Proposed New Diagnostic Criteria for Adult ADHD

When adults are assessed for possible attention deficit disorders, most clinicians use the DSM-IV diagnostic criteria for ADHD. These 18 items were developed on the basis of research that included no adults, only children aged 4 to 17 years.

There are many problems with using these criteria to diagnose adults. They do not pick up many of the problems important for adults with ADD. And when used with the stipulated cutoff at 6 of 9 items from either inattention or hyperactivity/impulsivity symptoms, only the most impaired 1-2% of adults are recognized as having ADHD; when used with children, the most impaired 7% of children are identified using the 6 of 9 item cutoff. Most experts acknowledge that some flexibility and clinical judgment are needed to adapt DSM-IV criteria for diagnosis of ADHD in adults.

DSM-V is scheduled for publication in 2011. Many are hoping that it will include new diagnostic criteria for adults. Russell Barkley and Kevin Murphy recently published a list of 9 symptoms for diagnosing ADHD in adults; they selected these after testing 91 items in research with adults. They suggest that if an adult has significant impairment from 6 or more of these symptoms in 2 or more settings, they warrant diagnosis for ADHD.

Symptoms suggested by the Barkley-Murphy research are all related to executive functions and include:


Easily distracted by extraneous stimuli.
Often makes decisions impulsively.
Often has difficulty stopping activities or behavior when he/she should.
Often starts a project or task without reading or listening to instructions.
Often shows poor follow-through on promises or commitments to others.
Often has trouble doing things in proper order or sequence.
Often drives a motor vehicle faster than others (excessive speeding)
Often has difficulty sustaining attention to tasks or leisure activities.
Often has difficulty organizing tasks and activities.
It will take years before the DSM-V committee actually decides what changes should be made in diagnostic criteria for ADHD. Meanwhile, these items can be useful to clinicians assessing adults. (From ADHD Report, Guilford Press, 2006)

I pulled this of Dr. Thomas Brown's website.

Hmm.. while I'm sure that a lot of folks on here can identify with these symptoms, I don't see a lot of them applying to the inattentive folk like myself.

I don't have any issues with these symptoms being added onto the already existing list, but are the researchers suggesting they want to replace the DSM's list with theirs?

Interesting. If my memory is working, I believe I identify more with the symptoms on this new proposed list.

I have a "childhood" type of ADHD hyperactive type which makes it a lot worse.

Hmm.. while I'm sure that a lot of folks on here can identify with these symptoms, I don't see a lot of them applying to the inattentive folk like myself.

I don't have any issues with these symptoms being added onto the already existing list, but are the researchers suggesting they want to replace the DSM's list with theirs?You may well be right. Barkley who helped develop this believes that ADHD and ADD (or as he calls it "sluggish cognitive tempo") are different disorders. Others like Tom Brown don't agree that they're seperate because research has indicated that a parent with ADHD is just as likely to have an ADD kids as an ADHD kid. Brown also points out that many of us start out hyperactive and morph into primarily inattentive -- that would be me!

I'm not recommending this list -- just kind of wondered what you all thought about it. Is it an improvement? Does it stil need a little work?

Scattered

Yup. I think too many of these symptoms are for Hyperactive and Impulsives. (I am both and don't even fit all the Hyperactivity/Impulsivity mentioned, BTW)

I also have a BIG problem with how "male" they symptoms are.

e.g. females may not drive too fast, etc, but we may do impulsive shopping, impulsive overeating, or be impulsively/hyperactively over-talkative/say too much, etc.

Yup. I think too many of these symptoms are for Hyperactive and Impulsives. (I am both and don't even fit all the Hyperactivity/Impulsivity mentioned, BTW)

I also have a BIG problem with how "male" they symptoms are.

e.g. females may not drive too fast, etc, but we may do impulsive shopping, impulsive overeating, or be impulsively/hyperactively over-talkative/say too much, etc.Iagree with you -- I fit, but just barely -- and I'm not a just barely type of ADD. Talking especially should be included for girls -- they need to get Sari Solden's input!;) Also something related to mommy and housekeeping types of problems would be nice.

Scattered

Proposed New Diagnostic Criteria for Adult ADHD

My answers to these questions:

Easily distracted by extraneous stimuli. YES
Often makes decisions impulsively. YES Sometimes
Often has difficulty stopping activities or behavior when he/she should. YES
Often starts a project or task without reading or listening to instructions. YES
Often shows poor follow-through on promises or commitments to others. YES
Often has trouble doing things in proper order or sequence. YES
Often drives a motor vehicle faster than others (excessive speeding) NO
Often has difficulty sustaining attention to tasks or leisure activities. YES Sometimes
Often has difficulty organizing tasks and activities. YES
I pulled this of Dr. Thomas Brown's website.It would be interesting to see others from the forum answer these.
I have been diagnosed as combined type.

