Trend toward ADHD Subtyping Is Premature. (Use 'Nos' Diagnostic Category More Often)

By Jancin, Bruce | Clinical Psychiatry News, December 2001 | Go to article overview

Trend toward ADHD Subtyping Is Premature. (Use 'Nos' Diagnostic Category More Often)


Jancin, Bruce, Clinical Psychiatry News


ASPEN, COLO. -- The time has come for psychiatrists to make much greater use of the "not otherwise specified" diagnostic designation in cases of attention-deficit hyperactivity disorder, thereby reversing a major and regrettable decade-long trend toward subtyping attention-deficit hyperactivity disorder, Dr. Randal Ross asserted at a psychiatry conference sponsored by the University of Colorado.

Attend a child and adolescent psychiatry conference these days and you're likely to hear presentations on attention-deficit hyperactivity disorder (ADHD) plus bipolar disorder, ADHD plus thought disorder, ADHD plus obsessive-compulsive disorder, and a host of other ADHD add-on subtypes. The problem with all this subtyping is that there are no persuasive data that it can be done with acceptable reliability. And diagnostic subtyping is not benign; indeed, it carries profound consequences for treatment, said Dr. Ross.

"Subtyping ADHD based on etiology is a nice goal, but we're not there yet," he argued. "Lithium, [divaiproex sodium], and antipsychotic agents all have significant side effects associated with their chronic usage-and we're exposing a lot of kids to these drugs when we re not 100% positive what the outcome is going to be."

Dr. Ross, a child and adolescent psychiatrist at the university, stressed that he's not denying that bipolar disorder occurs in children. Like schizophrenia, bipolar disorder is a neurodevelopmental disorder that probably involves brain changes and symptoms that emerge in early childhood. But there's no evidence that these symptoms are distinguishable from other forms of pediatric behavioral disinhibition that can occur.

The strongest suggestion that it is not possible to separate out a bipolar disorder phenotypic subtype of ADHD comes from negative family comorbidity studies. In families with children said to have ADHD with bipolar disorder, the prevalence of bipolar disorder among adult relatives has turned out to be no different from that in adult relatives of children with straightforward ADHD. …

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