ADHD in DSM-5: a field trial in a large, representative sample of 18- to 19-year-old adults. Issue 2 (23rd June 2014)

• Record Type: Journal Article
• Authors: Matte, B.; Anselmi, L.; Salum, G. A.; Kieling, C.; Gonçalves, H.; Menezes, A.; Grevet, E. H.; Rohde, L. A.
• Is Part Of: Psychological medicine. Volume 45:Issue 2(2015)
• Page Start: 361
• Page End: 373
• Publication Date: 2014-06-23
• Subjects: ADHD, -- diagnostic performance, -- DSM-5, -- epidemiology, -- prevalence; Psychiatry -- Periodicals; Medicine and psychology -- Periodicals; Clinical psychology -- Periodicals; 616.89
• DOI: 10.1017/S0033291714001470
• Languages: English
• ISSNs: 0033-2917

Abstract

Abstract : Background: The DSM criteria for adult attention-deficit/hyperactivity disorder (ADHD) have not been tested in American Psychiatric Association (APA) field trials for either DSM-IV or DSM-5. This study aimed to assess: ( a ) the prevalence of ADHD according to DSM-5 criteria; ( b ) the factor solution that provides the best fit for ADHD symptoms; ( c ) the symptoms with the highest predictive value for clinical impairment; and ( d ) the best symptomatic threshold for each ADHD dimension (inattention and hyperactivity/impulsivity). Method: Trained psychologists evaluated 4000 young adults from the 1993 Pelotas Birth Cohort Study with an instrument covering all DSM-5 ADHD criteria. A series of confirmatory factor analyses (CFAs) tested the best factor structure. Complex logistic regressions assessed differential contributions of each symptom to clinical impairment. Receiver-operating characteristic (ROC) analyses tested which would be the best symptomatic cut-off in the number of symptoms for predicting impairment. Results: The prevalence of DSM-5 ADHD was 3.55% [95% confidence interval (CI) 2.98–4.12]. The estimated prevalence of DSM-IV ADHD was 2.8%. CFA revealed that a bifactor model with a single general factor and two specific factors provided the best fit for DSM-5 symptoms. Inattentive symptoms continued to be the most important predictors of impairment in adults. The best cut-offs were five symptoms of inattention and four symptoms of hyperactivity/impulsivity. Conclusions: Our results, combined with previous findings, suggest a 27% increase in the expected prevalence of ADHD among young adults, comparing DSM-IV to DSM-5 criteria. The DSM-5 symptomatic organization derived a similar factor structure for adults as DSM-IV symptoms. Data using DSM-5 criteria support lowering the symptomatic threshold for diagnosing ADHD in adults.