Instability of the DSM-IV subtypes of ADHD from preschool through elementary school
Instability of the DSM-IV subtypes of ADHD from preschool through elementary school
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DOI：
10.1001/archpsyc.62.8.896
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发表时间：
2005-08-01
影响因子：
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通讯作者：
Willcutt, E
中科院分区：
文献类型：
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作者：
Lahey, BB;Pelham, WE;Willcutt, E
内容：注意力缺陷多动障碍（ADHD）的DSM-IV定义区分了3种尚未广泛研究的亚型。目的：确定ADHD亚型是否随时间的推移足够稳定以有效。设计：纵向研究，在8年的7次评估中保持率超过89%留存率。设置：门诊诊所参与者：志愿者样本118名4- 6岁儿童谁符合DSM-IV标准的ADHD，包括损害在2设置在至少I assessment.Main结果Measure：满足DSM-IV标准的亚型ADHD在第2年至第8年。符合ADHD标准的儿童数量随着时间的推移而下降，但大多数人都坚持了下来。符合联合亚型标准的儿童（CT，n=83）在随后的评估中符合ADHD标准的儿童多于主要为多动-冲动亚型的儿童（HT，n = 23）。在接下来的6次评估中，83名CT儿童中的31名（37%）和12名主要注意力不集中亚型（IT）儿童中的6名（50%）至少两次符合不同亚型的标准。随着时间的推移，HT亚型的儿童更有可能转变为不同的亚型，持续患有ADHD的HT儿童在后来的评估中大多转变为CT。亚型表现出一贯不同的平均水平的多动-冲动症状，在第2年至8年，对应于他们最初的亚型分类，但最初的亚型差异注意力不集中症状减少在以后years.Conclusions：在年幼的儿童，CT和IT可能是稳定的，足以隔离组的研究，但他们似乎太不稳定，用于个别儿童的临床评估。随着时间的推移，儿童很少保持在HT分类中;相反，他们有时会停止ADHD，但大多数在以后的几年中转移到CT。使用多动-冲动症状的连续评级作为诊断限定符应被视为DSM-V中ADHD名义亚型分类的替代方案。
Context: The DSM-IV definition of attention-deficit/hyperactivity disorder (ADHD) distinguished 3 subtypes that had not been extensively studied.Objective: To determine whether the ADHD subtypes are stable enough over time to be valid.Design: Longitudinal study with a greater-than 89% retention rate in 7 assessments over 8 years.Setting: Outpatient clinicsParticipants: Volunteer sample of 118 4- to 6-year-olds who met DSM-IV criteria for ADHD, including impairment in 2 settings in at least I assessment.Main Outcome Measure: Meeting DSM-IV criteria for the subtypes of ADHD during years 2 through 8.Results: The number of children who met criteria for ADHD declined over time, but most persisted. Children who met criteria for the combined subtype (CT, n=83) met criteria for ADHD in more subsequent assessments than children in the predominantly hyperactive-impulsive subtype (HT, n = 23). Thirty-one (37%) of 83 CT children and 6 (50%) of 12 children in the predominantly inattentive subtype (IT) met criteria for a different subtype at least twice in the next 6 assessments. Children of the HT subtype were even more likely to shift to a different subtype over time, with HT children who persisted in ADHD mostly shifting to CT in later assessments. The subtypes exhibited consistently different mean levels of hyperactive-impulsive symptoms during years 2 through 8 that corresponded with their initial subtype classifications, but initial subtype differences in inattention symptoms diminished in later years.Conclusions: In younger children, the CT and IT may be stable enough to segregate groups for research, but they seem too unstable for use in the clinical assessment of individual children. Children rarely remain in the HT classification over time; rather, they sometimes desist from ADHD but mostly shift to CT in later years. Using continuous ratings of hyperactivity-impulsivity symptoms as a diagnostic qualifier should be considered as an alternative to classifying nominal subtypes of ADHD in DSM-V.