Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-23T08:38:53.589Z Has data issue: false hasContentIssue false
  • English
  • Français

Exploring DSM-5 ADHD criteria beyond young adulthood: phenomenology, psychometric properties and prevalence in a large three-decade birth cohort

Published online by Cambridge University Press:  21 November 2016

E. S. Vitola ,
C. H. D. Bau ,
G. A. Salum ,
B. L. Horta ,
L. Quevedo ,
F. C. Barros ,
R. T. Pinheiro ,
C. Kieling ,
L. A. Rohde  and
E. H. Grevet
E. S. Vitola
Affiliation:
Department of Psychiatry, ADHD Out-patient Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
C. H. D. Bau
Affiliation:
Department of Psychiatry, ADHD Out-patient Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil Post-Graduate Program in Genetics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
G. A. Salum
Affiliation:
Department of Psychiatry, ADHD Out-patient Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
B. L. Horta
Affiliation:
Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
L. Quevedo
Affiliation:
Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
F. C. Barros
Affiliation:
Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
R. T. Pinheiro
Affiliation:
Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
C. Kieling
Affiliation:
Department of Psychiatry, ADHD Out-patient Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
L. A. Rohde
Affiliation:
Department of Psychiatry, ADHD Out-patient Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
E. H. Grevet*
Affiliation:
Department of Psychiatry, ADHD Out-patient Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
*
*Address for correspondence: E. H., Grevet, MD, PhD, Department of Psychiatry, Faculty of Medicine, Federal University of Rio Grande do Sul., Rua Ramiro Barcelos 2350, Porto Alegre, Rio Grande do Sul, Brazil (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

There are still uncertainties on the psychometric validity of the DSM-5 attention deficit hyperactivity disorder (ADHD) criteria for its use in the adult population. We aim to describe the adult ADHD phenotype, to test the psychometric properties of the DSM-5 ADHD criteria, and to calculate the resulting prevalence in a population-based sample in their thirties.

Method

A cross-sectional evaluation using the DSM-5 ADHD criteria was carried out in 3574 individuals from the 1982 Pelotas Birth Cohort. Through receiver operator curve, latent and regression analyses, we obtained parameters on construct and discriminant validity. Still, prevalence rates were calculated for different sets of criteria.

Results

The latent analysis suggested that the adult ADHD phenotype is constituted mainly by inattentive symptoms. Also, inattention symptoms were the symptoms most associated with impairment. The best cut-off for diagnosis was four symptoms, but sensitivity and specificity for this cut-off was low. ADHD prevalence rates were 2.1% for DSM-5 ADHD criteria and 5.8% for ADHD disregarding age-of-onset criterion.

Conclusions

The bi-dimensional ADHD structure proposed by the DSM demonstrated both construct and discriminant validity problems when used in the adult population, since inattention is a much more relevant feature in the adult phenotype. The use of the DSM-5 criteria results in a higher prevalence of ADHD when compared to those obtained by DSM-IV, and prevalence would increase almost threefold when considering current ADHD syndrome. These findings suggest a need for further refinement of the criteria for its use in the adult population.

