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Are all the 18 DSM-IV and DSM-5 criteria equally useful for diagnosing ADHD and predicting comorbid conduct problems?

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Abstract

In view of ICD-11 revision, we evaluate whether the 18 DSM-IV diagnostic items retained by DSM-5 could be further improved (i) in predicting ADHD ‘caseness’ and ‘impairment’ and (ii) discriminating ADHD without CD (ADHD − CD) cases from ADHD with CD (ADHD + CD) cases. In a multi-centre study sample consisting of 1497 ADHD probands and 291 unaffected subjects, 18 diagnostic items were examined for redundancy; then each item was evaluated for association with caseness, impairment and CD status using Classical Test Theory, Item-Response Theory and logistic regression methods. First, all 18 DSM-IV items contributed significantly and independently to the clinical diagnosis of ADHD. Second, not all the DSM-IV items carried equal weighting. “Often loses things”, “forgetfulness” and “difficulty sustaining attention” mark severity for Inattentiveness (IA) items and “often unduly noisy”, “exhibits a persistent pattern of restlessness”, “leaves seat in class” and “often blurts out answers” for Hyperactivity/Impulsivity (HI) items. “Easily distracted”, “inattentive to careless mistakes”, “often interrupts” and “often fidgets” are associated with milder presentations. In the IA domain, “distracted” yields most information in the low-severity range of the latent trait, “careless” in the mid-severity range and “loses” in the high-severity range. In the HI domains, “interrupts” yields most information in the low-severity range and “motor” in the high-severity range. Third, all 18 items predicted impairment. Fourth, specific ADHD items are associated with ADHD + CD status. The DSM-IV diagnostic items were valid and not redundant; however, some carried more weight than others. All items were associated with impairment.

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Acknowledgments

The IMAGE project is a multi-site, international effort supported by NIH grants R01MH62873 and R01MH081803 to S. V. Faraone. The IMAGE site principal investigators are Philip Asherson, Tobias Banaschewski, Jan Buitelaar, Richard P. Ebstein, Stephen V. Faraone, Michael Gill, Ana Miranda, Fernando Mulas, Robert D. Oades, Herbert Roeyers, Aribert Rothenberger, Joseph Sergeant, Edmund Sonuga-Barke and Hans-Christoph Steinhausen. Chief investigators at each site are Rafaela Marco, Nanda Rommelse, Wai Chen, Henrik Uebel, Hanna Christiansen, Ueli C. Mueller, Cathelijne Buschgens, Barbara Franke and Lamprini Psychogiou. We thank all. Silia Vitoratou was funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The authors are grateful to Rand R. Wilcox, for his statistical advice; Professor Eric Taylor and Professor Andrew Pickles for advice and support; and the Alicia Koplowitz Foundation, which sponsored Dr Alexandra Garcia Rosales. We also thank the children and families participating in the IMAGE project.

Conflict of interest

AGR: AGR reports no biomedical financial interests or potential conflict of interests. SV: SV reports no biomedical financial interests or potential conflict of interests. TB: TB served in an advisory or consultancy role for Hexal Pharma, Lilly, Medice, Novartis, Otsuka, Oxford outcomes, PCM scientific, Shire and Viforpharma. He received conference attendance support and conference support or received speaker’s fee from Lilly, Medice, Novartis and Shire. He is/has been involved in clinical trials conducted by Lilly, Shire and Viforpharma. The present work is unrelated to the above grants and relationships. PA: King’s College London has received funds for work completed by PA: grants from Janssen, Shire, Lilly, QBTech and Vifor; sponsored talks from Shire, Novartis, Janssen and Lilly; consultancy for Shire, Lilly and Novartis. JB: JB has been in the past 3 years a consultant to/member of advisory board of/and/or speaker for Janssen Cilag BV, Eli Lilly, Bristol-Myer Squibb, Shering Plough, UCB, Shire, Novartis and Servier. He is not an employee of any of these companies and not a stock shareholder of these companies. He has no other financial or material support, including expert testimony, patents or royalties. RO: In the last 24 months, RO reports no financial interests or potential conflicts of interest. AR: Advisory Board and Speakers Bureau: Lilly, Shire, Medice, Novartis; research support: Shire, German Research Society, Schwaabe; travel support: Shire; educational grant: Shire; consultant: UCB/Shire; Lilly. H-C S: In the last 36 months, H-C S has been a member of the advisory board and/or received payment for lectures including service on speakers bureaus by Shire and Medice. The present work is unrelated to the above grants and relationships. SVF: In the past year, SVF received consulting income, travel expenses and/or research support from Akili Interactive Labs, Alcobra, VAYA Pharma and SynapDx and research support from the National Institutes of Health (NIH). His institution is seeking a patent for the use of sodium–hydrogen exchange inhibitors in the treatment of ADHD. In previous years, he received consulting fees or was on advisory boards or participated in continuing medical education programs sponsored by: Shire, Alcobra, Otsuka, McNeil, Janssen, Novartis, Pfizer and Eli Lilly. Dr. Faraone receives royalties from books published by Guilford Press: Straight Talk about Your Child’s Mental Health and Oxford University Press: Schizophrenia: The Facts. WC: Wai Chen has received honorarium for lecturing and consultancy for Shire, Janssen and Flynn Pharma, research support from Shire, and support for attending meetings from Shire and Janssen. The present work is unrelated to the above grants and relationships.

Author information

Authors and Affiliations

  1. MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK

    Alexandra Garcia Rosales, Philip Asherson & Wai Chen

  2. Barnet, Enfield and Haringey Mental Health Trust, London, UK

    Alexandra Garcia Rosales

  3. Department of Biostatistics, Institute of Psychiatry, King’s College London, London, UK

    Silia Vitoratou

  4. Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany

    Tobias Banaschewski

  5. Department of Child and Adolescent Psychiatry, University of Göttingen, Göttingen, Germany

    Tobias Banaschewski & Aribert Rothenberger

  6. Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands

    Jan Buitelaar

  7. Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Essen, Germany

    Robert D. Oades

  8. Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland

    Hans-Christoph Steinhausen

  9. Research Unit of Child and Adolescent Psychiatry, Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark

    Hans-Christoph Steinhausen

  10. Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland

    Hans-Christoph Steinhausen

  11. Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA

    Stephen V. Faraone

  12. Division of Clinical Neuroscience, School of Medicine, University of Southampton, Southampton, UK

    Wai Chen

  13. Complex ADHD Service (CAHDS), Department of Health, Perth, WA, Australia

    Wai Chen

  14. Department of Child and Adolescent Psychiatry, School of Paediatrics and Child Health and School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, WA, 6840, Australia

    Wai Chen

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  1. Alexandra Garcia Rosales
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  2. Silia Vitoratou
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  3. Tobias Banaschewski
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  4. Philip Asherson
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  5. Jan Buitelaar
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  7. Aribert Rothenberger
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  8. Hans-Christoph Steinhausen
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  9. Stephen V. Faraone
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  10. Wai Chen
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Correspondence to Alexandra Garcia Rosales.

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Garcia Rosales, A., Vitoratou, S., Banaschewski, T. et al. Are all the 18 DSM-IV and DSM-5 criteria equally useful for diagnosing ADHD and predicting comorbid conduct problems?. Eur Child Adolesc Psychiatry 24, 1325–1337 (2015). https://doi.org/10.1007/s00787-015-0683-7

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  • DOI: https://doi.org/10.1007/s00787-015-0683-7

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