Instability of the DSM-IV Subtypes of ADHD from preschool through elementary school.
ABSTRACT The DSM-IV definition of attention-deficit/hyperactivity disorder (ADHD) distinguished 3 subtypes that had not been extensively studied.
To determine whether the ADHD subtypes are stable enough over time to be valid.
Longitudinal study with a greater-than 89% retention rate in 7 assessments over 8 years.
Volunteer sample of 118 4- to 6-year-olds who met DSM-IV criteria for ADHD, including impairment in 2 settings in at least 1 assessment.
Meeting DSM-IV criteria for the subtypes of ADHD during years 2 through 8.
The number of children who met criteria for ADHD declined over time, but most persisted. Children who met criteria for the combined subtype (CT, n = 83) met criteria for ADHD in more subsequent assessments than children in the predominantly hyperactive-impulsive subtype (HT, n = 23). Thirty-one (37%) of 83 CT children and 6 (50%) of 12 children in the predominantly inattentive subtype (IT) met criteria for a different subtype at least twice in the next 6 assessments. Children of the HT subtype were even more likely to shift to a different subtype over time, with HT children who persisted in ADHD mostly shifting to CT in later assessments. The subtypes exhibited consistently different mean levels of hyperactive-impulsive symptoms during years 2 through 8 that corresponded with their initial subtype classifications, but initial subtype differences in inattention symptoms diminished in later years.
In younger children, the CT and IT may be stable enough to segregate groups for research, but they seem too unstable for use in the clinical assessment of individual children. Children rarely remain in the HT classification over time; rather, they sometimes desist from ADHD but mostly shift to CT in later years. Using continuous ratings of hyperactivity-impulsivity symptoms as a diagnostic qualifier should be considered as an alternative to classifying nominal subtypes of ADHD in DSM-V.
SourceAvailable from: Claudia Grau Rubio[Show abstract] [Hide abstract]
ABSTRACT: Frequently in scholar context orientation professionals should make an evaluation from the students who present ADHD, using different demonstrated efficacy assessment tools. Taking as reference point the current criteria for the diagnosis of this disorder a qualitative analysis of the items is performed in six scales and questionnaires to collect information from teachers to the ADHD assessment. An assignation from every item to DSM-V criteria allows an analysis from the most frequent items, which ones have been omitted and which ones cannot be classified in any diagnostic criteria because of being referred to different kind of problems. It is noted some items whose are frequently observed and relevant in the school environment do not usually take part of the analyzed instruments or they are underrepresented in them. A good practice strategy is proposed to councilors to conduct proper counseling at school, selecting those tools to assess as many symptoms as possible. Professionals in educational guidance should go further the data offered by a few standardized instruments to offer the proper educational answer to such a complex reality as the ADHD is.04/2014; 25(1):62. DOI:10.5944/reop.vol.25.num.1.2014.12013
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ABSTRACT: The present study sought to evaluate whether white matter microstructure abnormalities observed in a cohort of adolescents with attention-deficit/hyperactivity disorder (ADHD) have specific relationships with either or both Hyperactivity/Impulsivity and Inattentive ADHD symptom domains that would support a dimensional view of ADHD as adopted in the DSM-V. Diffusion tensor imaging (DTI) data were acquired on 22 adolescents diagnosed with ADHD. Multiple regression analyses were performed to determine whether scalar DTI measures in 13 tracts-of-interest demonstrated meaningful associations with Hyperactivity/Impulsivity or Inattentive symptom severity. Fractional anisotropy and radial diffusivity measures of white matter integrity exhibited significant linear relationships with Hyperactivity/Impulsivity and Inattentive symptom severity. However, only radial diffusivity in the right superior longitudinal fasciculus was specifically linked to Inattentive symptom severity and not Hyperactivity/Impulsivity symptom severity. Our results provide preliminary evidence that symptom domains in ADHD are linked to neuroanatomical substrates and confirm the value in examining ADHD from a dimensional perspective. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.03/2015; DOI:10.1016/j.pscychresns.2015.02.009
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ABSTRACT: The best structural model for attention-deficit/hyperactivity disorder (ADHD) symptoms remains a matter of debate. The objective of this study is to test the fit and factor reliability of competing models of the dimensional structure of ADHD symptoms in a sample of randomly selected and high-risk children and preadolescents from Brazil. Our sample comprised 2512 children aged 6–12 years from 57 schools in Brazil. The ADHD symptoms were assessed using parent report on the development and well-being assessment (DAWBA). Fit indexes from confirmatory factor analysis were used to test unidimensional, correlated, and bifactor models of ADHD, the latter including “g” ADHD and “s” symptom domain factors. Reliability of all models was measured with omega coefficients. A bifactor model with one general factor and three specific factors (inattention, hyperactivity, impulsivity) exhibited the best fit to the data, according to fit indices, as well as the most consistent factor loadings. However, based on omega reliability statistics, the specific inattention, hyperactivity, and impulsivity dimensions provided very little reliable information after accounting for the reliable general ADHD factor. Our study presents some psychometric evidence that ADHD specific (“s”) factors might be unreliable after taking common (“g” factor) variance into account. These results are in accordance with the lack of longitudinal stability among subtypes, the absence of dimension-specific molecular genetic findings and non-specific effects of treatment strategies. Therefore, researchers and clinicians might most effectively rely on the “g” ADHD to characterize ADHD dimensional phenotype, based on currently available symptom items.European Child & Adolescent Psychiatry 04/2015; DOI:10.1007/s00787-015-0709-1 · 3.55 Impact Factor