Keywords

Adultsattention deficit hyperactivity disorderDSM-5prevalencepsychometry.
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 4 , March 2017 , pp. 744 - 754
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agnew-Blais, JC, Polanczyk, GV, Danese, A, Wertz, J, Moffitt, TE, Arseneault, L (2016). Evaluation of the persistence, remission, and emergence of attention-deficit/hyperactivity disorder in young adulthood. JAMA Psychiatry 73, 713–720.CrossRefGoogle ScholarPubMed
Amorim, P (2003). The Mini Neuropsychiatric Interview (MINI): validation of a short structured diagnostic psychiatric interview. Revista Brasileira de Psiquiatria 22, 26–39.Google Scholar
APA (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, DSM-III. American Psychiatric Association: Washington, DC.Google Scholar
APA (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised – DSM-III-R. American Psychiatric Association: Washington, DC.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, DSM-IV. American Psychiatric Association: Washington, DC.Google Scholar
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revised - DSM-IV-TR. American Psychiatric Association: Washington, DC.Google Scholar
APA (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn, DSM-5. American Psychiatric Association: Washington, DC.Google Scholar
Asherson, P, Buitelaar, J, Faraone, SV, Rohde, LA (2016). Adult attention-deficit hyperactivity disorder: key conceptual issues. Lancet Psychiatry 3, 568–578.CrossRefGoogle ScholarPubMed
Barbaresi, WJ, Colligan, RC, Weaver, AL, Voigt, RG, Killian, JM, Katusic, SK (2013). Mortality, ADHD, and psychosocial adversity in adults with childhood ADHD: a prospective study. Pediatrics 131, 637–644.CrossRefGoogle ScholarPubMed
Barkley, RA, Murphy, KR, Fischer, M (2008). ADHD in Adults: What the Science Says. Guilford Press: New York.Google Scholar
Batstra, L, Frances, A (2012). DSM-5 further inflates attention deficit hyperactivity disorder. Journal of Nervous and Mental Disease 200, 486–488.Google Scholar
Bauermeister, JJ, Canino, G, Polanczyk, G, Rohde, LA (2010). ADHD across cultures: is there evidence for a bidimensional organization of symptoms? Journal of Clinical Child and Adolescent Psychology 39, 362–372.CrossRefGoogle ScholarPubMed
Bitter, I, Simon, V, Bálint, S, Mészáros, A, Czobor, P (2010). How do different diagnostic criteria, age and gender affect the prevalence of attention deficit hyperactivity disorder in adults? An epidemiological study in a Hungarian community sample. European Archives of Psychiatry and Clinical Neuroscience 260, 287–296.CrossRefGoogle Scholar
Cao, M, Huang, H, Peng, Y, Dong, Q, He, Y (2016). Toward developmental connectomics of the human brain. Frontiers in Neuroanatomy 10, 25.Google Scholar
Caye, A, Rocha, TB, Anselmi, L, Murray, J, Menezes, AM, Barros, FC, Gonçalves, H, Wehrmeister, F, Jensen, CM, Steinhausen, HC, Swanson, JM, Kieling, C, Rohde, LA (2016). Attention-deficit/hyperactivity disorder trajectories from childhood to young adulthood: evidence from a birth cohort supporting a late-onset syndrome. JAMA Psychiatry 73, 705–712.CrossRefGoogle ScholarPubMed
Dalsgaard, S, Østergaard, SD, Leckman, JF, Mortensen, PB, Pedersen, MG (2015). Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. Lancet 385, 2190–2196.CrossRefGoogle ScholarPubMed
Das, D, Cherbuin, N, Butterworth, P, Anstey, KJ, Easteal, S (2012). A population-based study of attention deficit/hyperactivity disorder symptoms and associated impairment in middle-aged adults. PLoS ONE 7, e31500.CrossRefGoogle ScholarPubMed
