Report of the DSM-V ADHD and Disruptive Behavior Disorders Work Group
November 2008
F. Xavier Castellanos, M.D.
With regard to Disruptive Behavior Disorders (DBD), the work group identified six main issues:
1. Child-onset versus adolescent-onset subtypes of Conduct Disorder (CD);
2. The life-course continuity from Oppositional Defiant Disorder (ODD) to CD to Antisocial Personality Disorder (ASPD);
3. The use of psychopathic or callous-unemotional traits to designate subtypes of antisocial disorders in adults and children;
4. Female-specific diagnostic protocols for CD;
5. Early substance use as part of the CD criteria; and
6. The co-occurrence of mood symptoms and DBD and how to incorporate irritability into the nosology.
The next major focus has been on ADHD. The work group identified research questions relating to three broad areas:
1. Coverage, exclusions, and age of onset;
2. Adjusting criteria for key patient characteristics, especially age; and
3. Accounting for severity, heterogeneity, and subtypes.
The work group condensed these two memos into single-page announcements that were submitted for publication in the Journal of the American Academy of Child and Adolescent Psychiatry, Journal of Child Psychology & Psychiatry, European Child & Adolescent Psychiatry, Journal of Abnormal Child Psychology, Journal of Clinical Child and Adolescent Psychology, and Child and Adolescent Mental Health Journal among others.
The work group is currently revising a letter to be sent to targeted colleagues inviting them to assist in secondary analyses that would target Inattentive type of ADHD.
Next, the group plans to address the issue of callous unemotional traits as a specifier for CD, ASPD, and possibly ODD. This will also be based on secondary data analyses that are being conducted and/or coordinated.
The Journal of Abnormal Psychology has commissioned a special issue containing 9 articles that will focus on ODD and CD. Leaders in the field have signed on to submit manuscripts by April 30, 2009; these will undergo peer review and editorial oversight. These papers will provide comprehensive reviews of the pertinent literatures and provide an important foundation for proposed revisions.
The work group has commissioned and received an article on adult ADHD. A review of the literature on ODD has also been commissioned. Other reviews of the literature on age of onset of ADHD and on the interface between ADHD and autism are currently being prepared.
Finally, the group has established a sub-work group focusing on the overlap between mood and disruptive behavior symptoms which includes members from the Childhood and Adolescent Disorders Work Group.