I would also add: SEEKS OUT STIMULATING ACTIVITIES AND OFTEN PUSHES THEM TO AN UNSAFE LEVEL IN ORDER TO OBTAIN AN ADRENALINE RUSH! :D

I can see all of these applying to me.. I'm a female and definitely not hyperactive, but since getting on medication I've really become aware that I have a lot of impulsive tendencies, so maybe I'm actually a combined type as opposed to just inattentive.

I don't necessarily think the symptoms listed are "male".. the only reason I don't speed like I used to is because my car's getting old and I can't afford to pay a speeding ticket at the moment (thank you, impulsive spending). I rarely follow directions and never do anything in the order I should when working on projects, either for school, work, or around the house.

I do agree that there's still room for improvement, but this is at least a start. It would be nice to include symptoms pertaining to housekeeping/chores (and parenting I'm sure, although I'm still a long way off from that). Definitely talking too!

Easily distracted by extraneous stimuli.

I wonder if they mean extraneous as in external or as in irrelevant.

If it's external I miss that being easily distracted by internal stimuli isn't mentioned.

If it's irrelevant I can have views on that as well...:)

Easily distracted by extraneous stimuli. Yes
Often makes decisions impulsively. For the most part, no. I tend to be the opposite. Indecisive... That's not to say I don't ever do it, probably more than most neurologically typical..
Often has difficulty stopping activities or behavior when he/she should. Stopping activities, as in hyperfocus related, yes.
Often starts a project or task without reading or listening to instructions.This is not necessarily an indicator of ADHD in my opinion, but yes
Often shows poor follow-through on promises or commitments to others. I rarely come in contact with others outside of going to work... in which at work, it is difficult to finish projects, especially when working with others (which decreases any possible interest, killing all intrinsic drive)...
Often has trouble doing things in proper order or sequence.I guess this would depend on the meaning of "proper sequence". Most of the time, I can make it work I suppose...
Often drives a motor vehicle faster than others (excessive speeding). Yes
Often has difficulty sustaining attention to tasks or leisure activities. Yes
Often has difficulty organizing tasks and activities. Yes


Interesting list... Only Barkley would call "doing things without reading directions" ADHD. That is very much related to learning style/personality as well (choosing to do it that way, as opposed to impulsively doing it, or having difficulty reading the directions) {{ I know it's only one symptom, but even so, it doesn't have the same intrinsic cause in that case... }}

I think it needs work. The driving one is too specific to a particular activity IMO. Also it mentions trouble stopping activities, but what about starting them? Chronic procrastination seems to be a common trait among us.

Often starts a project or task without reading or listening to instructions
Maybe this should be extended to include: doesn't always comprehend instructions. It's not that I don't read the instructions, it's that I either "read between lines" that aren't there, or just plain can't make all the pieces of the puzzle fit together in a way that makes sense.. therefore, I wind up coming up with my own way of doing things. I didn't "skip" the instructions, I just wound up working without them.. if that makes any sense??

Easily distracted by extraneous stimuli. YES
Often makes decisions impulsively. YES 50/50
Often has difficulty stopping activities or behavior when he/she should. YES
Often starts a project or task without reading or listening to instructions. YES
Often shows poor follow-through on promises or commitments to others. YES especially promises
Often has trouble doing things in proper order or sequence. YES
Often drives a motor vehicle faster than others (excessive speeding) YES
Often has difficulty sustaining attention to tasks or leisure activities. Hyperfocus
Often has difficulty organizing tasks and activities. YES

I think that this covers a lot of my symptoms, but misses alot too.

Being mostly inattentive I easily identify strongly with 5 of those and show plenty of another 2. Funnily enough I never speed in my car, never have. But maybe I should. It might solve my problem of falling asleep at the wheel!!!!

I'm guilty of most of those.
Of course I've had ADD (or ADHD) since I was a kid.
I was on all the meds, all the diets (remember the fiengold diet?), etc.
Speeding is a sign of ADD?
Good Heavens, Memphis is a large ADD town then!
I do have trouble spending time with leisure activities, but I think that has something to do with my past life.
I spent so long in College (swapping majors), until I found a program that fit my needs, that I was on the go from 1988-2000. So when that stopped, I had a hard time stopping. Even 7 years later, I feel like I have to go somewhere.
I can play games on the PS2, but only for an hour or so.
Then I get bored with it, and think of things I need to do.
For the most part though, I'm high speed all the time, until I just crash at night.
Speeding....LOL
So my inability to stop myself from screaming at people that are doing the speed limit, is ADD?
I thought I was just a type A personality.
As for pushing things to the limit, I did that for years with alcohol, tobacco, and cars.

