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Comparative Study
, 45 (2), 361-73

ADHD in DSM-5: A Field Trial in a Large, Representative Sample of 18- To 19-year-old Adults

Comparative Study

ADHD in DSM-5: A Field Trial in a Large, Representative Sample of 18- To 19-year-old Adults

B Matte et al. Psychol Med.


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.

Keywords: ADHD; DSM-5; diagnostic performance; epidemiology; prevalence.

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    1. Amorim P (2003). The Mini Neuropsychiatric Interview (MINI): validation of a short structured diagnostic psychiatric interview. Revista Brasileira de Psiquiatria 22, 26–39.
    1. APA (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. DSM-5. American Psychiatric Association: Washington, DC.
    1. Asparouhov T, Muthén B (2006). Robust Chi Square Difference Testing with mean and variance adjusted test statistics. Mplus Web Notes: No. 10.
    1. Barkley RA (2010). Attention Deficit Hyperactivity Disorder in Adults. Jones & Bartlett Publishers: Sudbury, MA.
    1. Barkley RA, Murphy KR, Fischer M (2008). ADHD in Adults: What the Science Says. Guilford Press: New York, NY.

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