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

• Published in: European child & adolescent psychiatry Vol. 24; no. 11; pp. 1325 - 1337
• Main Authors: Garcia Rosales, Alexandra, Vitoratou, Silia, Banaschewski, Tobias, Asherson, Philip, Buitelaar, Jan, Oades, Robert D., Rothenberger, Aribert, Steinhausen, Hans-Christoph, Faraone, Stephen V., Chen, Wai
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2015; Springer Nature B.V
• Subjects: Attention Deficit Disorder with Hyperactivity - diagnosis; Attention deficit hyperactivity disorder; Child & adolescent psychiatry; Child and Adolescent Psychiatry; Comorbidity; Conduct disorder; Diagnostic and Statistical Manual of Mental Disorders; Errors; Female; Forgetfulness; Humans; Hyperactivity; Impulsive behavior; Impulsivity; Male; Medical diagnosis; Medicine; Medicine & Public Health; Mental health; Neurosciences; Original Contribution; Problem Behavior - psychology; Psychiatry; Psychotherapy; Redundancy; Redundant; Restlessness; Severity; Studies; Teenagers; Weighting; United Kingdom > UK; Switzerland; Germany; Conduct disorder; DSM-IV; Attention-deficit/hyperactivity disorder; Diagnostic criteria; Impairment
• ISSN: 1018-8827; 1435-165X
• DOI: 10.1007/s00787-015-0683-7

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.