Proposed Changes to DSM Diagnostic Criteria for ADHD: What Does it Mean?

Eileen Bailey Health Guide
  • In the news lately there has been a great deal of attention paid to the proposed changes in the new Diagnostic and Statistical Manual (DSM) for autism. Specifically, the term Asperger's disorder is being considered obsolete and may be included under the umbrella term of autism spectrum disorders, causing a bit of an uproar in the Asperger's community.


    The new DSM is published by the American Psychiatric Association (APA). The last revision was in 1994 and, since that time, there has been a large amount of research and a better understanding of psychiatric conditions.  A number of different panels are currently reviewing many different descriptions. This work is due to be completed in December of 2012 with the new DSM being published in May, 2013.

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    The APA has invited comments from the public during two different periods of time and will again be opening their site to hear your comments about the revisions this spring.


    There are a number of different changes to the definition of Attention Deficit Hyperactivity Disorder being considered and while I can't possibly list all of them here, I have highlighted some. You can also read the all of the possible changes here.


    More Descriptive Language

    The general overview of symptoms remains consistent with what is currently in the DSM, however, more descriptions are added. For example, the DSM-IV lists one of the symptoms of inattention as:


    Is often forgetful in daily activities

    The proposed DSM-V expands on this with:


    Is often forgetful in daily activities, chores, and running errands (for older adolescents and adults, returning calls, paying bills, and keeping appointments).

    Each symptom listed in the DSM would be expanded to include more examples.


    Attention Deficit Disorder (without Hyperactivity)

    Some of the ideas that are being considered for dealing with Predominantly Inattentive Type are:

    • Continue using the same structure, with Predominantly Inattentive (PI) as one of the subtypes of ADHD
    • Add a fourth subtype to denote inattentive type with minimal hyperactivity
    • Create a new diagnosis of Attention-Deficit Disorder for inattentive type with no hyperactivity. This would be the same as the inattentive type of ADHD but would be given a separate diagnostic code.


    In the current DSM, only three symptoms are listed under impulsivity.  One of the options for changing the criteria includes expanding this section, adding four additional symptoms of impulsivity and continuing with the more descriptive language to give examples of these symptoms.


    The current symptoms listed are:

    (g)  often blurts out answers before questions have been completed

    (h)  often has difficulty awaiting turn

    (i)   often interrupts or intrudes on others (e.g., butts into conversations or games)


    The four new symptoms that are being considered are:


    a. Often acts without thinking (e.g., often starts tasks without adequate preparation, such as reading or listening to instructions, jumps into activities, speaks out without considering consequences; makes important decisions on the spur of the moment, such as buying items, quitting a job suddenly, breaking up with friend).

  • b. Is often impatient (e.g., grabs things instead of asking, wants others to move faster, wants people to get to the point, often speeds while driving, cuts into traffic to go faster than others).

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    c. Often rushes through activities or tasks, is fast paced (e.g., averse to doing things carefully and systematically).

    d. Often has difficulty resisting immediate temptations or appealing opportunities, while disregarding negative consequences (in childhood, grabs toys off store shelf, or fascinating dangerous objects or plays with dangerous objects; in adulthood, commits to a relationship after brief acquaintance, takes job or enters into business arrangement without doing due diligence).


    Adult ADHD

    Over the years, many adults with ADHD have complained that much of the diagnostic criteria is aimed toward childhood behaviors and that as a person matures, some of the symptoms of ADHD diminish but that those symptoms that remain can still cause impairment. One proposed change is to lower the number of symptoms required for diagnosis from six to three.


    What do you think of these proposed changes? If you are interested in sharing your opinion with the APA, check their site from time to time to see if they have opened it up for comments. Please post here and let us know what you think.




Published On: January 30, 2012