Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes

Erik G. Willcutt, Joel Nigg, Bruce F. Pennington, Mary V. Solanto, Luis A. Rohde, Rosemary Tannock, Sandra K. Loo, Caryn L. Carlson, Keith McBurnett, Benjamin B. Lahey

Research output: Contribution to journalArticle

385 Citations (Scopus)

Abstract

Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for attention deficit/hyperactivity disorder (ADHD) specify two dimensions of inattention and hyperactivity-impulsivity symptoms that are used to define three nominal subtypes: predominantly hyperactive-impulsive type (ADHD-H), predominantly inattentive type (ADHD-I), and combined type (ADHD-C). To aid decision making for DSM-5 and other future diagnostic systems, a comprehensive literature review and meta-analysis of 546 studies was completed to evaluate the validity of the DSM-IV model of ADHD. Results indicated that DSM-IV criteria identify individuals with significant and persistent impairment in social, academic, occupational, and adaptive functioning when intelligence, demographic factors, and concurrent psychopathology are controlled. Available data overwhelmingly support the concurrent, predictive, and discriminant validity of the distinction between inattention and hyperactivity-impulsivity symptoms, and indicate that nearly all differences among the nominal subtypes are consistent with the relative levels of inattention and hyperactivity-impulsivity symptoms that define the subtypes. In contrast, the DSM-IV subtype model is compromised by weak evidence for the validity of ADHD-H after first grade, minimal support for the distinction between ADHD-I and ADHD-C in studies of etiological influences, academic and cognitive functioning, and treatment response, and the marked longitudinal instability of all three subtypes. Overall, we conclude that the DSM-IV ADHD subtypes provide a convenient clinical shorthand to describe the functional and behavioral correlates of current levels of inattention and hyperactivity-impulsivity symptoms, but do not identify discrete subgroups with sufficient long-term stability to justify the classification of distinct forms of the disorder. Empirical support is stronger for an alternative model that would replace the subtypes with dimensional modifiers that reflect the number of inattention and hyperactivity-impulsivity symptoms at the time of assessment.

Original languageEnglish (US)
Pages (from-to)991-1010
Number of pages20
JournalJournal of Abnormal Psychology
Volume121
Issue number4
DOIs
StatePublished - 2012

Fingerprint

Attention Deficit Disorder with Hyperactivity
Diagnostic and Statistical Manual of Mental Disorders
Impulsive Behavior
Shorthand
Attention Deficit Hyperactivity Disorder
Psychopathology
Intelligence
Meta-Analysis
Decision Making
Demography
Hyperactivity
Impulsivity

Keywords

  • Attention deficit/hyperactivity disorder
  • Dsm-5
  • Dsm-iv
  • Subtypes
  • Symptoms
  • Validity

ASJC Scopus subject areas

  • Clinical Psychology
  • Developmental and Educational Psychology
  • Arts and Humanities (miscellaneous)

Cite this

Willcutt, E. G., Nigg, J., Pennington, B. F., Solanto, M. V., Rohde, L. A., Tannock, R., ... Lahey, B. B. (2012). Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes. Journal of Abnormal Psychology, 121(4), 991-1010. https://doi.org/10.1037/a0027347

Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes. / Willcutt, Erik G.; Nigg, Joel; Pennington, Bruce F.; Solanto, Mary V.; Rohde, Luis A.; Tannock, Rosemary; Loo, Sandra K.; Carlson, Caryn L.; McBurnett, Keith; Lahey, Benjamin B.

In: Journal of Abnormal Psychology, Vol. 121, No. 4, 2012, p. 991-1010.

Research output: Contribution to journalArticle

Willcutt, EG, Nigg, J, Pennington, BF, Solanto, MV, Rohde, LA, Tannock, R, Loo, SK, Carlson, CL, McBurnett, K & Lahey, BB 2012, 'Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes', Journal of Abnormal Psychology, vol. 121, no. 4, pp. 991-1010. https://doi.org/10.1037/a0027347
Willcutt, Erik G. ; Nigg, Joel ; Pennington, Bruce F. ; Solanto, Mary V. ; Rohde, Luis A. ; Tannock, Rosemary ; Loo, Sandra K. ; Carlson, Caryn L. ; McBurnett, Keith ; Lahey, Benjamin B. / Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes. In: Journal of Abnormal Psychology. 2012 ; Vol. 121, No. 4. pp. 991-1010.
@article{e6d74316225e42368b78116b362a25c8,
title = "Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes",
abstract = "Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for attention deficit/hyperactivity disorder (ADHD) specify two dimensions of inattention and hyperactivity-impulsivity symptoms that are used to define three nominal subtypes: predominantly hyperactive-impulsive type (ADHD-H), predominantly inattentive type (ADHD-I), and combined type (ADHD-C). To aid decision making for DSM-5 and other future diagnostic systems, a comprehensive literature review and meta-analysis of 546 studies was completed to evaluate the validity of the DSM-IV model of ADHD. Results indicated that DSM-IV criteria identify individuals with significant and persistent impairment in social, academic, occupational, and adaptive functioning when intelligence, demographic factors, and concurrent psychopathology are controlled. Available data overwhelmingly support the concurrent, predictive, and discriminant validity of the distinction between inattention and hyperactivity-impulsivity symptoms, and indicate that nearly all differences among the nominal subtypes are consistent with the relative levels of inattention and hyperactivity-impulsivity symptoms that define the subtypes. In contrast, the DSM-IV subtype model is compromised by weak evidence for the validity of ADHD-H after first grade, minimal support for the distinction between ADHD-I and ADHD-C in studies of etiological influences, academic and cognitive functioning, and treatment response, and the marked longitudinal instability of all three subtypes. Overall, we conclude that the DSM-IV ADHD subtypes provide a convenient clinical shorthand to describe the functional and behavioral correlates of current levels of inattention and hyperactivity-impulsivity symptoms, but do not identify discrete subgroups with sufficient long-term stability to justify the classification of distinct forms of the disorder. Empirical support is stronger for an alternative model that would replace the subtypes with dimensional modifiers that reflect the number of inattention and hyperactivity-impulsivity symptoms at the time of assessment.",
keywords = "Attention deficit/hyperactivity disorder, Dsm-5, Dsm-iv, Subtypes, Symptoms, Validity",
author = "Willcutt, {Erik G.} and Joel Nigg and Pennington, {Bruce F.} and Solanto, {Mary V.} and Rohde, {Luis A.} and Rosemary Tannock and Loo, {Sandra K.} and Carlson, {Caryn L.} and Keith McBurnett and Lahey, {Benjamin B.}",
year = "2012",
doi = "10.1037/a0027347",
language = "English (US)",
volume = "121",
pages = "991--1010",
journal = "Journal of Abnormal Psychology",
issn = "0021-843X",
publisher = "American Psychological Association Inc.",
number = "4",

