Childhood Disorders 659
Criticisms of the DSM-IV-TR Diagnostic Criteria
Clinicians and researchers have pointed out numerous problems with the DSM-IV-TR
criteria for ADHD. First, the diagnostic criteria for children do not necessarily apply
very well to adults; adults with less than fi ve symptoms can be clearly impaired, even
though they don’t exhibit the minimum number (six) of symptoms required for a di-
agnosis (McGough & McCracken, 2006). Second, according to the DSM criteria, if
symptoms don’t arise until after age 7, the diagnosis of ADHD is not, strictly speak-
ing, applicable (American Psychiatric Association, 2000). However, research studies
Prevalence- The estimated prevalence of ADHD in school-aged children increased from 6% in 1997 to 9% in
2006 (National Center for Health Statistics, 2008). - Prevalence among American adults is about 4% (Kessler et al., 2006).
Comorbidity - Common comorbid disorders include mood and anxiety disorders and learning disorders.
- Children with hyperactive and impulsive symptoms are more likely to be diagnosed with op-
positional defi ant disorder or conduct disorder than are those with inattentive symptoms
(Christophersen & Mortweet, 2001): In surveys of the general population, 50–75% of children
with ADHD also meet the criteria for conduct disorder (Kazdin, 1995). Another study found
that over half of children with ADHD had comorbid oppositional defi ant disorder (Biederman
et al., 1996).
Onset - Children are not usually diagnosed before age 4 or 5 because the range of normal behavior for
preschoolers is very wide. - In younger children, the diagnosis is generally based more on hyperactive and impulsive symp-
toms than on inattention symptoms. - DSM-IV-TR requires that the disorder have its onset by age 7; however, research suggests that
onset may occur up to age 12. Note, however, that diagnosis may occur much later.
Course - Symptoms of ADHD become obvious during the elementary school years, when attentional
problems interfere with schoolwork. - By early adolescence, the more noticeable signs of hyperactivity—diffi culty sitting still, for
example—typically diminish to a sense of restlessness or a tendency to fi dget. - Children who had ADHD but not oppositional defi ant disorder or conduct disorder in childhood
have a higher risk of developing adolescent-onset conduct disorder than do peers who had
none of those disorders in childhood (Mannuzza et al., 2004). - As adults, people with ADHD may avoid sedentary jobs because of their restlessness.
Gender Differences - Males are more likely—in one survey, more than twice as likely—to be diagnosed with ADHD,
particularly the hyperactive/impulsive type, although this gender difference may refl ect a
bias in referrals to mental health clinicians rather than any actual difference in prevalence
(Biederman et al., 2005; National Center for Health Statistics, 2008).
Cultural Differences - In the United States, non-Hispanic white children are more likely to be diagnosed with ADHD
than are Hispanic or black children (Havey et al., 2005; Stevens, Harman, & Kelleher, 2005). - Worldwide, the prevalence of the disorder among children averages about 5% (Polanczyk &
Rohde, 2007), although some studies fi nd higher prevalence rates (Bird, 2002; Ofovwe,
Ofovwe, & Meyer, 2006); the variability across countries can be explained by the different
thresholds at which behaviors are judged as reaching a symptomatic level, as well as some-
what different diagnostic criteria (Bird, 2002).
Source: Unless otherwise noted, the source for information is American Psychiatric Association, 2000.Table 14.15 • Attention-Defi cit/Hyperactivity Disorder Facts at a Glance