ADHD in DSM-5: a field trial in a large, representative sample of 18- to 19-year-old adults.
ADHD in DSM-5: a field trial in a large, representative sample of 18- to 19-year-old adults.
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DOI：
10.1017/s0033291714001470
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发表时间：
2015-01
影响因子：
6.9
通讯作者：
Rohde, L. A.
中科院分区：
文献类型：
--
作者：
Matte, B.;Anselmi, L.;Salum, G. A.;Kieling, C.;Goncalves, H.;Menezes, A.;Grevet, E. H.;Rohde, L. A.
成人注意力缺陷多动障碍（ADHD）的DSM标准尚未在美国精神病学协会（阿帕）的DSM-IV或DSM-5现场试验中进行测试。本研究旨在评估：（a）根据DSM-5标准的ADHD患病率;（B）为ADHD症状提供最佳拟合的因子解;（c）对临床损害具有最高预测值的症状;以及（d）每个ADHD维度（注意力不集中和多动/冲动）的最佳症状阈值。受过训练的心理学家评估了4000名来自1993年Pelanmar出生队列研究的年轻人，使用涵盖所有DSM-5 ADHD标准的工具。一系列的验证性因素分析（CFA）测试的最佳因素结构。复杂的逻辑回归评估每种症状对临床损害的不同贡献。受试者工作特征（ROC）分析测试，这将是最好的症状截止预测损害的症状数量。DSM-5 ADHD的患病率为3.55% [95%置信区间（CI）2.98-4.12]。DSM-IV ADHD的估计患病率为2.8%。CFA显示，一个单一的一般因素和两个具体因素的双因素模型提供了最适合的DSM-5症状。注意力不集中的症状仍然是成年人中最重要的障碍预测因素。最好的分界点是五个注意力不集中的症状和四个多动/冲动的症状。我们的研究结果，结合以前的研究结果，表明在年轻人中ADHD的预期患病率增加了27%，比较DSM-IV和DSM-5标准。DSM-5症状组织推导出了与DSM-IV症状相似的成人因子结构。使用DSM-5标准的数据支持降低诊断成人ADHD的症状阈值。
The DSM criteria for adult attention-deficit/hyperactivity disorder (ADHD) have not been tested in American Psychiatric Association (APA) field trials for either DSM-IV or DSM-5. This study aimed to assess: (a) the prevalence of ADHD according to DSM-5 criteria; (b) the factor solution that provides the best fit for ADHD symptoms; (c) the symptoms with the highest predictive value for clinical impairment; and (d) the best symptomatic threshold for each ADHD dimension (inattention and hyperactivity/impulsivity). Trained psychologists evaluated 4000 young adults from the 1993 Pelotas Birth Cohort Study with an instrument covering all DSM-5 ADHD criteria. A series of confirmatory factor analyses (CFAs) tested the best factor structure. Complex logistic regressions assessed differential contributions of each symptom to clinical impairment. Receiver-operating characteristic (ROC) analyses tested which would be the best symptomatic cut-off in the number of symptoms for predicting impairment. The prevalence of DSM-5 ADHD was 3.55% [95% confidence interval (CI) 2.98–4.12]. The estimated prevalence of DSM-IV ADHD was 2.8%. CFA revealed that a bifactor model with a single general factor and two specific factors provided the best fit for DSM-5 symptoms. Inattentive symptoms continued to be the most important predictors of impairment in adults. The best cut-offs were five symptoms of inattention and four symptoms of hyperactivity/impulsivity. Our results, combined with previous findings, suggest a 27% increase in the expected prevalence of ADHD among young adults, comparing DSM-IV to DSM-5 criteria. The DSM-5 symptomatic organization derived a similar factor structure for adults as DSM-IV symptoms. Data using DSM-5 criteria support lowering the symptomatic threshold for diagnosing ADHD in adults.