August 1, 2005Archives of General Psychiatry
Instability of the DSM-IV Subtypes of ADHD From Preschool Through Elementary School
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Discussion
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Implication
Longitudinal cohort analysis reveals diagnostic instability of ADHD subtypes from preschool through elementary school, indicating continuous symptom ratings are superior to nominal categories.
Key Points
- To assess the diagnostic stability of DSM-IV ADHD subtypes across development from preschool into elementary school.
- Followed young children classified with DSM-IV ADHD subtypes—combined type (CT), predominantly inattentive type (IT), and hyperactive-impulsive type (HT)—from preschool through elementary school.
- Evaluated subtype persistence, diagnostic transitions, and symptom trajectory stability over time.
- Combined type and inattentive type demonstrated sufficient group-level stability for research stratification but proved too unstable for individual clinical decision-making.
- Children rarely maintained the hyperactive-impulsive subtype over time, predominantly transitioning into the combined type or desisting from ADHD altogether.
- Evidence favored replacing nominal categorical subtypes with continuous symptom ratings of hyperactivity-impulsivity as diagnostic qualifiers.
Cite This Study
Lahey et al. (2005) studied this question.