A Home of Their Own for the Predominantly Inattentive. New DSM V

The DSM or Diagnostic and Statistical Manual of Mental Disorders is a manual published by the American Psychiatric Association.  The manual is a tool used by researchers, insurance companies, and physicians to identify mental illnesses in both adults and children. 


The DSM  is currently undergoing revision.  The new manual is due out in 2013 and includes some potentially important changes for the Predominantly Inattentive category of ADHD.  Two of the proposed changes would give folks currently categorized and ADHD-PI, a home of their own sort of speak.


The primary purpose of the DSM is to provide professionals in the mental health community a written description of the characteristics and symptoms of every mental health condition.  The manual is necessary for there be consistency and agreement among providers and researchers regarding what defines a certain mental health condition.  The current DSM IV was published in 1994 and is considered the sacred book of psychiatric diagnosing.  It is used around the world to identify mental illness.

Having Inattentive ADD in its own category is a huge deal.  There has been very little research done on this sub-type of ADHD and this would change if the condition had a separate DSM code.  Research dollars and pharmaceutical study dollars are often doled out only if there is a corresponding DSM code.


I went onto the American Psychiatric Association webpage and this is what they are proposing.  There are essentially three options with regards to how the new manual will handle Inattention without hyperactivity or impulsiveness.


Option #1:  Use the existing definition and allow for up to 5 Hyperactive/Impulsive criteria in the definition of Predominantly Inattentive.

Option #2:  Make a 4th category in the general ADHD diagnosis called RPI (restrictive predominantly inattentive) which would be for folks with no more that 2 hyperactive/impulsive symptoms.

Option #3:  Make a totally new DSM diagnosis called Attention Deficit Disorder.  None of the diagnostic criteria for hyperactive or impulsive symptoms would be used to define this diagnosis.

Option one would lump many of the current ADHD-PI types into the combined type category, this is consistent with what Dr. Russell  Barkley supports.  He believes that most of the folks with ADHD-PI are really combined types that are missing just a few hyperactive or impulsive symptoms.  I totally disagree with this option.

Option two, (RPI), would be similar to what we have now except that individuals with predominantly inattentive symptoms would be clearly defined as having very few hyperactive impulsive (HI) symptoms.   I believe that folks with more than 3 HI symptoms are currently treated as combined ADHD types. So though they say that this would bring us to four subtypes, I believe that there still would be, in actual practice, only three.  The Hyperactive Impulsive type, the Combined type, and RPI type.  This option would better define the predominantly inattentive type and I would be fine with this.

Option three would get the "RPI" types out of the ADHD bag all together and give them a DSM diagnosis all of their own.  This is our best option as I believe that it would provide us with a unique code for research and treatment.

It has been said by a physician many times that getting the right treatment, always depends on having the right diagnosis.  There has been some pretty good evidence that the risk factors, co-morbididy, genetics, and treatment of individuals with predominantly inattentive ADHD are different than for the other subtypes of ADHD.  I think that giving the predominantly inattentive subtype its own DSM category would allow for more identification, study, and appropriate treatment of this condition.