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Did the ADHD Goalposts Just Move ?

The short answer is yes, they did.

20130905-173554.jpgDSM-5, the latest version of the ‘Diagnostic and Statistical Manual for Mental Disorders’ made changes to the definition of the requirements for an AD//HD diagnosis. Some argue that not only did the goalposts move, they also got wider so it’s easier to be diagnosed with ADHD, but we’ll leave that judgement up to you.

Firstly, who decides what an AD/HD diagnosis requires ? Well it’s the American Psychiatric Association that publishes the DSM, and when an update is planned they meet in committees to review the current definitions, and consider whether any conditions should be added or taken out.

So how do they decide that you need, for example 5 symptoms in a group to meet the diagnostic criteria ? Look at the data ? Do some research ? No, they have a discussion and reach a consensus.

Many people are surprised how unscientific the process to reach diagnostic criteria is, but they shouldn’t be. In 1973 the APA decided that Homesexuality was no longer a ‘Mental Disorder’ – how did they decide ? They had a vote – and voted 61% to 39% to take it out.

If you want to know more about the inside story of the DSM, we recommend you read the recently published book ‘Cracked’ by James Davies.

So back to the question in hand, how did the diagnostic criteria for AD/HD change in May 2013 ?

What hasn’t changed is that there are stil two lists of symptoms – one list for Inattention and one for Hyperactivity/Impulsively.

These are the differences between the last version of DSM-IV and DSM-5:-

  • “Several’ symptoms are now required in each setting (e.g. school, home).
  • Symptoms that emerged between the age of 7 and 11 can be considered, previously they had to appear before the age of 7.
  • You are now allowed to have both AD/HD and autistic spectrum disorder (doctors call this a ‘comorbid’ diagnosis), previously the possibility of having both conditions wasn’t officially possible.
  • Adult AD/HD now requires 5 of the symptoms to be present in each group, rather than 6 previously.

So the goalposts have definitely moved. Have they got bigger or smaller ?

  • The requirement for several symptoms in each setting is at least on paper a narrowing of the goalposts, but is this the case in practice ?
  • The inclusion of symptoms that emerged between the ages of 7 and 11 certainly widens the goalposts.
  • And the fact that children with ASD are now allowed to also have AD/HD doesn’t so much widen the goalposts but it puts many more players on the pitch.
  • Lastly if you are an adult you now need 17% less symptoms to get an AD/HD diagnosis.

It seems clear the clinical threshold for ADHD diagnosis is arbitrarily set. It’s also critical for the prescription of medication. If you are concerned about ADHD symptoms and don’t want to use medication, or don’t meet this arbitrary threshold that just moved, you could consider Neurofeedback, an alternative to medication with a strong evidence base.

If you have any questions about Neurofeedback or you’d like to make an initial appointment in London, Egham in Surrey or Hoddesdon in Herts, please call BrainTrainUK today on 0330 111 3299.