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The Adventures of Fundi Intervention Based on the Cognitive and Emotional Processing in Attention Deficit Hyperactive Disorder Patients
Published on: June 12, 2020
[From inattentive-type attention deficit hyperactivity disorder to the restrictive type]
Ana Laura Fernández-Perrone1, Daniel Martín Fernández-Mayoralas, Alberto Fernández-Jaen
1Hospital Universitario Quirón, Diego de Velázquez 1, Pozuelo de Alarcón, Madrid, Spain.
Insights
Attention deficit hyperactivity disorder (ADHD) is a heterogeneous neurodevelopmental disorder. The proposed restrictive subtype in DSM-5 may improve identification of inattentive ADHD patients for better research and clinical focus.
Area of Science:
- Neurodevelopmental disorders
- Childhood psychiatric conditions
Context:
- Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children, affecting 3-6% of the school-age population.
- ADHD presents heterogeneous neurobiological characteristics, with distinct frontostriatal and frontoparietal circuit involvement observed in combined and inattentive subtypes, respectively.
Purpose:
- To review the characteristics of patients with the inattentive subtype of ADHD.
- To explore the potential for a more homogenous subtype classification within the inattentive presentation.
- To examine the proposed restrictive subtype in DSM-5 for improved ADHD classification.
Summary:
- The current diagnostic criteria (DSM-IV-TR) present challenges in classifying ADHD presentations without significant hyperactivity.
- The DSM-5 aims to reformulate ADHD subtypes, introducing a 'restrictive ADHD' category for individuals meeting specific inattention and minimal hyperactivity-impulsivity criteria.
- This proposed subgroup is characterized by distinct neurobiological underpinnings, particularly involving the frontoparietal circuit.
Impact:
- The definition of the restrictive ADHD subgroup could enhance the detection of patients who have been historically under-recognized in clinical and research settings.
- Improved classification may lead to more targeted research and tailored clinical interventions for specific ADHD presentations.
Introduction:
Attention deficit hyperactivity disorder (ADHD) is a very heterogeneous neurobiological condition. It is the most common neurodevelopmental disorder in the childhood population. Its prevalence is estimated to be 3-6% in school-age children. AIM. To review the characteristics of patients with inattentive subtype ADHD, including those who could be grouped in a more homogenous subtype which the DSM-5 proposes for classification as the restrictive subtype.
Development:
The characteristic triad of symptoms consists of attention deficit, hyperactivity and impulsivity. The diagnostic criteria are defined in the DSM-IV-TR. For those with deterioration due to ADHD with no significant hyperactivity problems, this manual offers a confusing diagnostic label. Indeed, the neurobiological substrate underlying the diverse subtypes seems to be different in certain aspects, since the frontostriatal circuit appears to be more affected in combined ADHD, while the frontoparietal circuit is more compromised in the inattentive subtype. For these and other reasons, the DSM-5 will reformulate the different subtypes of ADHD and will probably include a new subgroup that will comprise those patients who satisfy at least six inattention criteria and fewer than two criteria for hyperactivity-impulsivity (restrictive ADHD).
Conclusions:
The definition of this subgroup could make it easier to detect some patients who have so far received little attention from the point of view of both research and clinical practice.
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