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.
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.
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