Barkley R A
Department of Psychiatry, University of Massachusetts Medical Center, Worcester 01655.
J Dev Behav Pediatr. 1990 Dec;11(6):343-52.
The present paper critiques the current diagnostic criteria from the DSM-III-R and the draft criteria proposed for the ICD-10 for attention deficit hyperactivity disorder (ADHD). Improvements made in the criteria over earlier editions are discussed along with continuing limitations in these approaches to clinical diagnosis. The issue of whether ADHD constitutes an actual syndrome is also reviewed. It is concluded that despite contradictory evidence for covariation of the symptoms, the disorder meets other important conditions for syndrome definition and should continue to be viewed as such. The variability of symptoms across settings and parameters which may affect this variability are briefly noted as is the impact of this symptom instability on establishing diagnostic criteria. A number of suggestions for revision of these criteria are provided that can be incorporated into current clinical and research practices to improve the rigor and discriminative validity of the criteria for ADHD. The implications of these revisions for clinical diagnosis are also discussed.
本文对《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）中当前的注意力缺陷多动障碍（ADHD）诊断标准以及为《国际疾病分类》第十版（ICD-10）提议的草案标准进行了批判。文中讨论了这些标准相较于早期版本所做的改进，以及这些临床诊断方法仍然存在的局限性。还回顾了ADHD是否构成一种实际综合征的问题。结论是，尽管症状共变存在相互矛盾的证据，但该障碍符合综合征定义的其他重要条件，应继续如此看待。简要指出了症状在不同情境和参数下的变异性以及可能影响这种变异性的因素，还有这种症状不稳定性对确立诊断标准的影响。提供了一些修订这些标准的建议，可纳入当前临床和研究实践中，以提高ADHD标准的严谨性和区分效度。还讨论了这些修订对临床诊断的影响。
