The DSM-V on Attention Deficit Hyperactivity Disorder

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The condition now called “Attention-Deficit/Hyperactivity Disorder” (ADHD) has been recognized for at least the last half-century. Although descriptions of ADHD-associated behaviors have been remarkably consistent over the years, the name of the syndrome has changed several times.

Early terminology was based on assumptions about the causes of the disorder. In the 1930s and l940s, children with the ADHD-like behaviors were called “brain damaged” or “brain injured” because it was known that brain damaged individuals showed similar behaviors. In the 1950s and 1960s, it became clear that, although many children exhibited the same set of behaviors as those called “brain damaged,” neither a definitive history of brain trauma, nor the presence of abnormal neurological signs could be documented. The assumption was made that neurological dysfunctions were causing these problems, but were too subtle to be detected with available medical procedures. Therefore, the term “Minimal Brain Dysfunction” came into common use.

“Hyperactive” or “Hyperkinetic” became the term of choice for characterizing these children by the 1960s. The argument was made, especially in education and psychology circles, that the diagnosis of the underlying disorder was based on behavioral criteria, not on any documented medical evidence. Thus, it made sense to use a term that was descriptive of observable behavior. At that time, excessive motor activity was considered the central problem evidenced by these children. Hence, the term “hyperactivity” became widely used.

By the 1970s, most professionals were in agreement that difficulties in attention and concentration were more critical symptoms of the disorder than hyperactivity, and were the primary reason that these children experienced so much social and academic difficulty. Therefore, during the 1980s and early 1990s, the emphasis changed again, favoring neither the attentional or hyperactivity/impulsivity features, but recognizing the unique contributions of each.

The second edition of the Diagnostic and Statistical Manual of Mental Disorders, (DSM-II), published in 1968 by the American Psychiatric Association (APA), was the first to name this syndrome. It was called “Hyperkinetic Reaction of Childhood” and described more as clinical impressions than multi-faceted, interactive behavioral symptoms.

The 1980, DSM-III changed the syndrome name to “Attention Deficit Disorder” (ADD). Two types were specified: with hyperactivity (ADD + H), and without hyperactivity (ADD-H). Diagnosis required the presence of a minimum set of behavioral criteria that were present prior to age seven, had lasted at least six months, and were evident in all three dimensions of the syndrome: attention, hyperactivity, and impulsivity.

The 1987, DSM-III-R (Revised) changed “Attention Deficit Disorder” to “Attention Deficit Hyperactivity Disorder” (ADHD). Rather than requiring symptoms from each of the three dimensions, it listed 14 symptoms, any eight of which were sufficient for diagnosis. ADD-H was not included, but changed to a vaguely defined category. Symptoms were now required to be clearly developmentally inappropriate and emphasis was placed on their co-existence with other 9 affective disorders.

The DSM-IV R, published in May of 1994, has named the syndrome “AttentionDeficit/Hyperactivity Disorder” (ADHD) in order to preserve continuity. ADHD is now divided into four major types, however, with a separation of attention problems from those of hyperactivity and impulsivity in the first three. (For a fuller description of the new criteria, see Section VI, “Current Definition”).

This latest version of ADHD diagnostic criteria offers significant improvement over earlier ones in that it is more descriptive of academic vulnerability, recognizes that diagnosis requires the input of many people who know the child well, and includes reporting about the child’s behavior across multiple settings.

Although most professionals now use the term ADHD to characterize these children, some of the older terms may continue to be used in the professional literature and in the popular press and media.

Estimates of incidence rates of ADHD vary widely, from less than 1% to more than 20% of the population. This variation occurs because of the imprecision of terms such as “hyperactivity” and “impulsivity.” The best current estimates are that between 3% and 5% of school children have this disorder.

If you have a child with a disability and have questions about special education law, please contact Joseph C. Maya, Esq., at 203-221-3100, or at JMaya@mayalaw.com, to schedule a free consultation.

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Source- Conn. ADHD Task Force, Report on Attention Deficit Hyperactivity Disorder (ADHD), Spring 2005, at http://www.ctserc.org/initiatives/teachandlearn/ADHD_report_5-2-05.pdf