Faraone, SV, Asherson, P, Banaschewski, T, Biederman, J, Buitelaar, JK, Ramos-Quiroga, JA, Rohde, LA, Sonuga-Barke, EJ, Tannock, R, Franke, B (2015). Attention-deficit/hyperactivity disorder Nature reviews . Disease Primers 1, 1–23.Google Scholar
Faraone, SV, Biederman, J (2016). Can attention-deficit/hyperactivity disorder onset occur in adulthood? JAMA Psychiatry 73, 655–656.CrossRefGoogle ScholarPubMed
Faraone, SV, Biederman, J, Mick, E (2006). The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychological Medicine 36, 159–165.Google Scholar
Fayyad, J, De Graaf, R, Kessler, R, Alonso, J, Angermeyer, M, Demyttenaere, K, De Girolamo, G, Haro, JM, Karam, EG, Lara, C, Lépine, JP, Ormel, J, Posada-Villa, J, Zaslavsky, AM, Jin, R (2007). Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. British Journal of Psychiatry 190, 402–409.CrossRefGoogle ScholarPubMed
Gibbins, C, Toplak, ME, Flora, DB, Weiss, MD, Tannock, R (2012). Evidence for a general factor model of ADHD in adults. Journal of Attention Disorders 16, 635–644.CrossRefGoogle ScholarPubMed
Gomez, R, Vance, A, Gomez, RM (2013). Validity of the ADHD Bifactor model in general community samples of adolescents and adults, and a clinic-referred sample of children and adolescents. Journal of Attention Disorders.Google Scholar
Hartung, CM, Lefler, EK, Canu, WH, Stevens, AE, Jaconis, M, LaCount, PA, Shelton, CR, Leopold, DR, Willcutt, EG (2016). DSM-5 and other symptom thresholds for ADHD: which is the best predictor of impairment in college students? Journal of Attention Disorders.Google Scholar
Horta, BL, Gigante, DP, Gonçalves, H, dos Santos Motta, J, Loret de Mola, C, Oliveira, IO, Barros, FC, Victora, CG (2015). Cohort profile update: the 1982 pelotas (Brazil) birth cohort study. International Journal of Epidemiology 44, 441, 441a–441e.Google Scholar
Kessler, RC, Adler, L, Ames, M, Demler, O, Faraone, S, Hiripi, E, Howes, MJ, Jin, R, Secnik, K, Spencer, T, Ustun, TB, Walters, EE (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS). Psychological Medicine 35, 245–256.CrossRefGoogle ScholarPubMed
Kessler, RC, Adler, L, Barkley, R, Biederman, J, Conners, CK, Demler, O, Faraone, SV, Greenhill, LL, Howes, MJ, Secnik, K, Spencer, T, Ustun, TB, Walters, EE, Zaslavsky, AM (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. The American Journal of Psychiatry 163, 716–723.Google Scholar
Kessler, RC, Green, JG, Adler, LA, Barkley, RA, Chatterji, S, Faraone, SV, Finkelman, M, Greenhill, LL, Gruber, MJ, Jewell, M, Russo, LJ, Sampson, NA, Van Brunt, DL (2010). Structure and diagnosis of adult attention-deficit/hyperactivity disorder: analysis of expanded symptom criteria from the Adult ADHD Clinical Diagnostic Scale. Archives of General Psychiatry 67, 1168–1178.CrossRefGoogle ScholarPubMed
Kieling, C, Kieling, RR, Rohde, LA, Frick, PJ, Moffitt, T, Nigg, JT, Tannock, R, Castellanos, FX (2010). The age at onset of attention deficit hyperactivity disorder. American Journal of Psychiatry 167, 14–16.Google Scholar
Kooij, JJ, Buitelaar, JK, van den Oord, EJ, Furer, JW, Rijnders, CA, Hodiamont, PP (2005). Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychological Medicine 35, 817–827.CrossRefGoogle Scholar
Marques, JMA, Zuardi, AW (2008). Validity and applicability of the Mini International Neuropsychiatric Interview administered by family medicine residents in primary health care in Brazil. General Hospital Psychiatry 30, 303–310.Google Scholar
Matte, B, Anselmi, L, Salum, GA, Kieling, C, Gonçalves, H, Menezes, A, Grevet, EH, Rohde, LA (2015 a). ADHD in DSM-5: a field trial in a large, representative sample of 18- to 19-year-old adults. Psychological Medicine 45, 361–373.Google Scholar
