Validity of change in DSM-5 attention-deficit/hyperactivity disorder (ADHD) age of onset criterion confirmed

In DSM-5, age of onset criterion for ADHD, previously set at 7 in DSM-IV, has been raised to 12. As explained in DSM-5, age of onset is now set at 12, rather than an earlier age, to reflect the importance of clinical presentation during childhood for accurate diagnosis, while also acknowledging the difficulties in establishing precise childhood onset retrospectively.

Using data from a nationally representative sample of youth who participated in the National Health and Nutrition Examination Survey (NHANES), a group of researchers led by Dr. Kathleen Merikangas of the National Institute of Health Intramural Research Program, evaluated symptoms of ADHD and its subtypes in 1,894 participants aged 12-15 years based on parent reports of symptomatology.

Researchers found that levels of severity, functional impairment, and patterns of comorbidity among the additional 3.46% of children who met all of the ADHD criteria except age of onset under 7 were comparable with those of other mental and behavioral disorders. Although raising the age of onset criterion in DSM-5 from 7 to 12 generated an increase in the prevalence of all subtypes of ADHD, the greatest increase was found for inattention, which tends to have a later onset than symptoms of hyperactivity that emerge earlier in development. Dr. Merikangas noted that youth with the inattention subtype of ADHD are less likely to be recognized and treated because their problems may be less apparent at school and at home. These findings highlight the importance of systematic study of diagnostic criteria in representative samples of the general population.

Funding for this study was supported by the Intramural Research Program of NIMH (Z01 MH002804). The views and opinions expressed in the article are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or U.S. government.