Several changes have been made to the diagnostic criteria for attention-deficit/hyperactiv- ity disorder (ADHD). Examples have been added to the criterion items to facilitate application across the life span; the age at onset description has been changed (from “some hyperactive- to ”Several inattentive or hyperactive-impulsive symptoms were present prior to age 12”); subtypes have been replaced with presentation specifiers that map directly to the prior sub- types; a comorbid diagnosis with autism spectrum disorder is now allowed; and a symptom threshold change has been made for adults, to reﬂect the substantial evidence of Clinically sig- nificant ADHD impairment, with the cutoff for ADHD of five symptoms, instead of six re- quired for younger persons, both for inattention and for hyperactivity and impulsivity.
Specific learning disorder combines the DSM-IV diagnoses of reading disorder, math- ematics disorder, disorder of written expression, and learning disorder not otherwise specified. Learning deficits in the areas of reading, written expression, and mathematics are coded as separate specifiers. Acknowledgment is made in the text that specific types of reading deficits are described internationally in various ways as dyslexia and specific types of mathematics deficits as dyscalculia.
810 Highlights of Changes From DSM-IV to DSM-5
The following motor disorders are included in DSM-S: developmental coordination disor- der, stereotypic movement disorder, Tourette’s disorder, persistent (chronic) motor or vocal tic disorder, provisional tic disorder, other specified tic disorder, and unspecified tic disorder.
The tic criteria have been standardized across all of these disorders in this chapter.
Two changes were made to Criterion A for schizophrenia: 1) the elimination of the special at- tribution of bizarre delusions and Schneiderian first-rank auditory hallucinations (e.g., two or more voices conversing), leading to the requirement of at least two Criterion A symptoms for any diagnosis of schizophrenia, and 2) the addition of the requirement that at least one of the
Criterion A symptoms must be delusions, hallucinations, or disorganized speech. The DSM-IV subtypes of schizophrenia were eliminated due to their limited diagnostic stability, low reli- ability, and poor validity. Instead, a dimensional approach to rating severity for the core symp- toms of schizophrenia is included in DSM-S Section III to capture the important heterogeneity in symptom type and severity expressed across individuals with psychotic disorders.
Schizoaffective disorder is reconceptualized as a longitudinal instead of a cross-sectional di- agnosis—more comparable to schizophrenia, bipolar disorder, and major depressive disorder, which are bridged by this condition—and requires that a major mood episode be present for a majority of the total disorder’s duration after Criterion A has been met. Criterion A for delu- sional disorder no longer has the requirement that the delusions must be nonbizarre; a spec- ifier is now included for bizarre type delusions to provide continuity with DSM-IV. Criteria for catatonia are described uniformly across DSM-5. Furthermore, catatonia may be diagnosed with a specifier (for depressive, bipolar, and psychotic disorders, including schizophrenia), in the context of a known medical condition, or as an other specified diagnosis.