Why ADHD Diagnoses are Set to Rise
I just returned from the Texas Psychological Association’s annual conference, which was held this year in San Antonio. It’s a great event that brings some of the best psychologists from Texas and around the country together to discuss current trends and other hot topics. I attended several sessions ranging from topics on executive function to health care reform.
The most interesting talk I listened to was a discussion of key updates the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, or what most people refer to as the DSM-5. The DSM is the most widely used resource to help psychiatrists and psychologists diagnose various disorders. The 5th edition was published in late 2013 and is now the preferred version over the previous edition.
Of the more relevant updates to my line of work was the change to criteria for a diagnosis of ADHD. According to the presenter, Dr. Corwin Boake, neuropsychologist and professor at UTHealth Medical School in Houston, the new edition of the DSM will lead to “an increased prevalence” of ADHD diagnoses. This is a HUGE statement! It’s no secret that diagnoses of ADHD have been on the rise in the last 10-15 years. But to expect a greater increase in the future is alarming. I want outline the changes to the DSM that Dr. Boake said would lead to this increase.
DSM-4: prior to 2014
- clinically significant impairment of function
- symptoms must be present with impairment before age 7
- 2 subtypes: inattentive and/or hyperactivity/impulsivity
- requires 6 or more symptoms in either category
DSM-5: after 2014
- interference with quality of function
- several symptoms must be present before age 12
- 3 presentations: inattentive, hyperactive-impulsive, combined
- requires 6 or more symptoms if younger than 17, 5 or more if older than 17
According to Dr. Boake during his presentation, the new changes to the DSM will make the diagnosis of ADHD much easier. As you can see above, the difference between the DSM-4 criteria of “impairment” vs. the DSM-5 criteria of “interference” is a big change. Impairment suggests a greater level of dysfunction than interference. Thus it does not take as severe a symptom to qualify for a diagnosis of ADHD under the 5th edition.
The other noteworthy difference between the two editions is the age of onset for ADHD symptoms. In the old edition, the diagnosis of ADHD required symptoms to begin before age 7. The newer edition requires symptoms to begin before age 12. Additionally, people over 17 years old must display only five symptoms rather than six symptoms to qualify for a diagnosis. Simply put, the new edition of the DSM puts a great emphasis on diagnosing ADHD at an older age than the previous edition. There is now a wider age range for individuals to qualify for a diagnosis of ADHD, and consequently more candidates for a diagnosis. This will ultimately lead to more individuals being diagnosed.
How This Impacts Your Student
My overall takeaway from Dr. Boake’s presentation was that it is becoming increasingly “easier” to obtain a diagnosis of ADHD. More importantly, individuals who were assessed and diagnosed under the 4th edition may not have met the criteria for ADHD, while those same individuals could have qualified for a diagnosis of ADHD under the new edition. This has a big implication for students, especially those in middle-school and high-school. If you’re child was assessed prior to 2014, you should check to see which edition of the DSM was used. There is a realistic chance your student may now qualify even though he previously did not.
Many of the psychologists listening to this presentation expressed their concerns with the easier criteria for a diagnosis of ADHD. I tend to agree. America has a higher rate of ADHD diagnoses than any other country in the world, and the new criteria will only add to that statistic. Furthermore, we have already swayed too far in the direction of medicating students to “fix” their difficulties with attention. I fear that a higher prevalence of ADHD diagnoses in the future will only add to this problem.
Parents and students must use this information wisely. A diagnosis of ADHD is not an excuse for poor performance in the classroom. Understanding strengths, weaknesses, and limitations is key to success. Hopefully the rise of ADHD will lead to the development and implementation of more creative and practical intervention strategies rather than increased medication. I look forward to this challenge.