By Umesh Jain
Rosemary Tannock wrote a brilliant paper called “Rethinking ADHD and LD in DSM-5: Proposed Changes in Diagnostic Criteria” published just recently in the J Learning Disabilities online November 9th, 2012 and can be found here: http://ldx.sagepub.com/content/early/2012/11/07/0022219412464341
It is one of clearest articles that describes ADHD that I have read and it is very well referenced. Since she is on the DSM-5 Committee, she has an insiders view of the process.
Now, I have ranted about the DSM-5 and the problems related to the categorizing of diagnoses concocted by psychiatrists but one gets to appreciate the challenges of coming up with some sort of consensus from this article. (See other blogs here: The DSM-IV-TR And Why It Sucks! and Best Before Date) I was disappointed that the DSM-5 will not go far enough to explain the lifespan model and the connection of symptoms threading from childhood to adulthood. We knew the age of diagnosis was going to change from age 7 to 12 which will make it easier to make the adult ADHD diagnosis.
There continues to be some controversy around the Inattentive Subtype (the more shy quiet internalizing individual) in that ADHD will be classified on the current presentation not the evolution of the disorder. But the fact that ADHD will likely be pulled out of the Disruptive Behavior Disorders group and put into a section called Neurodevelopmental Disorders is an achievement.
The implication of this could be good. ADHD finally gets to be seen as a true biological disorder and can be accommodated the same way. However, it is still hidden deep inside the book and not in the adult section so adult psychiatrists may still not know where to find the diagnostic criteria. Worse, they may not know how to handle the new placement. Do they have to get psychometric testing on their subjects? If they interpret the diagnosis too narrowly, they may reject it’s application altogether.
One thing is for sure, there will be controversy after the DSM-5 will be published. I am not sure it will lead us to the etiological understanding of the disorder and it will certainly not make it easier for us to diagnosis the condition.
If you would like me to explain each of the sections of the paper in lay person language, let me know. This is the most educated version of the future I have seen and it is really important you understand it.
If you would like to know more about what the DSM-5 is and the process to create it, The American Psychiatric Association released the following on December 1, 2013:
Click here to view DSM-V press release
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How do I prove I had symptoms in childhood if I was never diagnosed or treated?
I would love to have this explained in layperson terms, thx!
Dr. J, I think it would be invaluable for you to explain each section of the paper in lay language (which you may have already done by the time you read this). Thank you for your offer.
This is going to cause a firestorm for those of us who have an intense and personal interest in the diagnostic criteria. Unfortunately, with so many changes in the DSM, we are probably simply a voice in the wilderness. If there is anything that we can do to assist in a revision of the revision, please let us know.
I know for myself, as an inattentive, it is only remotely possible I would have been diagnosed between age 7 and 12. I can clearly see the symptoms in retrospect, but the impairment would probably have been considered mild, if noticed at all. Of course, I was a child long before teachers even thought about such things.
My son, who also has inattentive ADHD with a possible anxiety comorbidity, would almost certainly have been misdiagnosed had we sought treatment during those years (he was diagnosed at age 14). The symptoms he displayed looked like a lot of things and masked the roots.
I’m madder’n a wet hen about the new DSM, but don’t know what to do about it.
There’s a coup, mine was evident but not sufficient impairment at 7 so they didn’t really press the meds/life skills on me as I was killing it at primary school( 6-12 years old) but evident as all hell once I entered the next schooling phase (by then I had cut my parents out of my schooling mostly
)so I had to wait until the old “get ya kid diagnosed and go ‘oh that’s me’ moment to hit “
Thanks Larynxa…makes sense.
Currently, the diagnosis of ADHD requires that the patient had symptoms prior to age 7. But, in many cases, the symptoms might not have been enough of a problem to have been really noticed prior to age 7, and that means that many of us don’t meet that key requirement for a diagnosis of ADHD.
As you reach the higher grades, the work becomes more challenging, so ADHD symptoms will be more of a problem. Enough of a problem to be noticed. And that will mean more people meet the “symptoms in childhood” requirement for a diagnosis.
How does changing the age of diagnosis from 7 to 12 make the adult diagnosis easier?