Ünsel Bolat Gül, Ercan Eyüp Sabri, Salum Giovanni Abrahão, Bilaç Öznur, Massuti Rafael, Uysal Özaslan Taciser, Bolat Hilmi, Rohde Luis Augusto
Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey.
ADHD Outpatient Program, Department of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
Eur Child Adolesc Psychiatry. 2016 Oct;25(10):1121-32. doi: 10.1007/s00787-016-0839-0. Epub 2016 Mar 15.
The American Psychiatric Association (APA) working group on Attention-Deficit/Hyperactivity Disorder (ADHD) proposed the inclusion of four new impulsivity symptoms. However, they were not included in DSM-5 due to the lack of sufficient evidence. The aim of this study is to investigate the performance of the proposed four ADHD impulsivity symptoms with respect to: (a) ADHD factor structure; (b) performance in predicting clinical impairment; (c) specificity for ADHD diagnosis and (d) best symptomatic threshold to predict clinical impairment. The sample comprised 416 children (31 ADHD subjects according to both DSM-IV and proposed DSM-5, 20 ADHD subjects according to just one diagnostic system and 365 controls) from 12 schools. Diagnoses were derived using semi-structured interviews and ADHD rating scales. Results from confirmatory factor analysis indicate that addition of the four new impulsivity items provided a slightly better factor structure if compared to models including only 18 items. Regression analyses showed that only one of the new impulsivity symptoms (impatient) was part of the list of best predictors of impairment. None of the four new impulsivity items was specifically associated with ADHD diagnosis. The best cutoff point in the hyperactivity/impulsivity dimension for predicting impairment did not change significantly. Overall, our findings suggest that the determination on how to best capture impulsivity dimension as part of the ADHD construct needs more investigation and that there is not enough evidence to include these four assessed impulsivity symptoms as part of the ADHD criteria.
美国精神病学协会（APA）注意力缺陷多动障碍（ADHD）工作组提议纳入四种新的冲动症状。然而，由于缺乏充分证据，它们未被纳入《精神疾病诊断与统计手册》第五版（DSM - 5）。本研究的目的是调查所提议的四种ADHD冲动症状在以下方面的表现：（a）ADHD的因素结构；（b）预测临床损害的表现；（c）ADHD诊断的特异性；以及（d）预测临床损害的最佳症状阈值。样本包括来自12所学校的416名儿童（根据DSM - IV和提议的DSM - 5均诊断为ADHD的有31名受试者，仅根据一种诊断系统诊断为ADHD的有20名受试者，以及365名对照）。诊断通过半结构化访谈和ADHD评定量表得出。验证性因素分析结果表明，与仅包含18个项目的模型相比，添加这四个新的冲动项目可提供稍好的因素结构。回归分析显示，只有一种新的冲动症状（不耐烦）是损害最佳预测指标列表的一部分。这四个新的冲动项目均未与ADHD诊断有特异性关联。预测损害的多动/冲动维度的最佳临界点没有显著变化。总体而言，我们的研究结果表明，关于如何最好地将冲动维度作为ADHD结构的一部分进行捕捉的判定需要更多研究，并且没有足够证据将这四个评估的冲动症状纳入ADHD标准。
