▸ Attention-Deficit/Hyperactivity Disorder. Age of onset would increase from 7 years to 12 years. Also, the revision proposes adding new exemplifications for ADHD symptoms that illustrate behaviors across the life span. Also added would be four new symptoms of impulsiveness: acting without thinking, impatience, being uncomfortable doing things slowly and systematically, and difficulty resisting temptations or opportunities. The revision sets the threshold for diagnosis as six symptoms of inattention, and six symptoms of hyperactivity and impulsivity in children and adolescents up to age 16 years; in those aged 17 years and older, the threshold for each diagnosis was set to four symptoms. And the work group removed the exclusion of diagnosing ADHD in patients with autism spectrum disorders.
“No question that 50%–70% of children and adolescents with autism spectrum disorders present with very significant inattention and hyperactivity symptoms,” said Dr. F. Xavier Castellanos, professor of child and adolescent psychiatry at New York University. “Is it the same as ADHD? It's been a very sore point that you can't diagnose ADHD in these patients. The vote was to remove the exclusion. It leaves open the question of blurring a boundary” between ADHD and autism spectrum disorders, he said.
▸ Conduct Disorder. The work group added a proposed specifier for conduct disorder on callous and unemotional traits. Results from more than 30 studies suggest that the presence of callous and unemotional traits predicts a more severe, stable, and difficult-to-treat conduct disorder, said Paul J. Frick, Ph.D., professor and chair of psychology at the University of New Orleans. It constitutes just a small fraction of all conduct disorder cases. The callous and unemotional specifier requires at least two of these traits: lack of remorse or guilt, lack of empathy, unconcern about performance, and shallow or deficient affect. The ability of clinicians to assess these traits will need testing in a field trial, Dr. Frick said.
▸ Oppositional Defiant Disorder. The changes remove an exclusionary criteria for conduct disorder, organize the symptom criteria to separate emotional (“often loses temper”) and behavioral (“often argues with adults”) symptoms, and sets a severity index based on symptom number and setting number, Dr. Frick said.
Dr. Walsh said he has received research support from AstraZeneca. Dr. Pine, Dr. Zeanah, Dr. Castellanos, and Dr. Frick had no disclosures.