DSM-IV FIELD TRIALS FOR ATTENTION-DEFICIT HYPERACTIVITY DISORDER IN CHILDREN AND ADOLESCENTS

Objective: Optimal diagnostic thresholds were determined for DsM-IV at tention deficit hyperactivity disorder, and the psychometric propertie s were compared to alternative definitions. Method: Structured diagnos tic interviews of multiple informants for 380 clinic-referred youths a ged 4-17 years were conducted. In addition, standardized clinicians' v alidation diagnoses of attention deficit disorder were obtained to ass ess agreement with clinical judgment. Measures of impairment were obta ined to assess the accuracy of identifying youth with an impairing con dition. Results: Three subtypes of attention deficit hyperactivity dis order (predominantly inattentive, predominantly hyperactive-impulsive, and combined types) were distinguished on the basis of the degree of deviance on separate dimensions of inattention and hyperactivity-impul sivity. These three subtypes were found to differ in terms of types of impairment, age, and sex ratio, but not ethnicity. In terms of case i dentification of attention deficit hyperactivity disorder, DSM-IV was found to be very similar to DSM-III-R, except that DSM-IV identified m ore impaired girls and preschool children. Conclusions: These results support the decision to subdivide the heterogeneous category of DSM-II I-R attention deficit hyperactivity disorder into three subtypes. The resulting DSM-IV definition appears to be somewhat less biased toward the symptom pattern typical of elementary school boys.