}

TY - JOUR

T1 - Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes

AU - Willcutt, Erik G.

AU - Nigg, Joel

AU - Pennington, Bruce F.

AU - Solanto, Mary V.

AU - Rohde, Luis A.

AU - Tannock, Rosemary

AU - Loo, Sandra K.

AU - Carlson, Caryn L.

AU - McBurnett, Keith

AU - Lahey, Benjamin B.

PY - 2012

Y1 - 2012

N2 - Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for attention deficit/hyperactivity disorder (ADHD) specify two dimensions of inattention and hyperactivity-impulsivity symptoms that are used to define three nominal subtypes: predominantly hyperactive-impulsive type (ADHD-H), predominantly inattentive type (ADHD-I), and combined type (ADHD-C). To aid decision making for DSM-5 and other future diagnostic systems, a comprehensive literature review and meta-analysis of 546 studies was completed to evaluate the validity of the DSM-IV model of ADHD. Results indicated that DSM-IV criteria identify individuals with significant and persistent impairment in social, academic, occupational, and adaptive functioning when intelligence, demographic factors, and concurrent psychopathology are controlled. Available data overwhelmingly support the concurrent, predictive, and discriminant validity of the distinction between inattention and hyperactivity-impulsivity symptoms, and indicate that nearly all differences among the nominal subtypes are consistent with the relative levels of inattention and hyperactivity-impulsivity symptoms that define the subtypes. In contrast, the DSM-IV subtype model is compromised by weak evidence for the validity of ADHD-H after first grade, minimal support for the distinction between ADHD-I and ADHD-C in studies of etiological influences, academic and cognitive functioning, and treatment response, and the marked longitudinal instability of all three subtypes. Overall, we conclude that the DSM-IV ADHD subtypes provide a convenient clinical shorthand to describe the functional and behavioral correlates of current levels of inattention and hyperactivity-impulsivity symptoms, but do not identify discrete subgroups with sufficient long-term stability to justify the classification of distinct forms of the disorder. Empirical support is stronger for an alternative model that would replace the subtypes with dimensional modifiers that reflect the number of inattention and hyperactivity-impulsivity symptoms at the time of assessment.

AB - Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for attention deficit/hyperactivity disorder (ADHD) specify two dimensions of inattention and hyperactivity-impulsivity symptoms that are used to define three nominal subtypes: predominantly hyperactive-impulsive type (ADHD-H), predominantly inattentive type (ADHD-I), and combined type (ADHD-C). To aid decision making for DSM-5 and other future diagnostic systems, a comprehensive literature review and meta-analysis of 546 studies was completed to evaluate the validity of the DSM-IV model of ADHD. Results indicated that DSM-IV criteria identify individuals with significant and persistent impairment in social, academic, occupational, and adaptive functioning when intelligence, demographic factors, and concurrent psychopathology are controlled. Available data overwhelmingly support the concurrent, predictive, and discriminant validity of the distinction between inattention and hyperactivity-impulsivity symptoms, and indicate that nearly all differences among the nominal subtypes are consistent with the relative levels of inattention and hyperactivity-impulsivity symptoms that define the subtypes. In contrast, the DSM-IV subtype model is compromised by weak evidence for the validity of ADHD-H after first grade, minimal support for the distinction between ADHD-I and ADHD-C in studies of etiological influences, academic and cognitive functioning, and treatment response, and the marked longitudinal instability of all three subtypes. Overall, we conclude that the DSM-IV ADHD subtypes provide a convenient clinical shorthand to describe the functional and behavioral correlates of current levels of inattention and hyperactivity-impulsivity symptoms, but do not identify discrete subgroups with sufficient long-term stability to justify the classification of distinct forms of the disorder. Empirical support is stronger for an alternative model that would replace the subtypes with dimensional modifiers that reflect the number of inattention and hyperactivity-impulsivity symptoms at the time of assessment.

KW - Attention deficit/hyperactivity disorder

KW - Dsm-5

KW - Dsm-iv

KW - Subtypes

KW - Symptoms

KW - Validity

UR - http://www.scopus.com/inward/record.url?scp=84866457288&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866457288&partnerID=8YFLogxK

U2 - 10.1037/a0027347

DO - 10.1037/a0027347

M3 - Article

C2 - 22612200

AN - SCOPUS:84866457288

VL - 121

SP - 991

EP - 1010

JO - Journal of Abnormal Psychology

JF - Journal of Abnormal Psychology

SN - 0021-843X

IS - 4

ER -