pay close attention to details, difficulty organizing tasks and activities, excessive talking, fidgeting, or an inability to remain seated in appropriate situations.

Children must have at least six symptoms from either (or both) the inattention group of criteria and
the hyperactivity and impulsivity criteria, while older adolescents and adults (over age 17 years) must
present with five. While the criteria have not changed from DSM-IV, examples have been included to
illustrate the types of behavior children, older adolescents, and adults with ADHD might exhibit. The
descriptions will help clinicians better identify typical ADHD symptoms at each stage of patients’ lives.
Using DSM-5, several of the individual’s ADHD symptoms must be present prior to age 12 years, compared to 7 years as the age of onset in DSM-IV. This change is supported by substantial research published since 1994 that found no clinical differences between children identified by 7 years versus later in terms of course, severity, outcome, or treatment response.

DSM-5 includes no exclusion criteria for people with autism spectrum disorder, since symptoms of both disorders co-occur. However, ADHD symptoms must not occur exclusively during the course of schizo-phrenia or another psychotic disorder and must not be better explained by another mental disorder, such as a depressive or bipolar disorder, anxiety disorder, dissociative disorder, personality disorder, or substance intoxication or withdrawal.

Care Beyond Childhood
The ADHD diagnosis in previous editions of DSM was written to help clinicians identify the disorder in
children. Almost two decades of research conclusively show that a significant number of individuals
diagnosed with ADHD as children continue to experience the disorder as adults. Evidence of this came
from studies in which individuals were tracked for years or even decades after their initial childhood
diagnosis. The results showed that ADHD does not fade at a specific age.

Studies also showed that the DSM-IV criteria worked as well for adults as they did for children but that
a lower threshold of symptoms (five instead of six) was sufficient for a reliable diagnosis.