The Diagnostic Criteria of ADHD needs to be updated in the DSM. We need more Doctors, Psychiatrists & Mental Health Professionals to advocate for this.
I am currently reading Dr. Barkley's Taking Charge of Adult ADHD and at the very end of the book, he has a section that discusses the Official Diagnostic Criteria for ADHD according to the DSM-5.
I cannot begin to explain how angry and frustrated I feel reading the diagnostic criteria. It comes as no surprise to me whatsoever as to why ADHD is treated like a joke, especially in mainstream media, because none of symptoms listed in the DSM, actually conveys the severity of this disease or how debilitating it is.
First, according to the DSM-5, the symptoms for ADHD are are divided into two sections:
- Inattention
- Hyperactivity/Impulsivity
Nine (9) symptoms are listed for inattention and nine (9) for hyperactivity/impulsivity.
Those 9 symptoms included nuggets like being "talkative", being "forgetful", being "fidgety".
Some of my favorites are:
- Often unable to play or engage in leisure activities quietly;
- Often does not seem to listen when spoken to directly;
- Often runs about or climbs in situations where it is inappropriate.
If you're thinking that this criteria is something you'd use to diagnose a child, you'd be right. Because the criteria was developed to diagnose children, not adults.
I don't understand this. From Dr. Barkley's work, we understand that ADHD is actually a disorder of self-regulation. He outlined the 7 executive functions in aid of describing the particular deficits that people with ADHD do have:
- Self-Awareness & Metacognition
- Emotional Regulation
- Time Management (due to Time Blindness)
- Inhibition/Self-Restraint (due to Impulsivity and Poor Impulse Control)
- Working Memory
- Self-Motivation
- Organization, Planning & Problem Solving
In fact, in 12 Principles for Raising a Child with ADHD, he reminds parents of children with ADHD to remember that their child has an invisible disability and that they should keep the perspective that ADHD is a disability. He's a strong advocate for people with ADHD getting the accommodations they need.
But instead, as an example, in the DSM-5, instead of describing a symptom of ADHD as not being able to motivate oneself, it says:
- "Often has difficulty sustaining attention in tasks or play activities (e.g ., has difficulty remaining focused during lectures, conversations, or lengthy reading)"; OR
- "Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing records, completing forms, reviewing lengthy papers)."
IT IS NOT THE SAME THING.
The DSM certainly doesn't convey how difficult the grit of everyday life is for people with this disease. Is it any wonder then why so many of us aren't diagnosed until adulthood?
My question is Why? Why is the Diagnostic Criteria so lacking? If they need to keep the criteria to diagnose children, why isn't there a separate diagnostic criteria for adults?
It doesn't end there however, because of course not.
After I read the excerpt from Dr. Barkley's book, I consulted the DSM myself, I wanted additional information to see if the disparity was as I bad as I felt it was and it turns out it's worse.
There is a section in the DSM-5 that says: "ADHD is more frequent in males than in females in the general population, with a ratio of approximately 2:1 in children and 1.6:1 in adults. Females are more likely than males to present primarily with inattentive features."
According to DSM, ADHD is 2x more frequent in boys than in girls. Do I believe this? Fuck no. Do you I think that girls and woman are likely to be dismissed or misdiagnosed due to medical misogyny? ABSOLUTELY!!!
Which takes to me the problem of working with psychiatrists. The DSM-5 is the the text that psychiatrists are expected to consult during their differential diagnosis. I have often found that unless you're working with a psychiatrist that has specialized in ADHD and/or other neurodevelopmental disorders, they don't actually have a good understanding of what the disease actually is or how it affects people.
I mean, how many of us was actually diagnosed with a depression or anxiety disorder when it's actually ADHD? I practically consider it a right of passage. How many of us have had to actually relate a very real aspect of ADHD to our doctors because they seemed totally unaware of it?
The problem is that the Diagnostic Criteria of ADHD in the DSM-5 is inadequate and since this provides the general foundation for understanding what ADHD is to most doctors and also the general public, it's an explanation for why the general knowledge for this disease is largely misinformed.
It is why we need more doctors, psychiatrists and mental health professionals to advocate for the DSM to be updated to reflect current information about ADHD because they certainly aren't going to listen to us. (Ironic huh?)
But what do you think? Let me know your thoughts. Is anyone else frustrated by this? Because I have been stewing about it for the past few days and I can't seem to let it go.