[QUOTE=Scattered]Proposed New Diagnostic Criteria for Adult ADHD

My turn



Easily distracted by extraneous stimuli. YES, I even distract myself
Often makes decisions impulsively. YES
Often has difficulty stopping activities or behavior when he/she should. Don't really understand this one, but I'm opposite I have trouble starting - oh, I thought of one - drinking:faint:
Often starts a project or task without reading or listening to instructions.YES
Often shows poor follow-through on promises or commitments to others. YES, felt really bad about this pre-Dx
Often has trouble doing things in proper order or sequence.YES
Often drives a motor vehicle faster than others (excessive speeding)YES, normal speed seems slow:rolleyes:

Often has difficulty sustaining attention to tasks or leisure activities.YES
Often has difficulty organizing tasks and activities.BIG YES

Easily distracted by extraneous stimuli. (not really I think, I'm usually distracted by internal stimuli. )
Often makes decisions impulsively. Not sure... I'm probably more indecisive if anything.
Often has difficulty stopping activities or behavior when he/she should. Somewhat, depending, but my major problem is starting things.
Often starts a project or task without reading or listening to instructions. Yep..
Often shows poor follow-through on promises or commitments to others. Yep :(
Often has trouble doing things in proper order or sequence. It really depends on what. Yeah probably.
Often drives a motor vehicle faster than others (excessive speeding) I don't drive. I don't trust my reaction time. Anyway folks, global warming has arrived in full force. Go green and use public transport!
Often has difficulty sustaining attention to tasks or leisure activities. It depends. As far as leisure activities go I have problems learning new games like card games etc, I often still don't get the rules even asking repeatedly.
Often has difficulty organizing tasks and activities. Hell yeah

Easily distracted by extraneous stimuli. (I think so, I mean I do tend to.... oh look at the kitty. )
Often makes decisions impulsively. Definitely. I'm getting much better at controlling my impulses, but it still drives my wife nuts sometimes; I'm especially bad at impulse buys, although not (usually) on very expensive items - I don't want to get in a fight
Often has difficulty stopping activities or behavior when he/she should. BIG YES. This is one of my biggest problems - for example, I should be getting a shower and getting lunch right now, instead I'm answering on a forum that I couldn't stop reading :D - it's also really bad at work, if I go out to a site to check an article "real quick", I end up spending the next 30 minutes clicking links to other articles! A big time killer and a major reason I haven't been promoted yet...
Often starts a project or task without reading or listening to instructions. Yes, although I read/listen to instructions, just not usually completely, and that's what hurts me
Often shows poor follow-through on promises or commitments to others. Yes, and it's very hard for me to own up when I let someone down, which tends to kill great relationships
Often has trouble doing things in proper order or sequence. Proper order/sequence == BORING - I need to switch it up; much more interesting that way.
Often drives a motor vehicle faster than others (excessive speeding) Yes, but not all the time, and not much more than norma (50 in a 35 is about average for me)
Often has difficulty sustaining attention to tasks or leisure activities.Generally yes; I have a lot of trouble with games, sometimes I need to play one or two practice rounds before really learning the rules, and even then I'm still figuring them out. I think it really annoys my family sometimes :p
Often has difficulty organizing tasks and activities. Another one of the main reasons I haven't been promoted yet:mad:
Who else wants to contribute?

[QUOTE=Scattered]Proposed New Diagnostic Criteria for Adult ADHD


Easily distracted by extraneous stimuli.----Yes

Often makes decisions impulsively.------Sometimes but not a lot.

Often has difficulty stopping activities or behavior when he/she should.--No. Starting things I should is more my problem.

Often starts a project or task without reading or listening to instructions.--Never

Often shows poor follow-through on promises or commitments to others.---Rarely

Often has trouble doing things in proper order or sequence.---Nope, I am methodical and pre plan everything.

Often drives a motor vehicle faster than others (excessive speeding)----No, I use cruise control a lot. I watch my speedometer. To afraid of being pulled over by cop.

Often has difficulty sustaining attention to tasks or leisure activities.---Some tasks that I hate like cleaning, yes. /Leisure, No.

