Adult ADD – Going Beyond The DSM
ByThe DSM is the Diagnostic and Statistical Manual of the American Psychiatric Association – and it the manual used to diagnose psychiatric disorders – including ADD and ADHD.
The DSM criteria used to diagnose ADHD were developed with children as the focus. The criteria have been criticized in how poorly they help in the assessment and diagnosis of adult ADHD (or ADD).
Here is an article from the American Journal of Psychiatry which documents this issue in depth.
This article begins by summarizing the history of the diagnosis of ADHD.
It then criticizes the limitations of the diagnostic criteria for adults with ADHD.
One of the examples cited is the age of onset criteria – i.e. having to have symptoms before the age of 7 is often limiting. It is problematic, because it is often hard to establish this early history in an older adult. New research is showing that the age of onset is also too restrictive (this paper cites two new research papers which challenge this criterion).
Another criticism is that the description of impairment is done from the perspective of childhood ADHD and is not appropriate for the impairment that adults with ADHD experience.
Furthermore, the diagnostic threshold (i.e. 6 out of 9 symptoms) doesn’t reflect several lines of research which document that adults with fewer symptoms are still quite impaired from their ADHD.
The DSM-V is due out in 2011. Many researchers are working to improve the DSM criteria for adult ADD/ADHD. This is particulary needed because many doctors are not comfortable with the diagnosis of adult ADHD, and they need to have diagnostic criteria which will help them to diagnose this condition more easily. Also, new research has shown that 4.4% of american adults have ADD/ADHD. So there is a lot of need out there, and ‘new and improved’ DSM criteria are needed.
Please share your thoughts and comments below.
Dr. Kenny
Technorati Tags: Adult ADD, Adult ADHD, DSM, Diagnosis
Too much medicine is based on innovative diagnosis prompted by marketing efforts of the pharmaceutical industry.
Financial conflicts of interests make for bad medicine.
Check out this article from the French national newspaper Le Monde about selling drugs to the “Worried Well”
http://mondediplo.com/2006/05/16bigpharma
For the more scientifically oriented, we have a whole collection of papers from a conference on disease mongering. (i.e., pushing diseases for fun and profit)
http://collections.plos.org/plosmedicine/diseasemongering-2006.php
All of which contributes greatly to my skepticism about proposed treatments for ADD/ADHD
This is a big problem for the doctors who do not understand the mechanism of AD/HD. It all comes right back to the patient since doctors seem to express themselves freely with the patient. It is not particularly hilarious to listen to the negative comments on ADD from the doctor who should help you with your difficulties.
The requirement of actual memories from somebodies childhood is absurd. It is difficult to believe how it has not been corrected before. It has been known amongst clinical professionals for a long time already that the inattentive subtype doesn’t show so well. The child can appear totally normal to the family and at school but still experiencing many difficulties the adults are not aware of.
Another thing is the age of onset. In the inattentive cases the behaviors can change as late as in the teen ages. This has been very difficult for doctors to comprehend and many patients have suffered from the narrow way of understanding ADD. Only future tells how widely the misdiagnosis of depression has been has been made to the ADD-adults with later onset w/o lacking knowledge of childhood behavior related to attentional problems.
While the wheels grid slowly, others use what is on the table
See http://www.racp.edu.au/index.cfm?objectid=6EBAB63E-FFF9-2CED-52102DC3369183AB
Where a draft Guideline for ADHD in Australia is presented for comment. I feel that the rules of evidence based medicine which constrain this effort may be too constrictive.This does not come to grips with many of the controversial issues facing ADHD today, especially those driven by tabloid journalism relating to so-called over-diagnosis and over-medication
I certainly hope the DSM-V makes strides forward and not stay stagnant or backpaddle. There are so many factions fighting to discredit psychiatry in general and as a result disorders such as ADHD. Thank you Mr. Cruise et. al. I for one will attempt to stay out of fringe religions regardless of the aggravation caused by these attacks. Turn the other cheek as they say.
I know with a very comfortable (for me at least) margin for error that ADHD exists (in both children and adults) and that I have ADHD. As with most things it’s easy to see the signs looking back. I just wish that the Canada I grew up in (I was 7 in 1974) was more progressive and that I had had the options I do today. I can only imagine what possibilities would have opened up for a focused, controlled me!
I have to imagine that much of the reluctance of MDs to prescribe meds to ADHDers both young and old comes from the many patients that commit fraud and gain stimulants by pretending to have ADHD (or as heinous as it seems to me – to use one’s own child to do that). But to condemn the truly ADHD for the few who pretend is comparable to withdrawing availability to powerful med tools such as oxycodone or coedine for reasons such as that patients come into MD’s offices and pretend that they have serious chronic injuries like back or neck pain that require those medications. They instead control the release of these meds carefully using monitored prescription methods. Perfect? hardly but what is?
I wait as patiently as any ADHDer can – 2011 seems awfully far away to me.
Adult ADD – Going Beyond The DSM…
The DSM is the Diagnostic and Statistical Manual of the American Psychiatric Association and it the manual used to diagnose psychiatric disorders including ADD and ADHD….
Adult ADD – Going Beyond The DSM | ADD ADHD Blog.com…
The DSM is the Diagnostic and Statistical Manual of the American Psychiatric Association and it the manual used to diagnose psychiatric disorders including ADD and ADHD….
Adult ADD – Going Beyond The DSM | ADD ADHD Blog.com…
The DSM is the Diagnostic and Statistical Manual of the American Psychiatric Association and it the manual used to diagnose psychiatric disorders including ADD and ADHD….
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