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American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, 2013
Criteria for Adult ADHD Diagnosis: DSM-5
Hyperactivity
Inattention Fidgetiness b(hands or feet) or squirming in
seat
Lack of attention to details, makes careless
Leaves seat when not supposed to
mistakes
Restless or overactive
Difficulty sustaining attention
Difficulty engaging in leisure activities
Does not listen when spoken to directly quietly
Trouble completing or finishing job tasks Always ‘on the go’
Problems organizing tasks and activities Talks excessively
Avoids or dislikes sustained mental effort
Impulsivity
Loses and misplaces things
Blurts out answers before questions have
Easily distracted been completed
Forgetful in daily activities Difficulty waiting in line or taking turns
Interrupts or intrudes on others when they
are working or busy
American Psychiatric Association. Diagnostic and Statistical Manual (DSM) of Mental Disorders. 5th Edition
2013
DSM-5: Age-appropriate descriptions of ADHD
Inattention
• Mind elsewhere in the absence of obvious distractions
• Starts tasks, quickly loses focus, easily side-tracked
• Fails to finish tasks in the workplace
• Reporting task unrelated thoughts (mind wandering)
• Problems returning calls, paying bills
• Poor time management, not meeting deadlines
Hyperactivity
• Feeling restless
• Feeling uncomfortable being sat in restaurants or meetings
Impulsivity
• Butting into conversations or activities
• Intrude into and take over what other people are doing
American Psychiatric Association. Diagnostic and Statistical Manual (DSM) of Mental Disorders. 5th Edition 2013
Defining Adult ADHD (DSM-5)
● Criteria A: 5 or more symptoms of inattention or
hyperactivity-impulsivity
American Psychiatric Association. Diagnostic and Statistical Manual (DSM) of Mental Disorders. 5th Edition 2013
Domains of ‘IMPAIRMENT’
1. *Work Functions Psychosocial
2. *Social relationships
Psychiatric
3. *Coping with daily activities
4. Driving accidents (increased mortality) Neurodevelopmental
5. *Behavioural problems
6. *Distress from the symptoms
7. *Low self-esteem
(* NICE definition of impairment 2008)
8. Emotional instability
9. Sleep problems
10.*Risk for comorbid disorders (substance abuse, anxiety, depression,
personality disorder)
11. Cognitive impairments, including general and specific learning
difficulties (dyslexia, dyspraxia, autism spectrum disorder)
5.29%
Polanczyk et al 2007
Prevalence of ADHD in children
14 13.3 12.9
p 12
e 10 8.8
r 8 7.1
c 6.1 5.7 5.9
6
e
4
n
t 2
ADHD symptoms
ADHD
NORMAL
5 10 15
AGE
Developmental deficit
ADHD symptoms
ADHD
NORMAL
5 10 15
AGE
ADHD symptom scores at 7 and 17 years
ADHD
Age 17 years
Age 7 years
Control
INATTENTION
Child ADHD
group
Adult ADHD
group
INATTENTION HYPER-IMPULSIVITY
Child ADHD
group
Adult ADHD
group
0.8
Hyperactivity-
impulsivity
0.6
0.4
Both p<.001
0.2
-0.2
Controls Child ADHD Adult ADHD
14.7
15
12.7
10
4.7
5
2.8
1.4
Boomsma 2003
Martin 2002
Kuntsi 2001
Coolidge 2000
Thapar 2000
Willcutt 2000
Hudziak 2000
Nadder 1998
Levy 1997
Sherman 1997
Silberg 1996
Gjone 1996
Thapar 1995
Schmitz 1995
Stevenson 1992
Edelbrock 1992
Gillis 1992
Goodman 1989
Matheny 1980
Willerman 1973
0.9 DZtwins
MZ twins MZtwins
DZ twins
0.8
0.7
Correlations (r)
0.6
0.5
0.4
0.3
0.2
0.1
0
10 loci
8 look robust
On the path!
Adult twin studies
Phenotype Self-ratings Age Heritability
0.9
0.88
0.8
Heritability 0.72
0.7
0.6
0.5
0.4
0.3
0.2
0.1
ASSESSMENTS
POSSIBLY but…..
- Rater effects: self-versus informant
- False positive paradox
- Neurodevelopmental origins - 1/3 had
oppositional defiant, conduct disorder or school
failure
- Subthreshold cases in childhood, with ADHD
emerging later in life
70%
60%
50%
40%
30%
20%
10%
0%
7-9 years 7-12 years > 12 years
My mind is:
Constantly daydreaming
In a fog
A whirlwind of thoughts
Hamster on a wheel
Jack in the box
Waves in a storm
Flitting and jumping
Asherson, Expert Review, 2005
Mind Wandering in ADHD
“People with
Traffic noise Conversations Laughter
ADHD often
struggle with
filtering out”
Is it my fault Can I do my job Do you still
love me
Inattentive
behaviour
Performing
tasks
Inattentive Sleep
behaviour problems
Self-
Performing awareness
tasks and control
of behaviour
Inattentive Sleep
behaviour problems
Complete our online survey to help us
understand the relationship between
Creativity, Occupation, Mind wandering,
and Education (COME-on!!)
tinyurl.com/mindwander
@FloMowlem
Contact: Florence Mowlem for more information
E-mail: florence.d.mowlem@kcl.ac.uk