DSM-IV field trials for attention deficit hyperactivity disorder in children and adolescents

TLDR

The study established DSM‑IV diagnostic thresholds for ADHD by conducting structured interviews with 380 clinic‑referred youths, validating diagnoses against clinicians, and using impairment measures to differentiate the three subtypes based on inattention and hyperactivity‑impulsivity dimensions. ADHD subtypes differed in impairment, age, and sex ratio but not ethnicity; DSM‑IV matched DSM‑III‑R in case identification yet identified more impaired girls and preschoolers, supporting the subdivision into three subtypes and reducing bias toward elementary school boys.

Abstract

Optimal diagnostic thresholds were determined for DSM-IV attention deficit hyperactivity disorder, and the psychometric properties were compared to alternative definitions.Structured diagnostic interviews of multiple informants for 380 clinic-referred youths aged 4-17 years were conducted. In addition, standardized clinicians' validation diagnoses of attention deficit disorder were obtained to assess agreement with clinical judgment. Measures of impairment were obtained to assess the accuracy of identifying youth with an impairing condition.Three subtypes of attention deficit hyperactivity disorder (predominantly inattentive, predominantly hyperactive-impulsive, and combined types) were distinguished on the basis of the degree of deviance on separate dimensions of inattention and hyperactivity-impulsivity. These three subtypes were found to differ in terms of types of impairment, age, and sex ratio, but not ethnicity. In terms of case identification of attention deficit hyperactivity disorder, DSM-IV was found to be very similar to DSM-III-R, except that DSM-IV identified more impaired girls and preschool children.These results support the decision to subdivide the heterogeneous category of DSM-III-R attention deficit hyperactivity disorder into three subtypes. The resulting DSM-IV definition appears to be somewhat less biased toward the symptom pattern typical of elementary school boys.