Often has difficulty organizing tasks and activities.----No, Again I plan everything even my driving route to run arrands. I don't like to back track.


I really wonder sometimes if I have A.D.D. I have taken some tests that say no. The one I took from my therapist I couldn't understand some of the questions and my husband answered some of them for me. Of course he didn't understand some of the questions either. I think he saw me through his own Anxiety Disorder.

Easily distracted by extraneous stimuli.
Often makes decisions impulsively.
Often has difficulty stopping activities or behavior when he/she should.
Often starts a project or task without reading or listening to instructions.
Often shows poor follow-through on promises or commitments to others.
Often has trouble doing things in proper order or sequence.
Often drives a motor vehicle faster than others (excessive speeding)
Often has difficulty sustaining attention to tasks or leisure activities.
Often has difficulty organizing tasks and activities.
All of these are sometimes for me...

I couldn't figure out how to copy (that probably requires reading instructions :p), so I copied them down on paper.
Distracted by extraneous stimuli. Yes, as I stated above, I can get distracted about discussing cars, gossip at work, or just about anything that anyone coming into my office wants to discuss...except work!
Makes decisions impulsively. Sometimes I have to at work, but at home, I usually catch myself. My wife (who I suspect has some form of ADD) will do that quite often, but hey that's most women! "Oh I'm craving this or that"
(while at the store), yet after a few days, she hasn't touched it, so it goes in the trash. She impulsively bought a car 7 years ago (before we married) and got stuck with 10% financing!!!!! She's still paying on it, and it's a Neon!
(see, got distracted) :D
Difficulty stopping activities when he/she should. I've really worked on this for years and I'm better. It's just something you have to do, as nothing you get in a pill form can do it for you. At work it's cruising a few sites on the net, while waiting for a response to a voicemail or e-mail.
Sometimes it's a discussion I get into (see distraction). If I'm having a good time, and my cell phone isn't ringing, then why stop?
Often starts a project or task without reading or listening to instructions. What are instructions? :rolleyes: Hey, if it has a picture on the box, then I know what it's supposed to look like! But yes, I do this a lot, and have to write things down quite a bit both at home and work, so I don't forget.
Often shows poor follow-through on promises or commitments to others. I do this sometimes, but at work I really try not to.
If you haven't read my posts, then I will tell you that I'm a Fleet Manager and Purchaser for the gov't. If I promise to do something in regards to a vehicle, or a purchase, then it has to be done. If I forget, that puts everyone behind, including myself. You know, I'm seeing a lot of these fit my wife...who swears she doesn't have ADD, but loses things constantly.
Hmmm
Often has trouble doing things in proper order or sequence.
If I don't make a list, yes, this happens freqently, but not all the time.
I've learned from growing up with ADD, to set out things properly, and make sure I do them in order. If I hadn't learned that early in life, I wouldn't have made it through High School (told I'd never graduate from HS), or gotten
my Bachelors (told I'd never go to college either).
I've done things all my life that require things in order, such as cooking, cleaning, etc. But I can miss a step on occasion, and it really screws things up.
Often drives a motor vehicle faster than others. Yes, for several reasons. First, I spent 13 years in Law Enforcement, where I was with coworkers that did 80-90 on the interstate every day. So I started doing it.
Then I got a few sports cars, and took them to their limits (speed limits as governed by the manufacturer).
And, I've always been into speed/fast cars. I have a 1929 Essex Streetrod that I made fast on purpose, because I like to go fast!
Often has difficulty sustaining attention to tasks or leisure activities.
Depends on what it is.
If I'm working on my street rod, or detailing my car (or pigpens car if she's at home with it), then I pay close attention to what I'm doing, and can do it all day. If I'm at work, as I have stated above, I do get distracted.
If I'm crusing the net, I can sustain attention for some time, unless I have that "Wikipedia" thing going. BTW, that happens on Internet Movie Data Base as well as Internet Movie Car Database all the time.
Often has difficulty organizing tasks and activities.
Again, I've had to deal with ADD since I was a kid.
Back in the 70's, there wasn't a lot of progress made in this field, so I had to fend for myself.
I learned from my grandmother, and my father (who both had it), to make a list, and then prioritize it. It may take a few sheets of paper, but when you are done, you have the list, and it's in order from most important, to least important. I do this at work daily, because as I've mentioned above, I'm
bombarded by any number of over 200 people all wanting something, and their request is always a priority...according to them, not me. :D
Unless the boss requests it, and sometimes even if he does, I do things in the order they are received, otherwise you spend time hopping around, and you never get anything done.