Do the diagnostic criteria for ADHD need to change? Comments on the preliminary proposals of the DSM-5 ADHD and Disruptive Behavior Disorders Committee

The purpose of this commentary is to discuss the recent proposals for revision of the diagnostic criteria made by the DSM-5 ADHD and Disruptive Behavior Disorders Committee. The major concerns with the current diagnostic criteria for ADHD and hence the main suggestions for change focused on the general structure and organization of subtypes, the number, content and distribution of criteria, the age of onset criteria, the ascertainment of cross-situationality and the inclusion and exclusion criteria. Suggestions for change in these areas have been made in order that these changes can be tested in field trials before being finalised. Whilst several of the proposed revisions are relatively uncontentious e.g., the elaborated symptoms criteria, the identification of ADHD as a disorder of both behavioural and cognitive functioning, the situational and developmental dependence of symptoms, the permission to diagnose ADHD in the presence of an autism spectrum disorder, clarification of the relationship between ADHD and irritable mood and the importance of getting information from teachers and other third parties. Several of the other proposed changed are more contentious and will require extensive field testing to assess their impact on validity, reliability and clinical usefulness. These include changes to the way in which individuals with inattention but no hyperactivity/impulsivity are classified, the addition of four new impulsivity symptoms, a reduction in the number of symptoms required to meet criteria for older adolescents and adults and the raising of the age of onset to 12 years of age.