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Validity of proposed DSM-5 ADHD impulsivity symptoms in children

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Abstract

The American Psychiatric Association (APA) working group on Attention-Deficit/Hyperactivity Disorder (ADHD) proposed the inclusion of four new impulsivity symptoms. However, they were not included in DSM-5 due to the lack of sufficient evidence. The aim of this study is to investigate the performance of the proposed four ADHD impulsivity symptoms with respect to: (a) ADHD factor structure; (b) performance in predicting clinical impairment; (c) specificity for ADHD diagnosis and (d) best symptomatic threshold to predict clinical impairment. The sample comprised 416 children (31 ADHD subjects according to both DSM-IV and proposed DSM-5, 20 ADHD subjects according to just one diagnostic system and 365 controls) from 12 schools. Diagnoses were derived using semi-structured interviews and ADHD rating scales. Results from confirmatory factor analysis indicate that addition of the four new impulsivity items provided a slightly better factor structure if compared to models including only 18 items. Regression analyses showed that only one of the new impulsivity symptoms (impatient) was part of the list of best predictors of impairment. None of the four new impulsivity items was specifically associated with ADHD diagnosis. The best cutoff point in the hyperactivity/impulsivity dimension for predicting impairment did not change significantly. Overall, our findings suggest that the determination on how to best capture impulsivity dimension as part of the ADHD construct needs more investigation and that there is not enough evidence to include these four assessed impulsivity symptoms as part of the ADHD criteria.

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Author information

Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey

    Gül Ünsel Bolat & Eyüp Sabri Ercan

  2. ADHD Outpatient Program, Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

    Giovanni Abrahão Salum, Rafael Massuti & Luis Augusto Rohde

  3. National Institute of Developmental Psychiatry for Children and Adolescents, Sao Paulo, Brazil

    Giovanni Abrahão Salum & Luis Augusto Rohde

  4. Department of Child and Adolescent Psychiatry, Manisa Mental Health Hospital, Manisa, Turkey

    Öznur Bilaç

  5. Isparta Maternity and Children Hospital, Isparta, Turkey

    Taciser Uysal Özaslan

  6. Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, Turkey

    Hilmi Bolat

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  1. Gül Ünsel Bolat
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  2. Eyüp Sabri Ercan
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  3. Giovanni Abrahão Salum
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  4. Öznur Bilaç
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  7. Hilmi Bolat
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  8. Luis Augusto Rohde
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Correspondence to Gül Ünsel Bolat.

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Conflict of interest

Luis A. Rohde has received honoraria, has been on the speakers’ bureau/advisory board and/or has acted as a consultant for Eli-Lilly, Janssen-Cilag, Novartis and Shire in the last 3 years. He receives authorship royalties from Oxford Press and ArtMed. He also received travel awards for taking part of 2014 APA and 2015 WFADHD meetings from Shire. The ADHD and Juvenile Bipolar Disorder Outpatient Programs chaired by him received unrestricted educational and research support from the following pharmaceutical companies in the last 3 years: Eli-Lilly, Janssen-Cilag, Novartis, and Shire. Eyup Sabri Ercan is in charge of the advisory board of Lilly and Janssen-Cilag. The other authors have no biomedical financial interests or potential conflicts of interest to report.

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Ünsel Bolat, G., Ercan, E.S., Salum, G.A. et al. Validity of proposed DSM-5 ADHD impulsivity symptoms in children. Eur Child Adolesc Psychiatry 25, 1121–1132 (2016). https://doi.org/10.1007/s00787-016-0839-0

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  • DOI: https://doi.org/10.1007/s00787-016-0839-0

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