Revising the diagnostic criteria for Attention-Deficit Hyperactivity Disorder (ADHD): an adulthood perspective.

Abstract

Over the several decades since the publication of the DSMIII (American Psychiatric Association 1980), the diagnosis of ADHD in adults has been imbued with uncertainty. At that time, it was thought to be a disorder confined to childhood and consequently the criteria focused on children between the ages of 6–12. These criteria, involving both observable behaviors and reported symptoms, fit this age group quite well, but are not easily applied to either older adolescents or adults. Most other adult DSM diagnoses are based on symptom areas, not specific behaviors, making the application of the DSM ADHD criteria to adults an oddity. In the late 1970s and 1980s at the University of Utah in the United States (Wender et al. 1981; Wood et al. 1976), we started to publish studies of adults with ADHD and noted that many of these patients had problems beyond the accepted inattention, hyperactivity and impulsivity symptoms seen in children. With the publication of the Utah Criteria for the diagnosis of ADHD in 1985 (Wender et al. 1985), we tried to clarify and specify the kinds of problems with emotionality encountered in adults. We then began to develop the Wender–Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) to help define more precisely the mood lability, temper control and emotional over-reactivity that we found in our adults with ADHD. Both the criteria and the corresponding scale included a variety of emotional symptoms. In addition, both presented ADHD criteria as problem areas, not narrowly defined behaviors. In the 1990s, we published the widely accepted Wender Utah Rating Scale (Ward et al. 1993), which was devised to retrospectively identify childhood characteristics associated with ADHD. It encompasses symptoms, including emotionality, which have been associated with the persistence of ADHD into adulthood. In the early 2000s, publications from the Multimodal Treatment of Attention-Deficit Hyperactivity Disorder (MTA) study, which dealt with children exclusively, helped define more severe ADHD, which frequently included emotional and oppositional symptoms (Jensen et al. 2001). In fact, 70 % of these patients, all with Combined Type ADHD, had emotional and/or oppositional symptoms. Analyzing data in 2005 from a large multicenter study, we used the WRAADDS to define a subset of adult ADHD patients with high levels of emotional symptoms, which we labeled as ‘‘ADHD related emotional dysregulation’’ (Reimherr et al. 2005). These patients were more impaired than others in the sample and were highly responsive to treatment. Since then multiple well-respected researchers from Europe, the United States and more globally have documented the ongoing emotional symptoms in both pediatric and adult ADHD, and numerous reports support the position that emotional symptoms are integral to ADHD. F. W. Reimherr Department of Psychiatry, University of Utah School of Medicine and Psychiatric and Behavioral Solutions, 1522 South 1100 East, Salt Lake City, UT 84105, USA