The media is constantly reporting ever-increasing rates of diagnosis of ADHD, but new guidelines could mean that these rates are set to soar even more. The American Psychiatric Association recently published DSM-V, the first major revision to the diagnostic manual for psychiatric disorders since 1994. This is the 'bible' used by mental health clinicians in this country and beyond to make their diagnoses. In DSM-V, there are several important revisions to the diagnostic criteria for Attention Deficit Hyperactivity Disorder that now make it easier to classify a child (or adult) as having the condition.
The most worrying new leniency in ADHD diagnosis is the fact that to be diagnosed, symptoms no longer need cause significant impairment; they just have to be present. For example, in DSM-IV, symptoms were required to cause some impairment (i.e. undermine the child's functioning) in at least two settings.
DSM-V has changed this to "several inattentive or hyperactive-impulsive symptoms are present in two or more settings." Thus, symptoms must only be evident in more than one context but don't have to impair an individual's functioning in these settings. DSM-IV required "clear evidence of clinically significant impairment in social, academic, or occupational functioning."
Now, the new criteria only require "...clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning." The reduction from 'clinical impairment' to 'interfere with or reduce the quality of' is important and allows the net of diagnosis to be cast far wider; children will still need to display six out of nine inattentive or hyperactive symptoms, but they will no longer have to prove that they cause 'clinical impairment.'
This leniency might allow far more children to meet the diagnostic threshold for ADHD than before, and potentially lead to greater numbers being treated with medication or other interventions. Children who did not meet the threshold for DSM-IV may now be diagnosed as having mild or even moderate ADHD under the new criteria. The new guidelines also make it easier for an older adolescent or adult to get an ADHD diagnosis by raising the required age of onset and by requiring slightly fewer symptoms for those over 17.
This increased leniency has implications for parents, schools, clinicians and for welfare, since children and adolescents with ADHD diagnosis tend to be allocated extra resources. There is the danger that children might be medicated when they don't really need it, or that more money has to be found to support increasing numbers of children who might now meet the lower threshold of diagnosis. All this is great for the pharmaceutical industry and for health care professionals such as psychiatrists (who have set the new criteria, of course), but is it really in the best interests of children?
Of course, it is good that that children who need interventions but who just missed out on diagnosis before, might now access the input, resources and help that they need. As a University lecturer, I am also positive about the fact that students who might have missed out until now, might find it easier to now to get the support they need for their studies. But might there be a danger that in spreading the net too wide, we end up medicalising too many children whose difficulties might be helped with other, non-medical interventions? Could we also end up trivialising what is currently a very debilitating condition, by including, within its net, those who are less debilitated by it?