Could a Modified DSM Offer More Accurate Diagnosis of Adult ADHD?

How Adult ADHD is Diagnosed Currently

The number of adults that have been diagnosed with ADHD has risen over the years. A determination of adult ADHD is usually made by observation of the number and severity of symptoms as detailed in the Diagnostic and Statistical Manual of Mental Disordersobserved (DSM) by a qualified clinician. This might be supplemented by other clinical rating systems or self-rating assessments though these are not yet standardized.

The types of ADHD are divided into 3 groups, based on the symptoms observed:

  • ADHD predominantly inattentive presentation
  • ADHD predominantly hyperactive-impulsive presentation
  • ADHD combined presentation

Diagnosis Adult ADHD Can Be Difficult

One factor complicating a definitive diagnosis of adult ADHD is confusion of the symptoms with age related conditions, and for women, changes related to the effect of menopause on estrogen levels.

Another factor is medical conditions or treatments which may cause signs and symptoms similar to those of ADHD such as:

  • Mental health disorders – These include depression, anxiety, conduct disorders, learning and language deficits, or other psychiatric disorders
  • Medical problems that can affect thinking or behavior –  This group can include developmental disorder, seizure disorder, thyroid problems, sleep disorders, brain injury or low blood sugar (hypoglycemia)
  • Drugs and medications – Examples are alcohol or other substance misuse and certain medications

But another barrier to getting a diagnosis can be the DSM itself. It’s criteria were created primarily to diagnose ADHD in children and teens rather than adults. This could lead to adults with ADHD not being properly diagnosed.

New Research Provide a Potentially Better Approach

A new study, published in the Journal of Clinical Psychiatry and headed up by Frederick W. Reimherr, MD, in the department of psychiatry at the University of Utah, has employed a modified version of the DSM criteria to better serve the purpose of accurately diagnosing ADHD in adults.

The researchers defined ADHD inattentive presentation as having high levels of problems with attentional difficulties and disorganization, as well as lower levels of emotional symptoms. In this respect the presentation resembles the analogous DSM category. However, it is based on diagnostic criteria more appropriate for adults..

In place of the usual hyperactivity presentation, they defined an ADHD emotional dysregulation presentation which  has high levels of emotional dysregulation combined with inattentive symptoms, with these emotional symptoms defined by temper control problems, affective lability and emotional overreactivity.

The results showed a significant improvement in the diagnosis of adult ADHD when the emotional dysregulation factors were included along with the inattentive factors. Dr. Reimherr expressed confidence that the new methodology could be easily incorporated into current clinical practice and that it could be applied to the full spectrum of adults with ADHD.

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