What are the DSM 5-TR changes for ADHD?

Let’s discuss changes in the dsm-5 TR from the dsm-5 specifically as it relates to attention-deficit hyperactivity disorder or ADHD. Diagnostically nothing’s changed, but there are some things that are in there that weren’t in there before.

There’s a couple things additional or associated features and prevalence risk as well as prognostic factors. These include sex and gender related diagnostic issues, and diagnostic markers associated with suicidal thoughts or behaviors. These sections in the DSM 5-TR have new content.

ADHD is a little bit more prevalent than it used to be, right now 7.2% of children worldwide have attention deficit hyperactivity disorder, and for adults it’s actually the same as it used to be, there’s no changes there it is still 2.5% of adults. Why is it that there are more kids with ADHD and less adults?

Well, it’s because the symptom severity can lessen with some people over time. The brain learns to communicate with itself in a different way that’s more akin to someone that doesn’t have ADHD, and it minimizes the symptoms so some of the symptoms people have as a kid don’t show as an adult. This is called partial remission, meaning they no longer meet criteria to be diagnosed with ADHD.

Another change that is new is the hereditability. In the DSM 5-TR they are now saying the hereditability of ADHD is approximately 74%. So, if you’re a parent with ADHD, there’s a good chance that your child will have ADHD.

Diagnostic markers, this part is exciting!

No biological marker is diagnostic for ADHD. Although ADHD has been associated with the elevated power of the slow waves (the four to seven hertz waves) as well as decreased power of fast waves (the beta waves) a later review found no differences in theta or beta power in either children or adults with ADHD.

This relates relatively to controlled subjects, although some neuroimaging studies have shown differences in children with ADHD compared to the control subjects. A meta-analysis of all neuroimaging studies do not show differences between individuals with ADHD and the controlled subjects. This is likely due to differences in diagnostic criteria, sample size, task used, and technical aspects of the neuroimaging technique.

Until these issues are resolved no form of neuroimaging can be used for the diagnosis of ADHD because it unreliable. By putting this information in here it’s like “hey we recognize that there’s some research out there, but there needs to be more before we actually use this to say someone has ADHD”.

In neurofeedback we can tell if someone is a good candidate for neurofeedback by looking to see if there is excessive theta waves in the frontal lobe, and not fast enough or not strong enough as it pertains to the beta waves. So, the theta to beta ratio is one of the ways that ADHD presents itself.

What the DSM 5-TR is saying is “we recognize that there’s some studies that do this and studies that show this but there’s other studies that show that there is no difference.” “Until we sort things out, until we get more research on specified types of ADHD or they’re presentation we can’t use this to diagnose someone”.

For example, someone may have excessive theta waves but may not actually meet criteria or they may meet criteria, it could go either way. They could meet the criteria, but they might not have excessive theta waves. There’s different ways ADHD can present itself when looking at the brain. So right now, we can’t say from your qEEG we know that you have ADHD, but that’s the direction some of the research is going.

How does ADHD have an association with suicidal thoughts or behaviors?

ADHD is a risk factor for suicidal ideation and behavior in children and is similar in adulthood. ADHD is associated with increased risk of suicide attempt when it is comorbid with mood conduct or substance use disorders. Even after controlling for comorbidity, suicidal thoughts are more common in ADHD populations than in non-ADHD control subjects.

ADHD predicted persistence of suicidal thoughts in U.S. army soldiers. It’s important for clinicians to know this.

Untreated ADHD in girls for example makes them five times more likely to die by suicide. Thus, it is really important that all the clinicians out there know that this is a risk factor; if someone has ADHD, they’re more likely to have suicidal thoughts.

To watch the video on this topic visit DSM 5 TR Changes for ADHD | ADHD Awareness | ADHS Symptoms | Mental Health Matters – YouTube