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Am J Psychiatry 1994; 151:1673-1685
Copyright © 1994 by American Psychiatric Association
DSM-IV field trials for attention deficit hyperactivity disorder in children and adolescents
BB Lahey, B Applegate, K McBurnett, J Biederman, L Greenhill, GW Hynd, RA Barkley, J Newcorn, P Jensen and J Richters
University of Miami.
OBJECTIVE: Optimal diagnostic thresholds were determined for DSM-IV
attention deficit hyperactivity disorder, and the psychometric properties
were compared to alternative definitions. METHOD: Structured diagnostic
interviews of multiple informants for 380 clinic-referred youths aged 4-17
years were conducted. In addition, standardized clinicians' validation
diagnoses of attention deficit disorder were obtained to assess agreement
with clinical judgment. Measures of impairment were obtained to assess the
accuracy of identifying youth with an impairing condition. RESULTS: Three
subtypes of attention deficit hyperactivity disorder (predominantly
inattentive, predominantly hyperactive-impulsive, and combined types) were
distinguished on the basis of the degree of deviance on separate dimensions
of inattention and hyperactivity-impulsivity. These three subtypes were
found to differ in terms of types of impairment, age, and sex ratio, but
not ethnicity. In terms of case identification of attention deficit
hyperactivity disorder, DSM-IV was found to be very similar to DSM-III-R,
except that DSM-IV identified more impaired girls and preschool children.
CONCLUSIONS: These results support the decision to subdivide the
heterogeneous category of DSM-III-R attention deficit hyperactivity
disorder into three subtypes. The resulting DSM-IV definition appears to be
somewhat less biased toward the symptom pattern typical of elementary
school boys.
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