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ADHD in DSM-5: a field trial in a large, representative sample of 18- to 19-year-old adults

  • B. Matte (a1), L. Anselmi (a1) (a2), G. A. Salum (a1) (a3), C. Kieling (a1) (a3), H. Gonçalves (a2), A. Menezes (a2), E. H. Grevet (a1) and L. A. Rohde (a1) (a3)...

Abstract

Background

The DSM criteria for adult attention-deficit/hyperactivity disorder (ADHD) have not been tested in American Psychiatric Association (APA) field trials for either DSM-IV or DSM-5. This study aimed to assess: (a) the prevalence of ADHD according to DSM-5 criteria; (b) the factor solution that provides the best fit for ADHD symptoms; (c) the symptoms with the highest predictive value for clinical impairment; and (d) the best symptomatic threshold for each ADHD dimension (inattention and hyperactivity/impulsivity).

Method

Trained psychologists evaluated 4000 young adults from the 1993 Pelotas Birth Cohort Study with an instrument covering all DSM-5 ADHD criteria. A series of confirmatory factor analyses (CFAs) tested the best factor structure. Complex logistic regressions assessed differential contributions of each symptom to clinical impairment. Receiver-operating characteristic (ROC) analyses tested which would be the best symptomatic cut-off in the number of symptoms for predicting impairment.

Results

The prevalence of DSM-5 ADHD was 3.55% [95% confidence interval (CI) 2.98–4.12]. The estimated prevalence of DSM-IV ADHD was 2.8%. CFA revealed that a bifactor model with a single general factor and two specific factors provided the best fit for DSM-5 symptoms. Inattentive symptoms continued to be the most important predictors of impairment in adults. The best cut-offs were five symptoms of inattention and four symptoms of hyperactivity/impulsivity.

Conclusions

Our results, combined with previous findings, suggest a 27% increase in the expected prevalence of ADHD among young adults, comparing DSM-IV to DSM-5 criteria. The DSM-5 symptomatic organization derived a similar factor structure for adults as DSM-IV symptoms. Data using DSM-5 criteria support lowering the symptomatic threshold for diagnosing ADHD in adults.

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Copyright

The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution licence .

Corresponding author

* Address for correspondence: L. A. Rohde, M.D., Ph.D., Programa de Transtorno de Déficit de Atenção/Hiperatividade, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre, Rio Grande do Sul, Brazil. (Email: lrohde@terra.com.br)

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ADHD in DSM-5: a field trial in a large, representative sample of 18- to 19-year-old adults

  • B. Matte (a1), L. Anselmi (a1) (a2), G. A. Salum (a1) (a3), C. Kieling (a1) (a3), H. Gonçalves (a2), A. Menezes (a2), E. H. Grevet (a1) and L. A. Rohde (a1) (a3)...

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