Introduction
This paper is aimed at discussing and drawing attention to the proposed diagnostic amendments made by the DSM-5 ADHD and Disruptive Behaviour Disorders Committee. The current Diagnostic and Statistical Manual (DSM-IV) published by the American Psychiatric Association provides a standard criteria for the classification of mental disorders (American Psychiatric Association, 2000; Rutter, 2004) and the diagnostic procedures that are used by clinicians and psychiatrics in addressing these abnormalities.
The Attention deficit Hyperactivity Disorder (ADHD) has for many decades been one of the most commonly medically diagnosed behavioural condition that occurs at some stage in a child’s development. ADHD according to Holowenko (1999) and the American Psychiatric Association (2010a) refers to a mixed group of disruptive behaviours that cause difficulties with the child’s development, behaviour and performance, family relationships and social interaction.
It is characterized by inattentiveness, an almost reckless impulsiveness and knee-jiggling, toe-tapping hyperactivity (Holowenko, 1999). The manifestation of the disorder and the difficulties that they cause, as posited by the American Psychiatric Association (2010a), are typically more pronounced when a person is involved in some piece of work such as studying or work and is less severe while the individual is resting.
We consider first the proposed changes to ADHD in the DSM-5 and latter provide a commentary on the advantages of adopting these changes.
Proposed Changes to ADHD
The DSM-5 ADHD and Disruptive Behaviour Disorders Committee have enlisted different variations in their interim recommendations. First, the committee propose to widen the age onset of the syndrome from the current before seven years to before twelve years of age. This is the age in which symptoms of the disorder are first present (Low, 2011).
The second modification pertains to the restructuring of ADHD subtypes. As noted by Low (2011), the current DSM edition includes three diverse subtypes that inform this disorder as earlier stated. Low (2011) notes that the continual reference to these subtypes is problematic in that the subtypes are progressively changing over time and may lead to double detection for subsequent tests.
A different type of change may be the one including at least four new impulsivity symptoms when the DSM-IV present at a given moment is not correctly captured. These four additions comprise symptoms whereby the incumbent tends to act without thinking, is often impatient, is uncomfortable doing things slowly and systematically and finds it difficult to resist temptations or opportunities (Low, 2011; Cowley, 2001).
Under the new strategy those individuals considered to do things without prior thinking comprise of those who start tasks without adequately preparing for them or speak without considering the outcome, whereas impatience will encompass the child feeling unusually restless in terms of wanting to move faster than others or even driving speedily (including cutting into traffic), as indicated by Sarkis (2011).
The draft also proposes to make modifications that will better represent the adult ADHD. This will be geared towards ensuring that there is a consideration of a proposal advocating for reduction of the observed symptoms in adults from the current six to four symptoms among the older patients who are aged seventeen and above.
The move is supported by the fact that the number of symptoms is inversely proportional to age with the severity of the disorder exacerbating and so the proposed changes will address this issue as well as make the criteria more developmentally appropriate for adults (Low, 2011; Sarkis, 2011).
It is also in the interests of the committee to make the draft elaborate the criteria description (American Psychiatric Association, 2010b) by providing a more detailed description of the symptoms with regard to the proposed diagnostic presentations (Low, 2011; American Psychiatric Association, 2010b).
Merits associated with these changes
The increment of age of onset of symptoms to be present on or before the age of seven to the age of twelve and the subsequent change from impairment to symptoms is expeditious since it is almost difficult to judge inattention before the age of five and it also enables the clinicians to shift focus from impairments to symptoms. The proposed change is geared also to increasing the number of patients who receive the clinical benefits.
Lowering the threshold for the minimum number of symptoms necessary for an adult 17 years and above is a favourable move since it takes into account research findings that impairment persists more profoundly after the age of 18 even though the symptoms for the disorder decline significantly as intimated by the American Psychiatric Association (2010b).
This therefore better represents an adult’s case and so appropriate diagnosis will consequently be administered. The inclusion of four additional impulsivity criteria will correct the current underrepresentation of impulsivity and the fact that the recommendation is drawn from interviews with adult ADHD patients will make it more valid and reliable (American Psychiatric Association, 2010b).
The clause proposed to deal with inattention cases that are not hyperactive not only assigns a ‘descriptive name for a syndrome without hyperactivity but also recognizes the absence of empirical support for an idiosyncratic disorder by not assigning a new diagnostic code whereas allowing a small number of HI criteria to give it an immediate status’ (American Psychiatric Association, 2010b) which originally was not provided for.
Attention Deficit Hyperactivity Disorder as a Cognitive Disorder
According to Seth and Coghill (2010), ADHD relates perfectly well to both the behavioural and cognitive functioning of a child in his or her development. The consideration of ADHD as a cognitive disorder in the updated DSM-5 edition will shed light on those clinicians and other practitioners who view ADHD as a behavioural difficulty and allow them to appreciate that it is associated by far and wide to substantial cognitive impairments (Steele, Elkin and Roberts, 2007; Seth and Coghill, 2010).
The cognitive behavioural approach used by therapists can be extremely helpful for the adults with ADHD and who easily lose track of long term goals as he or she focuses impatiently on whatever seems most pressing at the moment as White (n.d.) indicates. Though the chronic ADHD is treated with medications, most of these patients continue to evidence at least some residual symptoms and functional impairments that may be amenable to a cognitive behavioural approach (Safren, 2006; Matson J, Andrasik and Matson M, 2008).
As such, pharmacotherapy is not an end in itself and thus evidence based alternative interventions such as behavioural school interventions and parent training are needed to complement (Knight, Rooney and Chronis, 2008; Chronis, Jones and Raggi, 2006). Hinshaw (cited in Kendall 2011) states that common co-morbidities of ADHD such as aggressive spectrum disorder and anxiety show little evidence of benefit from medication strategies alone, necessitating the cognitive-behavioural intervention strategies.
Conclusion
The Attention deficit Hyperactivity Disorder (ADHD) syndrome is a common impairment that has been there for ages affecting children as they develop from one stage to another. The American Psychiatric Association publishes standard criteria namely Diagnostic and Statistical Manual that provides clinicians and psychotherapists with a standard and a consistent way of addressing the disorder.
Improvements made on the criteria over the decades provide that ADHD could be handled cognitively as earlier discussed. This marks a mileage in the quest to make life better for patients with this disorder and offers more practical ways of understanding the disorder and as such it should be adopted by clinicians and other practitioners.
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