Matte, B, Rohde, LA, Grevet, EH (2012). ADHD in adults: a concept in evolution. Attention Deficit and Hyperactivity Disorders 4, 53–62.Google Scholar
Matte, B, Rohde, LA, Turner, JB, Fisher, PW, Shen, S, Bau, CH, Nigg, JT, Grevet, EH (2015 b). Reliability and validity of proposed DSM-5 ADHD symptoms in a clinical sample of adults. Journal of Neuropsychiatry and Clinical Neurosciences 27, 228–236.CrossRefGoogle Scholar
Medina-Mora, ME, Borges, G, Lara, C, Benjet, C, Blanco, J, Fleiz, C, Villatoro, J, Rojas, E, Zambrano, J (2005). Prevalence, service use, and demographic correlates of 12-month DSM-IV psychiatric disorders in Mexico: results from the Mexican National Comorbidity Survey. Psychological Medicine 35, 1773–1783.Google Scholar
Michielsen, M, Semeijn, E, Comijs, HC, van de Ven, P, Beekman, AT, Deeg, DJ, Kooij, JJ (2012). Prevalence of attention-deficit hyperactivity disorder in older adults in The Netherlands. The British Journal of Psychiatry 201, 298–305.Google Scholar
Moffitt, TE, Houts, R, Asherson, P, Belsky, DW, Corcoran, DL, Hammerle, M, Harrington, H, Hogan, S, Meier, MH, Polanczyk, GV, Poulton, R, Ramrakha, S, Sugden, K, Williams, B, Rohde, LA, Caspi, A (2015). Is adult ADHD a childhood-onset neurodevelopmental disorder? evidence from a four-decade longitudinal cohort study. The American Journal of Psychiatry 172, 967–977.Google Scholar
Morin, AJ, Tran, A, Caci, H (2016). Factorial validity of the ADHD adult symptom rating scale in a French community sample: results from the ChiP-ARDS study. Journal of Attention Disorders 20, 530–541.CrossRefGoogle Scholar
Muthén, LK, Muthén, BO (2012). Mplus User's Guide. Muthén & Muthén: Los Angeles, CA.Google Scholar
Polanczyk, G, de Lima, MS, Horta, BL, Biederman, J, Rohde, LA (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American Journal of Psychiatry 164, 942–948.Google Scholar
R Core Team (2013). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna, Austria. ISBN 3-900051-07-0 (http://www.R-project.org/)Google Scholar
Ruopp, MD, Perkins, NJ, Whitcomb, BW, Schisterman, EF (2008). Youden index and optimal cut-point estimated from observations affected by a lower limit of detection. Biometrical Journal 50, 419–430.CrossRefGoogle ScholarPubMed
Simon, V, Czobor, P, Bálint, S, Mészáros, A, Bitter, I (2009). Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. British Journal of Psychiatry 194, 204–211.Google Scholar
SPSS Inc. Released (2009). PASW Statistics for Windows. Version 18.0. SPSS Inc: Chicago.Google Scholar
StataCorp (2013). Stata Statistical Software: Release 13. StataCorp LP: College Station, TX.Google Scholar
Tau, GZ, Peterson, BS (2010). Normal development of brain circuits. Neuropsychopharmacology 35, 147–168.CrossRefGoogle ScholarPubMed
Thapar, A, Cooper, M (2016). Attention deficit hyperactivity disorder. Lancet 387, 1240–1250.Google Scholar
Tuithof, M, Ten Have, M, van Dorsselaer, S, de Graaf, R (2014). Prevalence, persistency and consequences of ADHD in the Dutch adult population. Tijdschrift voor Psychiatrie 56, 10–19.Google Scholar
Wagner, F, Martel, MM, Cogo-Moreira, H, Maia, CR, Pan, PM, Rohde, LA, Salum, GA (2016). Attention-deficit/hyperactivity disorder dimensionality: the reliable ‘g’ and the elusive ‘s’ dimensions. European Child & Adolescent Psychiatry 25, 83–90.Google Scholar
World Health Organization (1992). International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). WHO: Geneva.Google Scholar
Willcutt, EG (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics 9, 490–499.Google Scholar
Supplementary material: File

Vitola supplementary material

Table S1

Download Vitola supplementary material(File)
File 32.1 KB